Tuesday, May 13, 2008

COPD DISEASE MANAGEMENT

COPD DISEASE MANAGEMENT
C.O.P.D. stands for Chronic Obstructive Pulmonary Disease
It is a collective term used to cover the following conditions:
Emphysema:
Damaged air sacs (Alveoli) that can result in hypoventilation of the lungs. This is most commonly found seen in people with smoking history
Chronic Bronchitis:
Cough productive of sputum for at least 3 months and at least 2 years in a row. Caused by chronic irritation of the airways (bronchi and bronchioles). This is an an imflamatory problem which is also related to a smoking history problem
Asthma:
Hyper-reactive airways Breathing airways become extra sensitive and react to certain irritants which cause them to tlghten or constrict with acute episodes, thus can lead to inflammation.
Most people have a component of each of these conditions-The result is that the flow of air in and especially out of the lungs is obstructed.
Causes of Obstruction:
1) INFECTION - Phlegm blocks the airways
2) INFLAMMATION - The lining of the airways becomes irritated and swollen which makes the airway narrower. The irritation causes the production of white, frothy sputum.
3) BRONCHOSPASM - -The muscles which surround the airways tighten or constrict in response to the inhaled irritant.
With Chronic Obstructive Pulmonary Disease, one may suffer from 1 or all 3 of these obstructive causes. All can cause you to feel short of breath (SOB)
1-INFECTION Infection is caused by an organism that can be either viral or bacterial.
VIRAL BACTERIAL
Presence of warning signs:-- Usually absence of warning signs; mild cold/flu symptoms such as headache, sudden onset sneezing, muscle and joint aches.
Signs and Symptoms of full blown infection
- cough, fatigue, maybe fever - cough, fatigue, maybe fever
- shortness of breath(SOB) - shortness of breath(SOB)
- change in amount of sputum production - change in amount of sputum Production
- color of sputum (yellow, green or brown) - color of sputum (yellow, green or brown)
NO CURE, but often given antibiotics to Treated with antibiotics to prevent an additional bacterial infection from occurring.
Infections are spread from person to person most commonly by direct contact of the hands to eyes or nose.
REVENTION IS THE BEST MEDICINE
HAND WASHING
To prevent infection, the best defense is hand-washing This should be done with soap
and water for at least 30 seconds or with a waterless antibacterial alcoholic rinse. Make a point of
washing thumb and index fingers. As well, use a paper towel to turn off taps and open bathroom
doorknobs to avoid reinfection through contaminated surfaces.
* AVOID INFECTED PEOPLE IN CLOSE QUARTERS
* GET THE FLU SHOT EVERY YEAR (protects from common viruses of the season)
* GET THE PNEUMOCOCCAL VACCINE (protects from serious bacterium that cause infection)
Every time you get a bad infection you risk damaging your lungs further due to scarring Any respiratory infection can turn into pneumonia. If you suffer from C.O.P.D., you cannot afford to lose healthy lung tissue so you must act quickly to get treatment from your doctor.
Treatment for Infections - ANTIBIOTICS
* Make sure to take your antibiotics as directed by your doctor or pharmacist.
Some are taken with food, some are not.
* Take your antibiotics for the full time period that is prescribed even if you feel better before that.
Example of a 10 day prescription
You should be feeling somewhat better should be clear feel 100% better
If not, call Dr.
Day 3 Day 8 Day 10
SIDE EFFECTS of antibiotics:

* Nausea, cramps, diarrhea (because drugs are killing off normal healthy bacteria in your system)
* Yeast overgrowth : fuzzy coated tongue, canker sores, red rash perineal region, vaginal infection
You may be able to prevent or control these symptoms by eating plain yogurt or taking acidophilus capsules
ALLERGIC REACTION to antibiotics:
* Red, itchy rash or hives - STOP medication and call your doctor for a change in antibiotic
- Get a medic alert bracelet
* swelling of the tongue, itchy, burning of the tongue, -» Call ambulance or 911 EMERGENCY
trouble breathing
WHEN YOU ARE SICK WITH AN INFECTION:
/Stay at home and get plenty of rest (but don't stay in bed for 24 hours)
/Stop your exercise or endurance routine (approximately 1 week)
/Increase your fluid intake. Avoid caffeine, since it is a diuretic
/Increase the frequency of your lung hygiene program
Thoracic mobility exercises, deep breathing, steaming, devices, controlled
coughing)
*When you are feeling better, start your exercise training again gradually
2-INFLAMMATION
This is the primary cause of bronchitis. It is our bodies immune response to an irritant.
Many different things can cause irritation to the airways:
Infectious organisms, causing infectious bronchitis (will then need antibiotic)
Other irritants: Smoke
Chemicals
Dust
Animals, etc.
Inflammation of the airways causes them to: become swollen, produce extra mucus
damage the cilia (small hairs which help to move mucus up and out of the lungs)
SYMPTOMS of INFLAMMATION:
© increased shortness of breath
© frothy, white sputum
© increased wet cough and wheezing
© fatigue
MEDICATIONS for INFLAMATION :ANTI-INFLAMMATORIES
STEROIDS 1) inhaled steroid or "puffers": flovent, pulmicort, Qvar, vanceril
2) pills / IV (prednisone)
NON-STEROID: tilade
Side Effects of STEROIDS:
1) inhaled : thrush in the mouth and throat
Prevent by proper rinsing and spitting with water, followed by drinking a few sips of water.
2) pills/IV : fluid retention, weight gain, diabetes, osteoporosis, easy
bruising, steroid myopathy (muscle wasting)
3-BRONCHOSPASM
WHAT IT IS
When hyper reactive airways respond to irritants, the muscles surrounding the airways tighten and squeeze, causing the airway to become more narrow or constrict.
Irritants which may cause Bronchospasm:
smoke
cold air, windy air
perfumes, strong household cleaners
rapid movement of air (this may happen with exercise at a higher intensity level)
SYMPTOMS OF BRONCHOSPASM:
Sudden onset of:
Shortness of breath
Wheezing
Dry, hacking cough
PREVENTION:
avoid known irritants
cover your nose and mouth with a silk or cotton scarf when out in cold or windy weather
breathe through the nose rather than the mouth
The nose: 1) filters 2) warms 3) humidifies the air
MEDICATIONS FOR BRONCHOSPASM: BRONCHODILATORS
1) Short acting bronchodilators: Ventolin
Combivent (also has long-acting)
Atrovent
2) Long, slow acting bronchodilators: Serevent, Oxeze, Accolate
A preventative bronchoconstrictors) Combivent (also has short-acting)
Spiriva-only medication specific for COPD
*** Wait at least 1 to 2 minutes
*** Wait at least 1 to 2 minutes between each puff of medication
*** If you are taking both bronchodilator and steroid puffers, take your fast acting
bronchodilator first, then wait 10 to 15 minutes before you take the steroid
SIDE EFFECTS of BRONCHODILATORS:
- increased heart rate, trembling, jitteryfeeling
AEROCHAMBER
For all of your inhaler medications (Metered dose inhalers), you should be using an aerochamber to maximize the effectiveness of the medication.
Posted by Peter Ellis at Tuesday, May 13, 2008 1 comments
ANATOMY of the RESPIRATORY SYSTEM
SKELETON
RIBS: 12 in total (2 are floating)
Protects the lungs and heart
STERUM: Breast Bone at front of the chest
Costo-sterum and costo-vertebral joints: where the ribs meet the sternum at the front and the vertebrae in the back
SCAPULAR: complex (shoulder blade): attaches to the back of the rib cage
IMPACT OF PROBLEMS WITH THE SKELETON
The joints of the rib cage (costo-sternal and costo-vertebral) can become irritated with repetitive coughing. You may experience pain in the front of your chest or at the back where the joints are.. If you experience a sudden onset of severe pain, this pain may indicate rib fracture. You should ask your doctor so she/he can provide with proper pain management. You may be at risk of rib fracture if you are know to have osteoporosis or if you have prolonged courses of steroids (Prednizone).
To avoid rib fracture or irritated joints, you should practise controlled coughing techniques.
If your ribs are stiff due to your lung disease and (air trapping), you will need to do some thoracic mobility exercises to maintain movement you have or try to improve it.
Pursed exhalation creates positive pressure in the lung to prevent air trapping.
MUSCLES OF RESPIRATION:
1. DIAPHRAGM: Main muscle of breathing. Repsonsible for 60 to 80 percent of the work during inspiration. Domed shaped. Creates negative pressure in lung to bring air in.

2. INTERCOSTALS: Small muscles located in between each ribs. Responsible for 40 percent of the air intake during inhalation
3 ACCESSORY MUSCLES: muscles of the neck, not designed to work all the time. Used by people with lung disease when in distress or because they havedeveloped poor breathing pattern.
HOW WE BREATHE: The normal ratio of breathing is 1:2, inspiration/expiration. For example, if you breathe in for 2 seconds you should breathe out in 4 seconds.
When we breathe in, inspiration or inhalation
-The diaphragm contracts and shortens which flattens it. It allows more space for the lungs to expand.
-The intercostals contract which makes the ribs move out and up in a “Bucket handle” swinging movement.
When we breathe out, expiration or exhalation
-The diaphragm passively returns to its dome shape.
-The intercostals relax and allow the ribs to return to their starting position.
-The abdominal muscles help to push the air out during forced expiration. This happens when doing your flow tests or when coughing. If you use your abdominal muscles all the time, as some people with lung disease do, the muscles get tired which leaves you fatigued.
-People with emphysema have a slow and prolonged forced expiration.
Impact of problems with muscles of breathing
-Harder to breathe when carrying heavy parcels because the muscles in your arms and chest are being used to lift instead of helping you breathe properly. What are the possible solutions to this problem? Cary lighter loads, use a cart, get your groceries delivered, let you legs do more of the work when lifting from the floor. These tips should make it easier on your breathing and on your heart.
-Obstacles that can make breathing more difficult: obesity, pregnancy, a large meal, bloating, and poor posture.
All of theses can push up on your diaphragm and don’t allow it to flatten out on inspiration, The lungs don’t have as much room to expand thus making you short of breath.
How position can affect your diaphragm
Lying flat on your spine (supine):
-The resting level of the diaphragm rises up towards the lungs.
-Gravity pulls down on the ribs, making it harder to move them up.
- The organs are pushed up towards the diaphragm and it makes it more difficult to breathe.
Solution: Lie with pillows positioned under the upper back and head
Sitting :
-Gravity helps the diaphragm flatten out by pulling down on it.
-Better position for breathing as long as your back is supported and shoulders relaxed.
ORGANS:
Heart: Located between the lungs in the centre of the chest and to the left. Pumps the blood throughout the body.
Lungs : There are two lungs, the right has three lobes and the left has two lobes. The air comes into the lungs through the nose or mouth, travels down the trachea which divides into the left and right bronchus into the respective lungs. Each bronchus then divides into smaller bronchi which become bronchioles and finally the alveoli (air sacs). This is where the air exchange happens. The capillaries’ (Tiny blood vessels) surround the alveoli, the fresh oxygen comes in and the carbon dioxide is exhaled out.
Inside the bronchus and bronchioles are the cilia. Their job is to.help any secretions move up and out of the respiratory system. They are in constant movement. This movement is affected by any toxic substance inhaled into the lings including cigarette smoke. If the cilia are do not work properly, the secretions tend to pool in the lungs and may cause an infection or an inflammation. Once they are damaged, it is permanent The cilea do not regrow..
ENDURANCE TRAINING
ENDURANCE or AEROBIC training means:
Exercising at a low intensity for a long duration while using large muscle groups. The exercise should be comfortable and enjoyable. Examples include walking and biking.
The goal in doing endurance exercise is to train your muscles to be more efficient, or better, at using oxygen. The end result will make physical activities feel easier and allow you to do more.
Normal Responses during exercise: Increased heart rate, Increased breathing rate and mild increase of shortness of breath.
For endurance training, you should be in an appropriate “Training Zone” This can be monitored by the following :
Heart rate (your age-related traing zone)
Shortness of breath (2 – 4 out of 10 on the SOB scale, or 2 above resting level)
The talk test (you can still talk during exercise)
HOW OFTEN ?? The goal will be to achieve 20 to 30 minutes, 5 days a week
HOW LONG?? Forever !!!!! “If you don’t keep it, you lose it”
We also aim to deisgn your exercise program so that it is specific to functional needs and goals. For example, if your goal is to be able to walk up a hill to get to church, we will train you to walk using an incline on the treadmill. Training only on a bicyle in this case would not necessarily allow you to fully reach your goal.
PRECAUTIONS with endurance training:
Chest, arm or jaw pain or pressure
Unexplained swelling in your legs
Increased SOB or bad lung infection
Increased blood pressure
If you have a dramatic change in your medical condition as above, or are hospitalized, consult your physiotherapist or doctor before resuming exercise.
Posted by Peter Ellis at Tuesday, May 13, 2008 0 comments
Sunday, December 24, 2006
Corticosteroid Induced Osteopenia
Last October of 2006, I had a bone density scan of my lower spine, left hip and left wrist because I have been on a Flovent (a corticosteroid) for the last ten years for my COPD and bronchiectasis.
Last December, my GP told me that the bone density scan showed my bones were thin and I was at moderate risk for bone breakage!
My GP then prescibed Didrocal medicine! I take one tablet with a glass of water every evening before going to bed!
My respirologist warned me 8 yrs ago that one side effect of 250 mcg of Flovent was osteoporosis! I will start this calcium therapy treatment next Monday, Dec 26, 2006.
All I can say now it was a good thing that I had a bone density scan.
Posted by Peter Ellis at Sunday, December 24, 2006 2 comments
Friday, June 30, 2006

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