Chronic Obstructive Pulmonary Diseases (COPD)

COPD•Definition: Chronic Obstructive Pulmonary Disease (COPD) is not one single disease but an umbrella term used to describe chronic lung diseases that cause limitations in lung airflow (World Health Organization)

•Types of COPD:–Asthma–Emphysema–Chronic Bronchitis

Symptoms of COPD• Dyspnea

–Difficulty breathing

• Shortness of Breath

(SOB)

• Fatigue

• Coughing

• Sputum (phlegm)

Production

COPD Diagnosis• The main test for

COPD is Spirometry

• During the test, a technician will ask you to take a deep breath and then blow as hard as you can into a tube connected to a small machine

Facts About COPD• According to the American Lung Association,

COPD is the 4th leading cause of death in the United States – Behind heart disease, cancer, and strokes

• Cigarette smoking is the primary cause of COPD

• Long-term exposure to secondhand smoke can also increase a person's risk for COPD

• Industrial exposures, such as toxic fumes or dust, can increase a person's risk of COPD as well

What Is Asthma• A chronic disease that causes:

– Bronchial constriction and spasm (tightening of the muscles around the airways)

– Inflammation of the bronchioles– Airways that are overly sensitive to allergen

and irritant triggers– Excessive mucus production in the

bronchioles• There may be periods when there are no

symptoms but the airways are swollen and sensitive to some degree all of the time

Symptoms of Asthma• Breathlessness

• Nighttime or early morning coughing

• Coughing or wheezing after physical activity

• Breathing problems during particular seasons

• Coughing, wheezing, or chest tightness after allergen exposure

• Colds that last more than 10 days

• Relief when medication is used

What Is Asthma Video

• http://www.youtube.com/watch?v=qQEjzMTSzAY

Risk Factors for Developing Asthma• Smoking

• Environmental Pollutants

• Allergies

• Family History

• African Americans are more likely than Caucasians to be hospitalized for asthma attacks and to die from asthma

• It often starts in childhood. More boys have asthma than girls, but in adulthood, more women have asthma than men.

Asthma Triggers• Exercise

• Viral Illness

• Weather Changes

• Exposures to Airborne Chemicals

• Dust

• Tobacco Smoke

• Animal Dander (cats more of a problem)

• Cockroaches

• Dust Mites (tiny insects that eat dead skin)

• Grass, Mold, and Pollens

• Stuffed Animals

Additional Asthma Triggers• Wood Fires• Charcoal Grills• Perfume and

Scented Soaps• Household

Sprays • Paint• Gasoline

• Expressing strong emotions like anger, fear, or excitement

• When a person with asthma laughs, yells, or cries hard, natural airway changes may cause wheezing or other asthma symptoms 

Exercise Induced Asthma (EIA)• Tightening of the muscles around the

airways • Distinct from other types of asthma

because it only happens with exercise• Can be prevented by taking pre-exercise

medication and by warming up/cooling down

• About 10% of the general population without asthma, have EIA when they exercise

Symptoms of Exercise Induced Asthma• Coughing, wheezing,

chest tightness and shortness of breath

• Coughing is the most common symptom of EIA and may be the only symptom

• The symptoms of EIA may begin during exercise and will usually be worse 5 to 10 minutes after stopping exercise

Symptoms of Exercise Induced Asthma

•Symptoms range from mild to severe and often resolve in 20-30 min

• Occasionally some individuals will experience "late phase" symptoms four to twelve hours after stopping exercise

• Late-phase symptoms are frequently less severe and can take up to 24 hours to do away

Causes of Exercise Induced Asthma

• When you exercise you breathe faster due to the increased oxygen demands of your body.

• Usually during exercise you inhale through your mouth, causing the air to be dryer and cooler than when you breathe through your nasal passages. This decrease in warmth and humidity are both causes of bronchospasm

• Exercise that exposes you to cold air such as skiing or ice hockey is therefore more likely to cause symptoms than exercise involving warm and humid air such as swimming

Preventing Exercise Induced Asthma• Proper warm up for 6 to 10 minutes before

exercise • Proper cool down • Carefully monitor respiratory status

before, during and after exercise• Use medication (Albuterol) 15-30 minutes

before exercise begins• Check outdoor ozone/air quality levels• If your client is complaining of breathing

difficulty- BELIEVE IT and take action• Never encourage your client “tough it out”

when having asthma symptoms

Training Considerations• Clients with asthma can participate in

exercise/sports without restrictions• If your client is having trouble

exercising, their asthma may not be in good control

• If clients are having symptoms with activity, encourage them to use their rescue inhalers

Training Considerations

• Aerobic exercise should be guided by the client’s shortness of breath

• Intermittent exercise with frequent rest breaks at a ratio of two parts exercise to one part recovery

• A circuit training format is recommended emphasizing breathing control and rest as needed between sets

• If a client is experiencing unusual dyspnea during exercise, stop exercise

• Upper extremity exercises cause increased dyspnea and must be monitored

Training Considerations• Good

– Activities that involve only short bursts of exercise or intermittent periods of activity are usually better tolerated

– Walking, volleyball, gymnastics or baseball– Swimming that involves breathing warm and

moist air, is often well tolerated • Bad

– Aerobic sports are more likely to cause symptoms

– Distance running, soccer or basketball – Cold air sports such as ice hockey or ice-

skating may not be tolerated as well

Exercise Guidelines• Mode:

– Treadmill walking, cycling, elliptical trainers• Frequency:

– 3-5 days per week• Intensity: 40-60%• Duration: 20-45 minutes• Resistance Training:

– 1 set of 8-15 repetitions– 2-3 days per week– Allow for sufficient rest between exercise

Asthma Medications• Two categories of medications:

– Controller Medications • Taken every day to prevent swelling in the

lungs• Examples may be Inhaled Corticosteroids such

as Azmacort, Pulmicort, Flovent, Advair• These medications must be taken every day,

regardless if there are symptoms or not– Reliever or Rescue Medications

• Taken only when needed to relieve symptoms• Taken before strenuous exercise to prevent

exercise induced asthma (EIA) from developing

Reliever or Rescue Medications• Examples: Albuterol, Proventil, Ventolin, Maxair • Should be taken 10-15 minutes before

strenuous or aerobic activity begins• Taken when needed to relieve symptoms • Should be immediately and easily accessible • You should be aware that your client is using

this medication

What is an Asthma Attack?• Occurs when a person is exposed to

a trigger and their asthma symptoms start to appear

• This can occur suddenly without warning, or develop for days before the symptoms begin

• Attacks are preventable by avoiding exposure to triggers and taking medications

Handling an Asthma Attack• Remain calm and reassure the person• If the person has an inhaler with them, they should take it • Have the person sit up and breathe slowly- in

through the nose, out through pursed lips slowly

• Have the person sip room temperature water/ fluids

• If the person is a minor, contact the parent or guardian as necessary

• Do not leave the person unattended

Call 911 If…

• Lips or nail beds are bluish• Person has difficulty talking, walking or drinking• Quick relief or “rescue” meds (albuterol) is

ineffective or not available• Neck, throat, or chest muscles are pulling in

(retracting).• Nostrils flare out when trying to breathe• Obvious distress• Altered level of consciousness/confusion• Rapidly deteriorating condition.

What is Emphysema?• Damage to the lungs that is Permanent and

Irreversible

• Destruction of the alveoli

• The lungs become less efficient at gas exchange

• The lungs also lose their elasticity and the person experiences difficulty exhaling

• Loss of elasticity results in lung enlargement. The enlarged areas are ineffective in eliminating CO2 and in transferring O2 from the air into the blood stream

What is Emphysema• Damage to the

alveoli not only results in difficulty breathing, but the heart also has to work harder to circulate blood through the lungs.

• All these changes make less O2 available to the body

Symptoms of Emphysema• Shortness of Breath (SOB)

• Cough with Phlegm

• Dyspnea-difficulty breathing

• Coughing

• Wheezing

• Excess Mucus

• Cyanosis-bluish color of the skin

Causes of Emphysema• Cigarette smoking is the most

common cause of emphysema  –Smoking is responsible for

approximately 80-90% of deaths due to COPD

• Environmental Conditions–Pollution–Work Environment (miners)

Complications of Emphysema• People with emphysema eventually die

from it, or from complications resulting from:

–Recurring chest infections, pneumonia, the flu, colds

–Pulmonary Hypertension: Abnormally high blood pressure in the arteries of the lungs

–Cor Pulmonale: Enlargement and strain on the right side of the heart

Emphysema Treatment• Two surgical procedures can be done to

help people with emphysema:

–Lung-Volume Reduction Surgery: The most severely diseased parts of the lung are removed allowing the remaining lung tissue and muscles to work better

–Lung Transplantation: Last resort for people with emphysema

Emphysema Treatment• Quit smoking

–The single most important factor for maintaining healthy lungs

• Bronchodilator• Antibiotics/Steroids• Exercise

What’s In a Cigarette Video

• http://www.youtube.com/watch?v=rHVW8wojWgA&feature=related

What is Chronic Bronchitis?• Inflammation of the trachea, bronchi, and

bronchioles causing excessive mucous production and inflammation of the bronchial walls

Symptoms of Chronic Bronchitis• Persistent cough that produces mucus,

which may be blood streaked • Shortness of breath aggravated by

exertion or mild activity • Frequent respiratory infections that

worsen symptoms • Wheezing• Fatigue • Ankle/foot and leg swelling• Headaches

Causes of Chronic Bronchitis• Cigarette Smoking

–The longer and heavier a person smokes, the more likely it becomes that the person will get chronic bronchitis

• Secondhand Smoke

• Viruses

• Air Pollution

• Infection

• Allergies

Chronic Bronchitis Treatment• Quit Smoking!

• Drinking Water-lung secretions will be thinner and easier to clear when the person is well hydrated

• Bronchodilator Medications

• Vaccines-annual flu shot

• Humidifier

• Corticosteroids

• Exercise