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Matthew is a 72-year-old retired policeman with a complex medical history, including type 2 diabetes, a myocardial infarction eight years ago and moderate/severe COPD diagnosed three years ago. He is an former smoker, having stopped when he was diagnosed with COPD, but he has a significant pack-year history of 60 years. He was due for a review of his COPD but telephoned the practice to cancel his appointment saying he had a chest infection, which was making him feel unwell. The receptionist advised him to attend so that he could be assessed. He was seen by the advanced nurse practitioner (ANP) who recognised that his symptoms may have indicated that he was having an exacerbation of his COPD.
DiagnosisCOPD is commonly misdiagnosed. Many people who have COPD may not be diagnosed until the disease is advanced. To diagnose your condition, your doctor will review your signs and symptoms, discuss your family and medical history, and discuss any exposure you've had to lung irritants — especially cigarette smoke. Your doctor may order several tests to diagnose your condition. Tests may include:
TreatmentMany people with COPD have mild forms of the disease for which little therapy is needed other than smoking cessation. Even for more advanced stages of disease, effective therapy is available that can control symptoms, slow progression, reduce your risk of complications and exacerbations, and improve your ability to lead an active life. Quitting smokingThe most essential step in any treatment plan for COPD is to quit all smoking. Stopping smoking can keep COPD from getting worse and reducing your ability to breathe. But quitting smoking isn't easy. And this task may seem particularly daunting if you've tried to quit and have been unsuccessful. Talk to your doctor about nicotine replacement products and medications that might help, as well as how to handle relapses. Your doctor may also recommend a support group for people who want to quit smoking. Also, avoid secondhand smoke exposure whenever possible. MedicationsSeveral kinds of medications are used to treat the symptoms and complications of COPD. You may take some medications on a regular basis and others as needed. BronchodilatorsBronchodilators are medications that usually come in inhalers — they relax the muscles around your airways. This can help relieve coughing and shortness of breath and make breathing easier. Depending on the severity of your disease, you may need a short-acting bronchodilator before activities, a long-acting bronchodilator that you use every day or both. Examples of short-acting bronchodilators include:
Examples of long-acting bronchodilators include:
Inhaled steroidsInhaled corticosteroid medications can reduce airway inflammation and help prevent exacerbations. Side effects may include bruising, oral infections and hoarseness. These medications are useful for people with frequent exacerbations of COPD. Examples of inhaled steroids include:
Combination inhalersSome medications combine bronchodilators and inhaled steroids. Examples of these combination inhalers include:
Combination inhalers that include more than one type of bronchodilator also are available. Examples of these include:
Oral steroidsFor people who experience periods when their COPD becomes more severe, called moderate or severe acute exacerbation, short courses (for example, five days) of oral corticosteroids may prevent further worsening of COPD. However, long-term use of these medications can have serious side effects, such as weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection. Phosphodiesterase-4 inhibitorsA medication approved for people with severe COPD and symptoms of chronic bronchitis is roflumilast (Daliresp), a phosphodiesterase-4 inhibitor. This drug decreases airway inflammation and relaxes the airways. Common side effects include diarrhea and weight loss. TheophyllineWhen other treatment has been ineffective or if cost is a factor, theophylline (Elixophyllin, Theo-24, Theochron), a less expensive medication, may help improve breathing and prevent episodes of worsening COPD. Side effects are dose related and may include nausea, headache, fast heartbeat and tremor, so tests are used to monitor blood levels of the medication. AntibioticsRespiratory infections, such as acute bronchitis, pneumonia and influenza, can aggravate COPD symptoms. Antibiotics help treat episodes of worsening COPD, but they aren't generally recommended for prevention. Some studies show that certain antibiotics, such as azithromycin (Zithromax), prevent episodes of worsening COPD, but side effects and antibiotic resistance may limit their use. Lung therapiesDoctors often use these additional therapies for people with moderate or severe COPD:
In-home noninvasive ventilation therapyEvidence supports in-hospital use of breathing devices such as bilevel positive airway pressure (BiPAP), but some research now supports the benefit of its use at home. A noninvasive ventilation therapy machine with a mask helps to improve breathing and decrease retention of carbon dioxide (hypercapnia) that may lead to acute respiratory failure and hospitalization. More research is needed to determine the best ways to use this therapy. Managing exacerbationsEven with ongoing treatment, you may experience times when symptoms become worse for days or weeks. This is called an acute exacerbation, and it may lead to lung failure if you don't receive prompt treatment. Exacerbations may be caused by a respiratory infection, air pollution or other triggers of inflammation. Whatever the cause, it's important to seek prompt medical help if you notice a sustained increase in coughing or a change in your mucus, or if you have a harder time breathing. When exacerbations occur, you may need additional medications (such as antibiotics, steroids or both), supplemental oxygen or treatment in the hospital. Once symptoms improve, your doctor can talk with you about measures to prevent future exacerbations, such as quitting smoking; taking inhaled steroids, long-acting bronchodilators or other medications; getting your annual flu vaccine; and avoiding air pollution whenever possible. SurgerySurgery is an option for some people with some forms of severe emphysema who aren't helped sufficiently by medications alone. Surgical options include:
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Coping and supportLiving with COPD can be a challenge — especially as it becomes harder to catch your breath. You may have to give up some activities you previously enjoyed. Your family and friends may have difficulty adjusting to some of the changes. It can help to share your fears and feelings with your family, friends and doctor. You may also want to consider joining a support group for people with COPD. And you may benefit from counseling or medication if you feel depressed or overwhelmed. Preparing for your appointmentIf your primary care provider suspects that you have COPD, you'll likely be referred to a pulmonologist — a doctor who specializes in lung disorders. What you can doBefore your appointment, you might want to make a list of answers to the following questions:
You might want to have a friend or family member accompany you to your appointment. Often, two sets of ears are better than one when you're learning about a complicated medical problem, such as COPD. Take notes if this helps. What to expect from your doctorYour doctor may ask some of the following questions:
Your doctor will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor. What are expected findings of COPD?Shortness of breath, especially during physical activities. Wheezing. Chest tightness. A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish.
Which assessment finding should you expect in the client with COPD?In a patient with COPD, assessment of symptoms should include the following? Assessment of symptoms: Severity of breathlessness, cough, sputum production, wheezing, chest tightness, weight loss/anorexia. Change in alertness or mental status, fatigue, confusion, anxiety, dizziness, pallor or cyanosis.
What are the 4 main symptoms of COPD?Symptoms of COPD include:. Frequent coughing or wheezing.. Excess phlegm or sputum.. Shortness of breath.. Trouble taking a deep breath.. Which is the most common symptom associated with COPD?Main symptoms. increasing breathlessness – this may only happen when exercising at first, and you may sometimes wake up at night feeling breathless.. a persistent chesty cough with phlegm that does not go away.. frequent chest infections.. persistent wheezing.. |