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Breathe Easy

by Mindy Toran

Seniors are more likely to be diagnosed with COPD, but there is help out there to make the condition less obstructive to everyday life.

COPD, or chronic obstructive pulmonary disorder—a disease of the lungs which makes it very difficult to breathe—is the fourth leading cause of death in the United States and kills more than 120,000 Americans each year, according to the National Heart, Lung and Blood Institute, a division of the National Institutes of Health. The Centers for Disease Control reports that more than 12 million people have been diagnosed with COPD, and an additional 12 million likely have the disease and don’t even know it.

These statistics make it imperative that seniors living with COPD get a proper diagnosis and begin treatment as soon as possible. While it is a progressive disease and there is currently no cure, medication and therapy can help to slow its progression and improve the quality of life for people living with it. If you’re one of the thousands affected, make 2013 the year you reach out for help.

What causes COPD?
“COPD is a combination of two diseases—chronic bronchitis and emphysema—and is a condition where not enough air enters or leaves the lungs,” says Dr. Andrew Martin, chair of Pulmonary Medicine at Deborah Heart & Lung Center in Browns Mills. “Chronic bronchitis is typically indicated by a cough that lasts six months or more and is accompanied by thick mucus or phlegm, which clogs the airways. Chronic bronchitis may be diagnosed separate or apart from emphysema, which results in destruction of lung tissue and makes it difficult to breathe. Both conditions result in shortness of breath, wheezing and coughing up phlegm.”

In most cases, smoking is the main cause of COPD, but it can also be caused by air pollution, exposure to secondhand smoke, exposure to occupational hazards, a history of frequent respiratory infections during childhood and, in some cases, a rare genetic disorder called alpha-1 antitrypsin or AAT deficiency, which is caused by an inherited lack of a protective protein in the blood.

Seniors are more likely to be diagnosed with COPD, as it most often occurs in older people with a history of smoking. In many cases, people are not diagnosed with COPD until they have lost a significant amount of their lung function. They may blame their shortness of breath on age, fatigue or the side effects of smoking, and often compensate by reducing their activity levels, which causes even more deconditioning. When COPD is severe, shortness of breath can get in the way of doing even the most basic of tasks, such as bathing and getting dressed, cooking, cleaning or taking a walk. The disease develops slowly and worsens as time goes on.

Finding help
In order to begin treatment, it’s important to get a proper diagnosis, says Dr. Allen Salm, a pulmonologist at Virtua’s Garden State Pulmonary Associates in Marlton. “If you suspect you have COPD or you’re having difficulty breathing, you should visit your primary care provider, who can refer you to a pulmonologist—a doctor that specializes in treating people with lung disease. Your doctor or specialist will typically perform a simple breathing or pulmonary function test, which measures how well the lungs are working.”

The test, called spirometry, consists of a mouthpiece and breathing tube connected to a computer. The patient takes a deep breath and blows air out as fast and hard as he or she can for at least six seconds. The computer then measures the results to determine the degree of airflow obstruction.

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), there are four stages of COPD, which range from mild to very severe. The degrees of COPD range from mild airflow limitation to chronic, life-threatening respiratory failure.

“The No. 1 treatment for COPD, and the only way to prevent further damage, is to stop smoking,” says Deborah’s Martin. “The condition can also be treated with medication, including bronchodilators, which work by relaxing the muscles around the airways, helping to make breathing easier; inhaled steroids, which can reduce inflammation in the airways; and oral steroids or antibiotics as needed, which can be used for treating COPD exacerbations.”

One method of treatment is exercise. The most common form for people with lung disease is called pulmonary rehabilitation, which focuses on multidisciplinary therapies designed to minimize the impact of COPD while improving lung function. Components include exercise, disease management training, nutrition advice, and counseling to help patients physically and emotionally participate in activities of daily living. “Pulmonary rehabilitation can help patients get as fit and healthy as possible, despite their limitations due to lung disease,” says Martin.

Ed Mehaffey, director of Respiratory Services and the Pulmonary Rehabilitation Program at Advantage Therapy & Sleep Centers in Mount Laurel, Cherry Hill and Sewell, adds, “Pulmonary rehab focuses on energy conservation techniques, proper nutrition, exercise, and psychosocial issues, such as how to cope with lung disease both inside and outside of the home. In addition to exercises designed to help individuals with chronic lung disease regain independence, build strength and endurance and improve balance, we teach patients breathing techniques and strategies for living better with COPD.”

You’re not alone
Many pulmonary rehab centers offer group or one-to-one education centers to help people learn to better manage their COPD. Education generally focuses on how to properly use prescribed medications, smoking cessation, the importance of a healthy diet and exercise, energy conservation techniques, and how to understand and use oxygen therapy. In addition, social workers are typically on staff to help address issues such as depression and anxiety brought on by the inability to maintain a normal lifestyle.

“Pulmonary rehab programs are tailored to help individuals with COPD improve their daily activities,” says pulmonologist Dr. Alan Pope, vice president of Medical Affairs and chief medical officer at Lourdes Health System in Camden. “These programs are designed to help make the stresses of daily living easier, teach behavior techniques to manage the disease and provide support from others going through the same thing. It’s particularly important for individuals with COPD to maintain a regular program of activity and ambulate on a regular basis in order to stay as conditioned as they can.”

In more severe cases, patients may be prescribed oxygen therapy, which increases the amount of pure oxygen a person breathes in so the lungs have more to absorb and distribute to the body. By getting the most oxygen possible, breathing is easier and a person is able to do more without becoming short of breath.

“Long-term use of oxygen can significantly increase the survival rate and improve the quality of life for individuals with COPD,” says Virtua’s Salm. “The ultimate goal of treatment for patients with COPD is to slow the progression of the disease, minimize infection and improve nutrition and conditioning.”

For seniors, good self-care is extremely important. “Good basic hygiene such as eating a healthy diet, getting plenty of rest, frequent hand washing, getting annual flu and pneumococcal vaccines, avoiding crowds during the winter, and regular exercise are particularly beneficial to older patients with COPD,” says Lourdes’ Pope. “It’s important that patients maintain an active social life that focuses on conditioning, take the appropriate medications to control their symptoms, quit smoking, and comply with oxygen therapy, if necessary, in order to prevent progression of the disease and maintain a healthy lifestyle.”

Published (and copyrighted) in Suburban Family Magazine, Volume 3, Issue 10 (December, 2012).
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