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Avoid irritants to reduce breathlessness

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Karen Clancy, MSc, RGN.

Respiratory Nurse Consultant, Pennine Acute Hospitals NHS Trust, Rochdale Infirmary

Defining COPD

Defining COPD
What is COPD?

Chronic obstructive pulmonary disease is a common respiratory condition. It is thought that over 600,000 people in the UK have been diagnosed with it, although it is suggested that this number is not a true representation, as many people have symptoms but have not been diagnosed (Respiratory Alliance, 2003).

The acronym COPD is used as an umbrella term, covering chronic asthma, bronchitis and emphysema.

The three conditions can be related. Asthma affects the lining of the breathing tubes (the bronchial airways). These become sensitive and inflamed when exposed to irritants (triggers), which results in shortness of breath, wheeze, phlegm production, cough and chest tightness. In asthma these symptoms are usually reversible, but in chronic asthma the symptoms tend to persist.

Symptoms suggestive of chronic bronchitis include a productive cough and phlegm production on most days for three months during any two consecutive years (National Respiratory Training Centre, 2002). In emphysema there has been damage to the small breathing sacs (alveoli) in the lung, the function of which is to transport oxygen and the waste product of breathing (carbon dioxide) across the blood. When these air sacs become damaged they lose their elasticity, which results in symptoms of breathlessness, particularly on exertion.

Diagnosis
How is COPD diagnosed and can it be cured?

COPD cannot be cured, but with treatment your symptoms can be improved. A diagnosis is made from the symptoms presented, response to respiratory medication and the results of lung function testing (spirometry).

Three parameters are usually measured from the spirometry test: the volume of air that can be blown out in the first second from the forced exhalation (FEV1), the total volume of air that can be exhaled from maximum inhalation to maximum exhalation (FVC), and the ratio of FEV1 to FVC % and FEV1%. The spirometry results are compared to predicted values, which are based on age, height, gender and nationality.

Medication
How will the medication help me?

The main aim of treatment in COPD is to try and reduce the degree of breathlessness and improve exercise capability. Where possible, treatment is delivered by inhalers using a short-acting bronchodilator such as salbutamol, terbutaline and ipratropium. These drugs reduce breathlessness, which in turn increases ability to exercise and improves lung function (FEV1). Benefits last from between four and five hours.

Self-help measures
How can I help myself?

By stopping smoking you will slow down the progression of the disease. You should also take regular exercise, monitor your weight and eat a balanced diet.

Continue with your inhaled therapy and try to avoid situations where you may be exposed to irritants that may increase your respiratory symptoms, such as smoky environments, extreme changes in temperature, people with coughs and colds.

Should you find that your inhaled therapy is becoming ineffective and you are experiencing increased respiratory symptoms, such as breathlessness, wheeze, and phlegm production which is different from normal, you must visit your GP as there are other treatments available.

You should consider having the annual influenza vaccination and the pneumococcal vaccination to protect you against these illnesses (NICE, 2004).

Patient case history
Mr Black, aged 52 years was admitted to hospital with shortness of breath, increased sputum production, wheeze and a cough. He described a three-year history of annual bronchitis, in which he suffered symptoms of a chest infection requiring antibiotics. He admitted to being an ex-smoker, previously smoking up to 20 cigarettes a day for almost 30 years.

Over the past few years he had noticed that he became short of breath with activity, particularly when climbing stairs or walking on an incline.

On clinical examination he was wheezy, with signs of tachypnoea and breathlessness, which was worse on exertion.

He was treated with antibiotics, nebulised bronchodilator therapy and prednisolone. He was discharged with a provisional diagnosis of chronic obstructive pulmonary disease (COPD) and a bronchodilator (salbutamol) inhaler to use as required.

Two weeks later, Mr Black attended the outpatients department, where he received the results of his spirometry test: airflow obstruction was confirmed.

This result, along with his respiratory history and previous clinical examination, confirmed the diagnosis of mild COPD.

Author contact details
Karen Clancy email: Karen.Clancy@pat.nhs.uk

Useful contacts
The British Lung Foundation, tel: 020-76885555; email: enquiries@blf-uk.org

NHS guidance on the management of COPD: www.nice.org.uk

Asthma UK: www.asthma.org.uk Advice line: 08457010203

National Respiratory Training Centre. (2002) Hospital Respiratory Course. Warwick: National Respiratory Training Centre.

National Institute for Clinical Excellence. (2004)Chronic Obstructive Pulmonary Disease. Management of chronic obstructive pulmonary disease in adults in primary and secondary care. Clinical guideline 12. London. NICE.

Respiratory Alliance (2003)Bridging the Gap. Commissioning and delivering high quality integrated respiratory healthcare. Berkshire:Direct Publishing.

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