How Do You Know When You Are in a COPD Crisis?
What Causes Chronic Obstructive Pulmonary Disease?
Chronic obstructive pulmonary disease, or COPD, is a respiratory disease process that is actually the result of both chronic obstructive bronchitis and emphysema. The damage to the lungs is the result of repeated episodes of infection and respiratory distress, both of which result in scarring of the alveoli in the lungs.
The lungs look like an upside-down tree with the main trunk, the bronchial tubes, that split to form the right and left lung. The right lung has three lobes and the left lung has two. The heart takes up a lot of space in the left side, which is why the right lobe has a middle lobe, and the left lung does not. Each lobe of both lungs contain tiny air sacs, or alveoli. In a normal lung, these little sacs are elastic; they expand and constrict with every breath.
However, with the disease process of COPD the air sacs lose their elasticity, and they can barely open or close. The walls of the lobes become thick and inflamed, and the lungs fill with thick fluid and mucus. Sometimes this leads to severe respiratory distress, and sometimes the person can function fairly well. However, once diagnosed with COPD, the disease process progresses and worsens gradually over time.
COPD is caused by irritation and inflammation in the lungs. Cigarette smoking is the number one cause of COPD, and unfortunately, it is often diagnosed years after the person has stopped smoking. Many times this can be traced back to the amount of cigarette smoke that person inhaled over their lifetime.
People who are exposed to secondhand smoke are also at risk of contracting COPD. Pipe and cigar smokers are at risk, as well.
Although many improvements to the workplace have been set in place in the last several decades, thanks to OSHA (Occupational Safety and Health Administration), exposure to workplace lung irritants are also a risk factor in the causes of COPD.
There is only one form of genetic COPD, and that is a rare condition diagnosed at birth called alpha-1 antitrypsin deficiency. Alpha 1 is a protein found in the liver and it is felt that the lack of this protein may play a part in children who are born with COPD. However, the majority of patients diagnosed with COPD are current smokers—or were smokers at an earlier point in their lives.
What Are the Signs of COPD?
COPD is diagnosed by the persons medical history, the physicians assessments, consults with pulmonologists, chest x-rays, spirometry, arterial blood gases, pulse oximetry. Signs and symptoms of COPD include chronic productive cough with sputum that is usually white and frothy and is often called a "smokers cough" and shortness of breath with exercise. Exercise is misleading as exercise for a person with COPD may consist of getting out of bed and walking to the bathroom. If this causes shortness of breath, tight feeling inside the chest, extreme coughing fit lasting nearly two minutes and wheezing, your physician needs to see you.
If, along with any of the above signs and symptoms the persons also has swelling of the legs or difficulty breathing in the middle of the night (or whenever asleep laying flat on the bavck) or if increased urination occurs at night, this is another reason the person must see the physician. Sometimes COPD is not alone. Sometimes the person with COPD also has Congestive Heart Failure and the above are a few warning signs of CHF.
Persons with COPD may have these signs all at once or just one sign now and then, such as with a rise in the barometric pressure, increase of summer temperature, or with heavy pollen count such as in the fall and the spring of the year. Some persons with COPD are not as affected by outside forces as others, some persons may show these same signs and not have COPD at all! That is why consulting with your physician is so important. Only your physician can properly diagnose, refer you to appropriate physicians and monitor your medical care. It is extremely detrimental to your health to attempt to treat yourself.
How Is COPD treated?
Your primary physician will be the one to oversee your care, however, many times the person will be closely followed by a pulmonologist, who is a specialist on all lung disease processes and can make sure the person is receiving the best treatment of choice. Most of the time, depending on the severity and if there is an acute infection involved, the treatment involves inhalers and oxygen that may or may not be used daily or only as needed.
Some medications that a person with COPD may have to take on a regular basis include:
- Bronchodilators - These are also called "puffers" and are in a small aerosol can that fits in the palm of your hand. The person receives the medication, such as albuterol or pulmocort, or both by placing the mouthpiece in their mouth, closing their lips tightly around the mouthpiece, exhaling a deep breath through their nose then depressing the chamber of the small aerosol can and breathing the misted medication in through their mouth at the same time.
- Inhalers are not uncommon, many children with asthma are in charge of their own 'puffers' but often the person who deals with COPD on a chronic day to day basis makes the error of not using their inhaler exactly as it should be handled. This results in the person not receiving a full dose of their medication and before it is time for the next dose the person is already reaching for their inhaler again. Eventually, this creates an imbalance in the lungs and can lead to some problems such as increased shortness of breath.
- Oxygen - Often the person with COPD will not have to remain on oxygen at all times. Oxygen, used correctly, can often assist with the relief of both shortness of breath and of the anxiety that often accompanies it. However, used incorrectly, oxygen can lead to increased carbon dioxide in the blood which then causes mental status changes, chest pain, irregular heart rate which left untreated can be fatal. An important thing to remember is to follow your physicians orders about the amount of oxygen to use. For example, if your oxygen is supposed to be 2 liters per minute by nasal cannula and you are using an oxygen concentrator then the little black ball of your O2 concentrator needs to float exactly in the middle of the line for 2 liters, not above it, certainly never more than that for an extended period of time.
- Sometimes a person with COPD has to take steroids by mouth (an example of a steroid medication is prednisone) and this medication must be taken exactly as the physician orders it. The use of prednisone or other corticosteroid medication is a very effective way of relieving the feelings of inflammation and irritation of the lung fields.
- Sometimes, because persons with COPD are prone to infections, the person is treated with antibiotics.The most important thing to remember about antibiotics is to take them exactly as the physician orders. Taking antibiotics until you feel better or stopping because they make your stomach hurt is not acceptable. The cause of resistant infections, such as methicillin resistant staphylcoccus aureous is because bacteria have become accustomed to being killed only a little bit, never completely eradicated. The bacteria grows back and it grows back smarter than the humans who created the antibiotic! Now the bacteria know what will kill them so they build up a wall to that antibiotic. The researchers develop stronger, more powerful antibiotics, we get sick, we take them until we feel better, not for the whole course and the whole thing starts all over again. And for all you healthy people out there giving yourself a pat on the back for not being a part of this? You do not get off the hook so easily. Bacteria doesn't care who did or did not cause them to become smart bacteria! They will come after all of us, its really just waiting for a juicy infection to come along!
- So please, take every last pill if your physician writes a prescription for antibiotics!
- Of course, know what side effects may occur with all of your medications and it goes without saying if any side effects do occur, please stop that medication and call your physicians office and or seek assistance from your local urgent care of emergency room as soon as possible.
Will I always need medicine and oxygen?
COPD is a chronic disease process. This means it will never go away and will likely become more severe over time. However, it does wax and wane. In other words, some days will be much better than others. The ways to manage COPD are simple.
- Follow all of your physicians orders for medications, exercise, hygiene and diet. "Exercise" you ask? Yes, as strange as it sounds, it may actually help. Of course, you must use common sense; no fair walking when the smog or pollen count is sky high, no fair walking when the temperature is extremely cold or hot and absolutely no fair overdoing it! Do NOT compete with younger people! Let them pass right by on the YMCA gym balcony walkway. Walking will help with your lung capacity as long as you can do it without damaging your already damaged lungs.
- The worst thing anyone with COPD can do is just go from bed to chair and that is it. That raises that person's risk of infection and decreases their quality of life. As long as possible, keep on your feet and keep on a schedule. There will eventually come a time when the person with COPD will not be able to manage any of their basic day to day activities without total assist but for as long as possible, stay independent and as healthy as possible.
- Do not smoke or allow anyone around you to smoke.
That said, remember that a person with COPD must not challenge or compete with his or her own body! Exercise must be done in short, frequent intervals. Exercise and diet both must be done alternately. A person with COPD burns calories much faster than other people because it takes more calories just to breathe. Therefore, short, frequent meals and short, frequent bouts of energy.
Makes sense. Eat, walk, rest, eat, walk, and so on.
Here is another thing that may help:
Please try to take just a small step, not literally, but figuratively. Start with deep breathing. Take a shallow breath and Aim that breath to your deep belly. Now let that breath out but do it really slow! And pucker up when you exhale. Make the exhalation last longer than the time it took you to inhale.
Sounds funny doesn't it? Now on your second breath take a slightly bigger breath in through your nose and this time aim that breath towards your diaphragm, between your deep belly and your lungs. Now exhale same way, taking a longer time to exhale and do it through your puckered lips
Pretend you are a goldfish!
Now third breath in through your nose and this time aim that breath to your lungs and you can inhale longer this time if you like. Let it out same way really slowly. Through your puckered up lips.
Your just did one deep breathing exercise and you did it laying down. Keep on doing these exercises, oh say just a bit to start; whatever you feel comfortable doing. If it's just once a day to start, hey, you started. The more you do the better you will feel, is what I am betting on.
Let me know what you think and of course, tell your doctor I said to try deep breathing exercises to see if that will make you feel better and improve your lung function.
When do I know if I should call my physician?
You must learn your own bodies "yell" for help. Your body will tell you, if you listen to the signals your body gives you. The problem with COPD is it involves oxygen. Not the oxygen in the O2 concentrator but rather the oxygen in your bloodstream! When you are in the midst of a COPD crisis, that oxygen level drops. Without adequate oxygen in your bloodstream your brain will not be as "quick on its feet" so to speak and you will get fuzzy headed and not even realize it.
I think everyone has this little red button inside their brain. If everything is fine and kosher, it just sits there, but if something starts to "not feel right" that red button starts to throb, then glow then finally its going off like a fire engines siren and bursting out with strobing red lights all through your brain! Pay attention to that little red button. It is hard to turn off if you let it go too long.
Signs that say "Call your Doctor" are as follows:
- Increased shortness of breath and anxiety
- Change in the color and or consistency of sputum
- Unrelieved coughing
- Chest pain
- Tightness of chest and or painful respiration's
- Coughing up blood
- Increased temperature. This is because a person with COPD usually runs a lower temperature than the rest of the population. So if a COPD person has a temp of 99 F this is a low grade temp and could mean an infection
Some things that are worth posting on your refrigerator are:
- Emergency contact numbers, such as family or friends.
- Physicians names and numbers, including what type they are such as "family practice" or "pulmonologists."
- Current list of ALL of your medications even the ones you take that are over the counter and or vitamins.
- Ambulance services if you have one or the number of the local ambulance service. However, remember the number to 911 is still 911.
Consult Your Physician
What is written here does not now nor does it ever take the place of your physician’s advice and services of your physician.
Consult your physician every time for all things medically related and of course, if you feel you have any of the signs or symptoms of what has been written in this article, please contact your physician for a consultation as soon as possible.
Types of Metered Dose Inhalers
long acting Inhaled Corticosteroid
Redness and burning on inside of mouth and gums. Always rinse and spit, do not swallow after using these types of inhalers. Cannister may not be refilled.
Short acting bronchodilator (selective beta 2 adrenergic agonist)
dry cough, headache, gastric distress and rapid heartbeat
Anticholinergic bronchodilator in Dry Powder Inhaler
Only used daily! Can cause urinary retention and urinary tract infections.
Long acting selective beta 2 adrenergic bronchodilator
Not to be used as a rescue inhaler! But sometimes used as prevention of bronchospasm just before planned exercise Side effects include palpiutations, nervousness, shakiness, anxiety
Anticholinergic bronchodilator Long acting
Often given together with albuterol in both inhaler and nebulizer form
Long Acting Inhaled Corticosteroid
infections, long term damage to eyes, pancreas, immune system
Combination Selective Long Acting beta-2 adrenergic receptor agonist with Long Acting Inhaled Corticosteroid
Do Not Take as needed for shortness of breath! Use Albuterol rescue inhalers for SOB Side effects include headache, dry mouth, cataracts
Combination Long Acting Anticholinergic bronchoconstictor (ipratropium) with beta-2 adrenergic bronchodilator (albuterol)
This is albuterol and ipratropium together, hence the "combi" in the name of this inhaler. Side effects are headache, rapid heartbeat, chest pain, cough, gastric distress
- Changes in Inhaler Devices for Asthma And COPD - Redorbit
Asthma and chronic obstructive pulmonary disease (COPD) involve chronic inflammation and constriction of the bronchioles. Optimal therapy for many patients requires control of both pathologic mechanisms through the use of inhaled bronchodilators and