Gladys’ Health Part A: Chronic Obstructive Pulmonary Disease (COPD)
Gladys was diagnosed with Gold B COPD in 1999.
2010 – Cognitive changes – diagnosed with Alzheimer’s disease
2015 – Oxygen therapy for COPD
2018 – Health and wellbeing deteriorated – placed in LTC facility
2019 – Dies due to complications of Alzheimer’s disease
Gladys’ Symptoms
Gladys had a hard time managing her smoking habit. She began to experience the following symptoms:
- Shortness of breath while doing everyday activities
- Chronic cough
- Producing a lot of mucus
- Fatigue
Respiratory Zone
Airway Obstruction in COPD
COPD Diagnosis
Spirometry measures the amount of air you can inhale and exhale, and whether your lungs deliver enough oxygen to your blood. During the most common test, called spirometry, you blow into a large tube connected to a small machine to measure how much air your lungs can hold and how fast you can blow the air out of your lungs.
Other pulmonary function tests include:
- History & Risk factors
- Physical exam
- Assess severity
- Pulse oximetry
- Exercise Testing
- Complete Blood Count
- Arterial Blood Gas
Gladys’s Pulmonary Function Test Results
- FEV₁ – the forced expiratory volume in 1 second
- FVC – the forced vital capacity
- The FEV₁/FVC ratio is used to define obstructive defect and used to diagnose the disease progression.
FEV₁+FVC=FEV₁/FVC
- Your FEV₁ is influenced by other factors including age, sex, height, and ethnicity.
Risk Factors of COPD Among Women
- 3.17 million deaths (5% of all global deaths) were caused by COPD in 2015
- WHO reports a prevalence of 251 million cases of COPD in 2016
- COPD diagnoses and mortality are greater among men compared to women
- But in developed countries like Canada, COPD diagnoses and mortality is almost equal in men and women
Most common risk factors:
- Smoking
- Exposure to secondhand smoke
- Air pollution
- Occupational dust and fumes
Influence of sex on COPD involves several factors:
- Differential susceptibility to the effects of tobacco
- Anatomic, hormonal, and behavioural differences
- Differential response to therapy
Which of these risks are relevant to Gladys’ case?
Metabolism
- Step 1: Glycolysis
- Step 2: Transformation of pyruvate to acetyl CoA
- Step 3: Citric Acid Cycle
- Step 4: Oxidative phosphorylation
The process of changing food to fuel in the body is called metabolism.
- Oxygen and food are the raw materials of the process.
- Energy and carbon dioxide are the finished products.
- Carbon dioxide is a waste product that is exhaled.
- Metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used.
- Metabolism of fat produces the least.
- For some COPD patients, eating a diet with fewer carbohydrates and more fat helps them breathe easier.
Treatment for Gladys
Gladys was referred to a respiratory specialist and enrolled into a smoking cessation program, but was unable to quit.
To facilitate an active lifestyle and exercise was referred to a pulmonary rehabilitation program that included self-management education.
She was provided with the recommended medications that included inhalers and vaccinations and had regular follow-up appointments with her specialist.
Gladys’ new recommended diet
- Vitamins and minerals:
- Steroids may increase your need for calcium
- Calcium carbonate or calcium citrate with vitamin D
- Sodium may cause edema and may increase blood pressure
- Drink plenty of water-keeps you hydrated and keeps the mucus thin
- Rest before eating.
- Eat more food early in the day if you are usually too tired to eat later on.
- Avoid foods that cause gas or bloating. Tends to make breathing more difficult.
- Eat 4 to 6 small meals a day. Enables the diaphragm to move freely and lets the lungs fill and empty more easily.
- Drinking fluids with meals may make you feel too full. Drink an hour before or after meals.
- Consider adding nutritional supplements at night to avoid feeling full during the day.
Physical Activity and COPD
Moderate exercise has benefits:
Physical benefits
- The body’s use of oxygen
- Energy levels
- Cardiovascular fitness
- Muscle strength
- Shortness of breath (SOB)
Emotional & Mental Benefits
- Anxiety
- Stress & depression
- Sleep
- Self-esteem
Exercises help blood circulate, help your heart send oxygen to your body, and strengthen your respiratory muscles.
Types of Exercises for COPD
Pulmonary Rehabilitation consists of education and exercise classes that teach about lungs, the disease, and how to exercise and be more active with less SOB.
Examples include:
- Stretching
- Aerobic
- Resistance
Self-management: COPD and Emotional Health
If feelings of sadness, fear and worry start to affect ability to keep up with normal activities and life enjoyment, they may be symptoms of anxiety and depression
Managing anxiety and depression can increase ability to stick with treatment, improve physical health, and reduce medical costs
Things to do:
- Talk to healthcare team
- Self care
- Connect with others who understand
Treatment for Gladys continued
In 2015,Gladys was able to quit smoking, but the disease progressed to stage GOLD C COPD.
She was prescribed long-term oxygen therapy and oral medications.
Gladys’ Medications
Bronchodilators
- Open airway by Relaxing the muscles around the airways
- Short-acting bronchodilators can be either SABAs (short-acting beta-agonists) or SAMAs (short-acting muscarinic antagonists). Often called “rescue medications” because they act quickly
- Long-acting bronchodilators can be either LABAs (long-acting beta2 agonists) or LAMAs (long-acting muscarinic antagonists). Often called “preventative or maintenance medications”
Inhaled Corticosteroids (ICS)
- Reduces swelling and mucus production
- Long-term use of steroids have may have serious side effects
