COPD. (Chronic Obstructive Pulmonary Disease) (Emphysema) (Chronic Bronchitis) Education For Our Community

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1 COPD (Chronic Obstructive Pulmonary Disease) (Emphysema) (Chronic Bronchitis) Education For Our Community

2 Chronic Obstructive Pulmonary Disease (COPD) Definition Chronic obstructive pulmonary disease (COPD) is a long term lung disease. COPD makes it difficult to move air in and out of the lungs. It will make breathing difficult. COPD includes: Emphysema air sacs of lungs are damaged. Chronic bronchitis airways of lungs are damaged. The changes to lung tissue differ with the two diseases. However, they often occur together. The causes and treatment of each conditions are similar. Normal and Emphysemic Lung

3 Causes COPD is caused by damage to the lungs. This damage is caused by: Cigarette smoking Inhaling toxins or other irritants. Genetic predisposition that makes the lungs more vulnerable to damage from smoke or pollutants (includes alpha-1-antitrypsin deficiency). Risk Factors Factors that increase your chance of developing COPD include: Smoking cigarettes. Long-term exposure to second-hand or passive smoke. Family members with COPD. Exposure to pollutants. History of frequent childhood lung infections. Age: 40 years or older.

4 Symptoms Early symptoms of COPD include: Coughing. Increased sputum production (mucus from deep in the lungs). Wheezing. Shortness of breath with activity. As the disease progresses, symptoms may include: Increased shortness of breath. Choking sensation when lying flat. Fatigue. Trouble concentrating. Heart problems. Weight loss. Breathing through pursed lips. Desire to lean forward to improve breathing. More frequent flare-ups (periods of more severe symptoms).

5 Diagnosis The doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will need to test how impaired your lungs may be. This may be done with: Lung function tests (spirometry) to test the force of your breath. Blood test to test oxygen and carbon dioxide levels in the blood. Your doctor may also need detailed pictures of your lungs. This may be done with: Chest x-ray. CT scan. Treatment There is no treatment to cure COPD. Treatment aims to ease symptoms and improve quality of life. Treatment includes: Smoking Cessation Quitting smoking slows the disease. It the most important part of treatment. There are many programs to help you quit including: Behavior change program.

6 Medication. Combination of behavior program and medication. Environmental Management Limit the number of irritants in the air you breathe. It may help make breathing easier. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes. Medication Medication for COPD may help by: Opening the airways. Relaxing the breathing passages. Decreasing inflammation. Treating lung infections (antibiotics). Maintenance medications must be taken on a daily basis. Rescue medications are used only for emergencies. Some medication may be taken as pills or liquids. Others are inhaled medication that is delivered directly to the lungs. A metered dose inhaler works best when used with a spacer.

7 Vaccines The flu and pneumonia can make your symptoms worse. Get vaccinated against pneumonia and the flu. The flu vaccine may also reduce COPD flare-ups. Oxygen Oxygen therapy may be helpful if the oxygen levels in your blood are too low. It can relieve trouble breathing and improve energy. You may only need it for specific activities or it may be given throughout the day. Exercise Special exercises can strengthen chest muscles. This can make it easier to breathe. Regular physical activity can reduce the workload on your lungs by building you endurance. Physical activity is also associated with improved quality of life. Follow your doctor's recommendations for activity levels and restrictions. Breathing and Coughing Techniques Special methods of breathing can help bring more air into the lungs. It can also help force trapped air out of the lungs. Effective coughing techniques can also help clear mucus from your lungs. Ask your doctor if

8 these techniques can help you. Some examples include: Pursed lip breathing. Diaphragmatic breathing. Controlled coughing technique. Nutrition Eating habits to consider with COPD: Eat a healthy diet. It should be low in saturated fat. It should also be rich in fruits, vegetables, and whole grain foods. Maintain a normal weight. Excess weight causes the lungs and heart to work harder. It may be hard to eat because you feel full. Try eating several smaller meals during the day instead of a few large meals. Slow down your eating pace. This will make it easier to breathe. If you need to gain weight, add food or drinks throughout the day. Talk to a dietitian about how many calories you need each day.

9 Lifestyle Changes The following may help you manage COPD symptoms and avoid flare-ups: Pace your activities. Plan ahead. Prioritize. Position. Learn relaxation techniques and other methods to manage stress. Seek emotional support from professionals, family, and friends. Anxiety can increase the rate of respiration, making breathing more strenuous. The dyspnea cycle often leads to feelings of depression and anxiety. Surgery A small number of patients may benefit from surgery. Surgery options include removing a part of the lung or a lung transplant.

10 Prevention Take these steps to reduce your chance of developing COPD: If you smoke, quit. Avoid exposure to second-hand smoke. Avoid exposure to air pollution or irritants. Wear protective gear if exposed to irritants or toxins at work.

11 Discharge Instructions for Chronic Obstructive Pulmonary Disease (Discharge Instructions for COPD) Treatment options such as medication, lifestyle changes, and oxygen may help to ease your breathing. You may also be taught breathing and coughing techniques. In rare cases, surgery may be needed. Steps to Take Pulmonary Rehab Talk to your physician to find out if you are a candidate for pulmonary rehab (you must have a Dr. s order for pulmonary rehab). If you would like more information about pulmonary rehab contact Virginia at ext or Home Care To help control your breathing symptoms: Quit smoking. This is the most important thing you can do. Your doctor may refer you to a smoking cessation program.

12 Limit the number of irritants in the air you breathe. Avoid smoke, dust, smog, extreme heat or cold, and high altitudes. Take all medications as directed by your doctor. Colds and the flu can make your breathing worse. Steps to help prevent these infections include: Get a flu shot and pneumonia vaccine. Wash your hands regularly. Avoid others with colds and flu. Be aware of your signs of shortness of breath. This will help you identify and address it earlier. Certain techniques may help your breathing. For example: Pursed Lip Breathing Breathe in slowly through your nose for one count. Purse your lips as if you were to whistle. Breathe out through pursed lips for two counts. Continue until you are breathing easier

13 Diaphragmatic Breathing Sit or lie on your back so you feel at ease. Inhale slowly through your nose and count to 2. As you inhale your stomach should move out. Breathe out through pursed lips and count to 4. As you exhale you should feel your stomach move in. Controlled Coughing Technique Done to help clear mucus. Sit in a chair or on the edge of the bed. Fold your arms across your stomach. Breathe in slowly through your nose. Lean forward. Press your arms against your stomach. Open your mouth and cough 2-3 short, forceful coughs. Relax and repeat. Diet Eating habits to consider with COPD: Eat a healthy diet. It should be low in saturated fat. It should also be rich in fruits, vegetables, and whole grain foods. Maintain a normal weight. Excess weight causes the lungs and heart to work harder.

14 It may be hard to eat because you feel full. Try eating several smaller meals during the day instead of a few large meals. Slow down your eating pace. This will make it easier to breathe. If you need to gain weight, add food or drinks throughout the day. Talk to a dietitian about how many calories you need each day. Your doctor may recommend a meeting with a dietitian. The dietitian will help you determine an ideal weight range and a healthy meal plan. Physical Activity Exercise regularly. It will help keep you fit and make your immune system strong. Special exercises can strengthen chest muscles. This can make breathing easier. Talk to your doctor about an appropriate exercise program.

15 Medications Medications are an important part of managing COPD. They help by either: 1. Relaxing and opening airways 2. Reducing inflammation 3. Reducing mucus production or clearing mucus It is very important to take your medications as prescribed: The right medication The right time Take long-acting/chronic medications even if you are not experiencing symptoms Important notes: - Inform your physician of ALL medications that you are currently taking. Including herbal and over the counter medications. Some of these may interact with your current medications or worsen your COPD symptoms. - Contact your physician if side effects occur. - Take medications exactly as your physician prescribes. - Keep enough medication on hand so that you do not run out; always have a new inhaler on hand before the old one is completely gone. - If you miss a dose, contact your physician or pharmacist. Do not take two doses.

16 - Establish daily routines to take your medications. - Do not abruptly stop taking your medication. - Keep records of your current medications to provide to the hospital and pharmacy. - Review proper inhaler technique with your physician or pharmacist; different types of inhalers may be used differently than others. - If you are having difficulty with your inhaler, speak with your physician about devices that can assist you. - Be sure to regularly check expiration dates especially on a rescue inhaler that you do not need to use often. - Some medications may be used with a nebulizer, speak with your physician if this is your preferred method of medication administration. There are several classes of medications used to treat COPD; they are listed below.

17 1. Bronchodilators: help to relax and open airways. There are multiple types of bronchodilators. Fast-acting beta-2 agonists also help to prevent exercise-induced wheezing, clear mucus and stop an attack. Should be taken before other bronchodilators and inhaled corticosteroids. o Inhaled 1. Albuterol sulfate (ProAir, Proventil HFA, Ventolin HFA) 2. Levalbuterol HCL (Xopenex HFA) 3. Metaproterenol sulfate (Alupent) 4. Terbutaline sulfate (Brethaire) - Inform your physician if you: o Need to use this inhaler more often than prescribed o Do not have sufficient relief - Side effects o Trembling, nervousness, insomnia, rapid heartbeat, and increased blood pressure Long-acting beta-2 agonists take effect more slowly and work longer than fast-acting beta-2 agonists. Also help to prevent exercise-induced wheezing and clear mucus. o Inhaled 1. Formoterol fumarate (Foradil) 2. Salmeterol xinafoate (Serevent)

18 - Inform your physician if you: o Need to use your rescue inhaler more often than prescribed o Do not have sufficient relief - Side effects o Trembling, nervousness, rapid heartbeat, and headache Anticholinergics take effect more slowly than fast-acting beta-2 agonists. o Inhaled 1. Ipratropium bromide (Atrovent HFA) 2. Tiotropium bromide (Spiriva) - Inform your physician if you: o Need to use your rescue inhaler more often than prescribed o Do not have sufficient relief - Side effects o Nervousness, dizziness, drowsiness, headache, upset stomach, constipation, and dry mouth. Methylxanthines are long acting, stimulate the diaphragm and breathing, and may be useful if symptoms occur during sleep. o Swallowed 1. Theophylline (Elixophyllin, Theolair, Theochron, Theo-24)

19 - Inform your physician if you: o Need to use your rescue inhaler more often than prescribed o Do not have sufficient relief o Begin a new medication or stop taking an old medication - Side effects o Headache, nervousness, insomnia, irregular heartbeat, diarrhea, or nausea o Can interact with other medications, blood levels must be monitored regularly o Limit caffeine intake 2. Corticosteroids: may be inhaled or swallowed. They reduce inflammation and swelling in the airways, reduce mucus production, and decrease sensitivity of airways to irritants and allergens. Do not stop taking these medications without consulting your doctor, high doses must be tapered and cannot be stopped abruptly. Inhaled very little enters the bloodstream, so few side effects. Do not use for fast relief or shortness of breath. Must be used daily, important to rinse mouth after use. o Beclomethasone dispropionate (QVAR) o Budesonide (Pulmicort) o Flunisolide (Aerospan HFA) o Fluticasone propionate (Flovent HFA) - Inform your physician if you:

20 o Need to use your rescue inhaler more often than prescribed o Do not have sufficient relief o Are already taking additional corticosteroids for another disease state - Side effects o Few side effects because little enters the blood stream o Possible infection if mouth is not rinsed after use Swallowed enter the blood stream so may cause side effects. Always take with food or milk. o Methylprednisolone (Medrol) o Prednisone (many brand names) - Inform your physician if you: o Need to use your rescue inhaler more often than prescribed o Do not have sufficient relief o Are already taking additional corticosteroids for another disease state - Side effects o Insomnia, mood changes, skin bruising, weight gain, stomach problems, high blood pressure, glaucoma, cataracts, osteoporosis, or high blood sugar

21 3. Combination medications: combine the effects of different types of medications. Important to rinse mouth after use of a combination medication including a steroid. Inhaled o Fluticasone propionate plus salmeterol xinafoate (Advair) o Budesonide plus formoterol fumarate (Symbicort) - Inform your physician if you: o Need to use your rescue inhaler more often than prescribed o Do not have sufficient relief o Are already taking additional corticosteroids for another disease state - Side effects: o Vary depending on which medications are used in combination o Listed above under each individual medication class Do not start or stop any medication without discussing with your physician first. Oxygen may also be prescribed. It will increase the amount of oxygen in the air that you breathe. Your doctor will explain how much oxygen to use and

22 when you may need it. Your oxygen and oxygen machine will be supplied to you by a medical supply company. The company can come to your home and show you how to properly use your equipment. Make sure you have their emergency contact numbers in case you have concerns about the equipment.

23 Life Style Changes You and your doctor will plan lifestyle changes that will help you to breathe easier. Here are some general guidelines: Quit smoking. Pace your activities. Learn methods to manage stress including relaxation techniques. Seek emotional support from professionals, family, and friends. Anxiety can increase the rate of respiration, making breathing more strenuous. Avoid situations which might expose you to a respiratory illnesses. The dyspnea cycle often leads to feelings of depressing and anxiety. Prevention COPD can not be cured. To keep your breathing from getting worse following steps in Home Care section above.

24 Managing your COPD using the Zones EVERY DAY EVERY DAY: Check your Four S s: Sputum, Shortness of Breath, Swelling and Sensorium. Take your usual medicines, including oxygen, as you are told to do so by your health care provider. Keep all physician appointments. Which COPD Zone are you today? GREEN, YELLOW or RED? GREEN ZONE ALL CLEAR This zone is your goal Your symptoms are under control. My sputum is clear/white/usual color and easily cleared. My breathing is no harder than usual. I can do my usual activities. I am able to think clearly. YELLOW ZONE CAUTION This zone is a warning My sputum has changed (color, thickness, amount). I am more shortness of breath than usual. I cough or wheeze more. I weigh more and my legs/feet swell. I cannot do my usual activities without resting. Action: Call your health care provider. You will probably be told to begin taking an antibiotic and prednisone. Have your pharmacy phone number available. Health Care Provider: Phone: RED ZONE EMERGENCY Call your health care provider. You may be asked to come in to be seen, be told to go to the emergency room, or be told to call I cannot cough out my sputum. I am much more short of breath than normal. I need to sit up to breathe. I cannot do my usual activities. I am unable to speak more than one or two words at a time. I am confused.

25 Follow-up Your doctor may need to do additional tests to monitor your condition. Keep any follow-up appointment as directed by your doctor. Call Your Doctor If Any of the Following Occurs After you leave the hospital, call your doctor if any of the following occurs: Refer to the Yellow and Red Zones. Increased coughing. Increased sputum production. Wheezing. Shortness of breath with activity. Increased shortness of breath. Choking sensation when lying flat. Fatigue. Trouble concentrating. Weight loss. Breathing through pursed lips. Desire to lean forward to improve breathing. More frequent flare-ups (periods of more severe symptoms). Signs of infection, including fever and chills. Nausea and vomiting. Rash or hives.

26 Call for Medical Help Right Away If Any of the Following Occurs Call for medical help right away if you have symptoms including: Refer to the Yellow and Red Zones. Sudden or severe shortness of breath. Dizziness or lightheadedness. Chest pain. Rapid, irregular heartbeat. Palpitations. Weakness or fainting. If you think you have an emergency, call for medical help right away.

27 PATIENT AND FAMILY RESOURCES: 1. Free COPD information at the following website: 2. The COPD Education for our Community booklet that you received at Morris Hospital can be accessed at: Morris Hospital education/ 3. The American Lung Association can be found at the following website address: 4. Try this site to organize your medications at home: 5. Helpful websites with information about quitting smoking: National Cancer Institute or American Cancer Society American Heart Association American Legacy Foundation American Lung Association Centers for Disease Control and Prevention

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30 References Patient Education Reference Center (PERC), EBSCO Publishing; October Chronic Obstructive Pulmonary Disease By: Wood D, Randall B, Patient Education Reference Center (PERC), October 1, Retrieved November 6th, 2012 from &site=nrc-perc Patient Education Reference Center (PERC), EBSCO Publishing; October Discharge Instructions for Chronic Obstructive Pulmonary Disease By: Neff DM, Randall B, Patient Education Reference Center (PERC), September 1, Retrieved November 6th, 2012 from &site=nrc-perc Living well with chronic lung disease: A guide for pulmonary rehab. (2011). Krames Patient Education

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