COPD Education Booklet

COPD
(Chronic Obstructive Pulmonary Disease)
(Emphysema)
(Chronic Bronchitis)
Education
For Our
Community
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
Causes
COPD is caused by damage to the lungs. This
damage is caused by:
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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:
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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.
Symptoms
Early symptoms of COPD include:
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Coughing.
Increased sputum production (mucus from deep
in the lungs).
Wheezing.
Shortness of breath with activity.
As the disease progresses, symptoms may include:
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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).
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:
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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:
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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.
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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:
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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.
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
these techniques can help you. Some examples
include:
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Pursed lip breathing.
Diaphragmatic breathing.
Controlled coughing technique.
Nutrition
Eating habits to consider with COPD:
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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.
Lifestyle Changes
The following may help you manage COPD symptoms
and avoid flare-ups:
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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.
Prevention
Take these steps to reduce your chance of
developing COPD:
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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.
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
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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 815-9422932 ext. 7837 or [email protected].
Home Care
To help control your breathing symptoms:
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Quit smoking. This is the most important thing
you can do. Your doctor may refer you to a
smoking cessation program.
•
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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:
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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
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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
Diaphragmatic Breathing
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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.
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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.
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•
•
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.
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.
- 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.
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)
- 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)
- 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:
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
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
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.
Life Style Changes
You and your doctor will plan lifestyle changes that
will help you to breathe easier. Here are some
general guidelines:
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•
•
•
•
•
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.
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?
ALL CLEAR – This zone is your goal
GREEN
ZONE
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.
CAUTION – This zone is a warning
YELLOW
ZONE
• 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:______________
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 9-1-1.
RED
ZONE
• 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.
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:
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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.
Call for Medical Help Right Away If Any of
the Following Occurs
Call for medical help right away if you have
symptoms including:
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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.
PATIENT AND FAMILY RESOURCES:
1. Free COPD information at the following website:
http://www.mayoclinic.com/health/copd/DS00916
2. The “COPD Education for our Community
Community”” booklet that you received at Morris Hospital can be accessed at:
Morris Hospital
http://www.morrishospital.org/patients
http://www.morrishospital.org/patients-visitors/discharge-education/
education/
3. The American Lung Association can be found at the following website address:
http://www.lung.org/lung-disease/copd/
disease/copd/
4. Try this site to organize your medications at home:
http://www.mymedschedule.com/
5. Helpful websites with information about quitting smoking:
• National Cancer Institute www.cancer.gov or http://cis.nci.nih.gov
• American Cancer Society www.cancer.org
• American Heart Association www.americanheart.org
• American Legacy Foundation www.americanlegacy.org
• American Lung Association www.lungusa.org
• Centers for Disease Control and Prevention www.cdc.gov/tobacco/osh/
References
Patient Education Reference Center (PERC), EBSCO Publishing; October
2012. Chronic Obstructive Pulmonary Disease By: Wood D, Randall B,
Patient Education Reference Center (PERC), October 1, 2012. Retrieved
November 6th, 2012 from
http://search.ebscohost.com/login.aspx?direct=true&db=npr&AN=20098
66652&site=nrc-perc
Patient Education Reference Center (PERC), EBSCO Publishing; October
2012. Discharge Instructions for Chronic Obstructive Pulmonary Disease
By: Neff DM, Randall B, Patient Education Reference Center (PERC),
September 1, 2012. Retrieved November 6th, 2012 from
http://search.ebscohost.com/login.aspx?direct=true&db=npr&AN=20098
69488&site=nrc-perc
Living well with chronic lung disease: A guide for pulmonary
rehab. (2011). Krames Patient Education