Cop D Brochure
Cop D Brochure
Cop D Brochure
AMERICAN COLLEGE OF CHEST PHYSICIANS Member Services 3300 Dundee Road Northbrook, IL 60062-2348 Phone: (800) 343-2227 or (847) 498-1400 Fax: (847) 498-5460 E-mail: registration@chestnet.org Web site: www.chestnet.org
Additional copies of this Patient Education Guide, Product Code 5032, may be purchased from the American College of Chest Physicians.
Table of Contents
4 Living Well With COPD 4 What is COPD? 5 Inside Your Lungs 6 How COPD Affects the Body 7 Causes of Chronic Obstructive Pulmonary Disease (COPD) 7 Symptoms of COPD 8 Making the Diagnosis 9 Important Steps for Better Living With COPD 9 Step 1: Quit Smoking 10 Other Airway Irritants 10 Step 2: Flu (Inuenza) and Pneumonia Shots 11 Step 3: Understand Your COPD Medicines 12 Bronchodilators 18 Anti-inammatories 20 Antibiotics 22 How To Take COPD Medicines 23 Spacers and Holding Chambers 24 Dry Powder Inhalers 28 Nebulizers 29 Your Medicine Schedule 30 Step 4: Exercise and Get Good Nutrition 32 Step 5: Conserve Your Energy and Control Stress 34 Step 6: Control Your Breathing 37 Step 7: Use Oxygen Therapy 38 Step 8: Manage Acute Exacerbations of Chronic Bronchitis 39 Surgical Options 42 Glossary & Abbreviations
What Is COPD?
COPD is Chronic Bronchitis and Emphysema
Chronic obstructive pulmonary disease (COPD) is a common lung disease, affecting 16 million Americans, and the number is growing. COPD causes 13.4 million doctors ofce visits and 634,000 hospitalizations each year. Long-term cigarette smoking causes nearly all cases of COPD. It takes many years for COPD to develop before people need medical help. Most people begin to feel the disease symptoms between 50 and 70 years of age.
Understanding how your lungs work will help you understand more about COPD.
Exhale
Diaphragm Large muscle moves down to expand the chest and draw air into the lungs. Air Sacs
Air sacs (alveoli) are elastic and expand easily like blowing up a balloon. Diaphragm Large muscle moves up and the chest contracts to force waste air out of the lungs.
Waste air from the body (carbon dioxide CO2) is carried by the blood vessels back to the air sacs to be exhaled through the airways, windpipe, and nose.
Blood Vessels
CO2 passes from the blood vessels into the air sacs.
Oxygen (O2) from the air passes through the air sacs and into the blood vessels. The blood then carries the oxygen to all parts of the body.
Doctors use the term COPD to describe two different diseases emphysema and chronic bronchitis because many people with COPD have a combination of these two diseases. In addition, some people with COPD may also have asthma-like symptoms or reactive airway disease. People with COPD may have worsening attacks from time to time, called acute exacerbations.
Extra mucus
Emphysema
With emphysema, the air sacs (alveoli) and small airways (bronchioles) are damaged and lose their elasticity (if you think of the air sacs as little balloons, they are worn out and never able to return to their normal size). When you breathe out, stale air becomes trapped inside the air sacs. This makes it harder for fresh air (oxygen) to come in and carbon dioxide (CO2) to go out. The blood vessels around the air sacs are also damaged, which prevents fresh air (oxygen) from reaching the blood stream and carbon dioxide (CO2) from going out of the body.
Chronic Bronchitis
With chronic bronchitis, the airways (bronchial tubes) become swollen and inamed and produce large amounts of mucus. The swollen tissues and mucus can make breathing difcult, because the inside of the tubes become narrow or closed in. The airways (bronchial tubes) often become easily infected, because it is difcult to cough out the excess mucus.
Symptoms of COPD
Usually, people with COPD rst notice problems with coughing or phlegm and then breathlessness (shortness of breath) during activities, such as stair-climbing and walking uphill. Symptoms sometimes creep up on people. Without realizing it, people may also cut back or stop doing some activities to prevent problems with breathlessness. Over time, breathlessness worsens, sometimes to the point that dressing and bathing become difcult. Oxygen (O2) levels in the blood may fall, and carbon dioxide (CO2) levels may rise, which can cause tiredness, poor concentration, and heart strain. The strained heart may enlarge and lead to swelling of the ankles and legs, called edema. People with COPD are also at risk for heart disease. COPD and heart disease often go together, because long-term cigarette smoking is one of the biggest risks for both diseases. Although there is no cure for COPD, symptoms can be controlled to improve the quality of life. The lung and airway damage cannot be repaired, but ALL of the symptoms of COPD can be reduced if you take action. Your quality of life can be improved, and the length of your life can be extended. You can live well with COPD. Its up to YOU to take control.
Quit smoking Get u and pneumonia shots Understand your COPD medicines Exercise and get good nutrition Conserve your energy and control stress Control your breathing Use oxygen therapy Manage acute exacerbations
Learn what things you are sensitive to and take steps to avoid or control them.
Step 2: Flu (Influenza) and Pneumonia Shots
Many people with COPD become very ill every year during u season. The u can greatly increase your chances of coming down with pneumonia. Stay away from people with colds and u Wash your hands often to prevent the spread of germs Always ask your doctor about getting a u shot every year at the end of September or in early October Flu and pneumonia shots are not the same, but they are both very important for people who have COPD If other people are using your phone, clean it afterward with an antibacterial gel If you are unable to get the u shot (for example, people who are allergic to eggs cannot have a u shot), make sure you get treatment as early as possible (there are special medicines available that are active against the u virus)
Discuss with your doctor whether a pneumonia vaccine (sometimes called Pneumovax 23) is wise for you; generally, the vaccine is given every 5 to 7 years and is active against a common type of pneumonia.
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COPD Medicines
Understanding your medicines and how to take them regularly and effectively is a very important step in living better with COPD. The medicines can greatly improve your breathing and other symptoms if taken correctly. Many types of medicine are used to treat COPD. The most important are bronchodilators, which prevent and reverse the tightening of the muscles around the airways (bronchospasm), and anti-inammatories, which reduce the inammation and swelling of your airways. If the tightening and inammation are controlled, problems with wheezing and shortness of breath should improve. Antibiotics are used for acute exacerbations, or worsening attacks. Set aside money for COPD medicine. Buy more before you run out. Ask your provider any questions you have about medicines. Your proider may need to change your medicines over time.
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Bronchodilators
Anticholinergics Short-Acting and Long-Acting
Open airways by relaxing tight muscles around them. Always inhaled. Available as metered-dose inhalers, dry powder inhaler, or as a liquid for nebulization. Most often used together with short-acting or long-acting beta2-agonists. POSSIBLE SIDE EFFECTS Coughing Dry mouth Nausea Headache
ATROVENT Ipratropium
GENERIC Ipratropium
SPIRIVA
DUONEB
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Bronchodilators
Beta2-Agonists Short-Acting and Long-Acting
SHORT-ACTING BETA2 AGONISTS Open airways by relaxing tight muscles around them. Usually inhaled, although occasionally taken as tablets. Available as metered-dose inhaler, dry powder inhaler, or as a liquid for nebulization. Carry the inhaler with you wherever you go for quick relief from sudden shortness of breath. An older medication is Alupent (metaproterenol); if you take this, you may want to discuss other options with your doctor. If you are taking oral beta2-agonists, discuss other options with your doctor. The oral medicine may have more side effects. POSSIBLE SIDE EFFECTS Rapid heartbeat Nervousness Tremors and shakiness Nausea Dry mouth and throat Increased blood pressure Muscle weakness Decreased blood potassium level
GENERIC Albuterol
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Bronchodilators
Beta2-Agonists Short-Acting and Long-Acting
SHORT-ACTING BETA2 AGONISTS (CONTINUED)
COMBIVENT Albuterol and Ipratropium MAXAIR AUTOHALER Pirbuterol GENERIC Albuterol
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Bronchodilators
Beta2-Agonists Short-Acting and Long-Acting
LONG-ACTING BETA2 AGONISTS Open airways by relaxing tight muscles around them. Often dry powdered inhalers, although they are occasionally taken as tablets. The inhaled medicines are only taken twice a day. Not to be used for quick relief of shortness of breath. POSSIBLE SIDE EFFECTS (Very uncommon) Racing heart Tremors (shaking) Nervousness
FORADIL Formoterol
VOLMAX Albuterol
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Bronchodilators
Methylxanthines
Open the airways by relaxing tight muscles around them. Taken as pills. POSSIBLE SIDE EFFECTS Racing heart Tremors (shaking) Nervousness Nausea Headaches Insomnia (sleeplessness) Heartburn Seizures
Some Examples:
UNIPHYL Theophylline, Anhydrous THEO-24 Theophylline, Anhydrous AEROLATE Theophylline, Anhydrous GENERIC Hydrous Theophylline SLO-BID Theophylline, Anhydrous
Notes: For medications like these, it is very important to follow your doctors instructions regarding how to take the medicine. Inform your doctor if you stop smoking or start taking any other medicines. Your doctor may request a blood test to check the theophylline level in your blood. This may be done with any change in the dose of theophylline or routinely once or twice a year.
Over-the-counter Medicines
You may have tried some of the short-acting inhalers available without a prescription at drug stores. These medicines may cost less than the bronchodilator inhalers your doctor prescribes, but they dont save you money in the long run. They are much less effective and are used more often to get the benet prescription medicines provide. They can also be dangerous. Its best not to use over-the-counter inhalers without the guidance of your physician.
Expectorants
Expectorants (mucolytic medicines) are sometimes used to treat the increased mucus or thicker mucus that can occur with COPD. These medicines may help keep mucus thin and more easily cleared from the airways. These are taken as pills. The expectorant most commonly used for COPD is guaifenesin.
Anti-inammatories
Corticosteroids
Also called glucocorticoids or steroids. Reduce inammation and swelling of the airways. Not the same as anabolic steroids, which are muscle-building steroids misused by athletes.
Remember: Many people are uneasy about steroids and stop taking them or take less than the doctor prescribes. Steroids are meant to work over a period of time to reduce swelling of the airways. They must be used regularly to be effective. Always take steroids exactly as your doctor directs, even when you feel better or do not believe they are helping you. If you stop taking steroids, your breathing can get worse, sometimes much worse.
POSSIBLE SIDE EFFECTS You may notice after a few days: Fluid retention Increased appetite You may experience after several months of use: Adrenal suppression (less able to handle stress) Decreased resistance to infection (get infections more easily) You may experience after several months or years of use: Moon face Cataracts Excess facial hair Osteoporosis
Ask your doctor or nurse how you can avoid some of the side effects by limiting salt intake and avoiding high-calorie foods.
Anti-inammatories
Inhaled Steroids
POSSIBLE SIDE EFFECTS Reduce inammation and swelling of the airways. Because they are inhaled, they generally only affect your lung and airways, not your entire body. Rinse your mouth, gargle, and spit after using them. Oral thrush (yeast infection of the mouth) and sore tongue Hoarseness
Notes: Inhaled steroids, in small doses, have fewer side effects than systemic steroids, because they do not affect the entire body. Large doses of inhaled steroids can have some of the same side effects as systemic steroids. To lessen the most common side effects, which are oral thrush (yeast infection of the mouth), sore throat, and hoarseness, rinse your mouth, gargle, and spit after use.
ADVAIR Combination of Flovent and Serevent PULMICORT Budesonide
AEROBID Flunisolide
AZMACORT Triamcinolone
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Antibiotics
Bacterial infections of the lungs (pneumonia) and airways (acute bronchitis) are very serious for people with COPD. They can cause further lung damage and make breathing more difcult. Bacterial infections cause many people with COPD to be hospitalized. Antibiotics for people with COPD: Are not useful for viral infections, such as colds and u. Work by killing germs (bacteria) that cause infection. Many different types are available. Your doctor will choose the best one for your infection. Heres what you can do if you have to take antibiotics for an infection: Finish the entire prescription, even if you feel better. Quitting antibiotics early can cause some of the germs to survive and cause another, more severe, infection later. Tell your doctor if you are having a rash or some other unusual reaction to your antibiotic, especially if it is something that makes it difcult for you to take them. POSSIBLE SIDE EFFECTS (Vary with different types of antibiotics) Stomach cramping Nausea Diarrhea Skin rash
If you get lots of infections, try to tune in to when one might be beginning so that you can get antibiotics early if your doctor thinks you need them.
Some Examples:
LEVAQUIN Levooxacin ZITHROMAX Azithromycin BIAXIN Clarithromycin
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Antibiotics
AUGMENTIN Amoxicillin-clavulanate OMNICEF Cefdinir LORABID Loracarbef
CEFTIN Cefuroxime
SEPTRA DS Trimethoprim-sulfamethoxazole
GENERIC Doxycycline
GENERIC Erythromycin
CIPRO Ciprooxacin
GENERIC Amoxicillin
KETEK Telithromycin
These medicines can have side effects and vary with different types of antibiotics. Your doctor or pharmacist can help you reduce side effects. Ask if the antibiotic can affect other medicines you are taking or if it should be taken after meals.
For all your medicines, remember: Always take the medicine as prescribed. Complete the full medicine course. Discuss with your doctor whether you should take medicines before exercise or other activities.
Note: All the medicines listed in this booklet are examples of those currently available in the United States. Your doctor may prescribe others not listed, or you may be taking some not available in the United States. The medicines listed here may also have different brand names in other countries. No matter what medicine you are prescribed, always ask your doctor or pharmacist for an explanation of the medicine and how it is used.
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Many bronchodilators and anti-inammatories come as sprays or powders that are used from an inhaler. Breathing in the medicine through the inhaler sends it directly to your airways and lungs. How well this medicine reaches your lungs depends on using the inhaler correctly. Its common for many people to have trouble using their inhalers. There are different types of inhalers, and each may require a slightly different technique. Ask your doctor or nurse to help you use your inhaler correctly.
STEP 2: Hold the inhaler like this Sit up straight or stand, tilt your head back slightly, take a deep breath, and breathe out normally.
STEP 3: Hold the inhaler about 1 1/2 to 2 inches in front of your open mouth. As you start to breathe in, push down once on the top of the inhaler, and keep breathing in slowly and deeply to carry the medicine far into your lungs (usually about 3 to 5 seconds).
STEP 4: Hold your breath for up to 10 seconds with your mouth closed, then breathe out very slowly. This allows the medicine to deposit in the lungs. If you use more than one puff, resume normal breathing and then repeat the above steps for each puff of medicine.
STEP 5: Afterward, if you are using inhaled steroids, rinse your mouth, gargle with water, and spit it out. This will help prevent a yeast infection in your mouth and throat.
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It is better to use a spacer with the metered-dose inhaler, because many people have trouble coordinating breathing with the activation of the metered-dose inhaler. The spacer also reduces the amount of medicine deposited in the upper airways and allows the smaller particles of medicine to get deeper into the smaller airways. For this reason, the inhaler will be more effective with the use of the spacer, especially with inhaled steroids.
STEP 3: Take a deep breath in and breathe out normally. Sit up straight or stand, tilt your head back slightly, take a deep breath, and breathe out normally.
STEP 4: Close your lips around the spacer mouthpiece (make sure you remove the cap). Press the inhaler button to release a puff of medicine into the spacer. Breathe in slowly and deeply (usually about 3 to 5 seconds).
STEP 6: There are many types of spacers and chambers; decide which one will work best for you.
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A dry powder inhaler is a device designed for breathing powdered medicine into the lungs without using an aerosol propellant. Drug makers offer inhaler medicine as powders, because some aerosol propellants harm the earths ozone layer. Eventually, metered-dose inhalers with chlorouorocarbon propellant will not be available. Several types of dry powder inhalers are available, and each requires a slightly different technique.
STEP 1: Hold the Diskus as shown. Push the thumb grip as far as it will go to the right to open the Diskus.
STEP 2: Slide the lever to release the medicine until you hear a click. The Diskus is now ready to use.
STEP 4: Keep the Diskus level, and seal your lips around the mouthpiece. Breathe in as quickly and as deeply as you can on the mouthpiece.
STEP 5: Remove the Diskus from your mouth, and hold your breath for up to 10 seconds. Never exhale back into the Diskus.
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REPEAT IF SOME POWDER REMAINS STEP 4: Take a deep breath in, and then breathe out normally. Grip the mouthpiece with your teeth, and seal your lips around it. Keep the Turbuhaler level and breathe in as quickly and as deeply as you can on the mouthpiece. STEP 5: Hold your breath for up to 10 seconds, and breathe out slowly with the Turbuhaler away from your mouth. Never exhale back into the Turbuhaler.
STEP 6: Replace the cover. Rinse your mouth, gargle with water, and spit it out.
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STEP 4: With the Aerolizer held upright, press both side buttons once only, and release. You will hear a click as the capsule is punctured. If you do not release the buttons, the capsule will not spin.
STEP 5: Place your mouth on mouthpiece, and tilt your head back slightly after fully exhaling. Hold the inhaler with blue buttons facing sideways, and inhale. Breathe in fast, steadily, and deeply. As the medicine is released, you will feel a sweet taste on your tongue and hear a whirring noise. (If you dont, the capsule may be stuck. Just tap on the side of the inhaler and inhale again. Do not press the side buttons again.) Remove the inhaler from your mouth, and hold your breath for as long as you comfortably can (about 10 seconds).
STEP 6: Open the inhaler to see if any powder remains, if it does, repeat another breath. Discard the empty capsule.
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STEP 1: Open the blister card by peeling back the foil, using the tab, until one capsule is fully visible. The foil cover should only be peeled back as far as the STOP line printed on the foil.
STEP 2: Open the HandiHaler by pulling the dust cap upwards. Open the mouthpiece.
STEP 3: Place the capsule in the center chamber. It does not matter which end of the capsule is placed in the chamber.
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STEP 7: To ensure you get the full dose of Spiriva, you must repeat the last step. After you have nished taking your daily dose of Spiriva, open the mouthpiece again, tip out the used capsule, and dispose. Close the mouthpiece and dust cap for storage.
Nebulizers
How To Use a Nebulizer
Notes:
It is very important to clean the nebulizer after each use and let it air dry to prevent infection. Do not leave liquid medicine in the nebulizer cup between uses.
Your doctor may prescribe a form of liquid medicine that must be breathed in by using a nebulizer. A nebulizer turns medicine into a mist that can be breathed in slowly through a mouthpiece. There are different brands and types of nebulizers, and the medicine used comes in different forms. Discuss the long-term use of a nebulizer with your doctor; with proper technique, you will be able to receive the same amount of medicine using a metered-dose inhaler, and there is less chance of infection.
STEP 1: Prepare your nebulizer cup and the correct amount of medicine.
STEP 2: Take a deep breath in, and breathe out normally. Place the mouthpiece between your teeth, and close your mouth around it. Place your thumb over the nger port, if used.
STEP 3: You may breath in and out normally, although it is better if you can take several slow deep breaths at a time and rest in between each series of breaths.
STEP 4: Tap the side of the cup occasionally to keep the medicine droplets at the bottom of the cup.
STEP 6: Take the nebulizer apart, and clean and dry it according to the manufacturers instructions.
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List daily activities that match times for taking your medicines.
For instance, brushing your teeth, eating meals, going out for a walk, or the times of your favorite television shows.
Remember, it may not be easy, but, in time, your medicine schedule will become a part of your everyday routine. Quitting smoking and taking your medicines regularly and effectively are the two most important steps you can take to live better with COPD.
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Pulmonary Rehabilitation
Pulmonary rehabilitation may help you reduce the impact of COPD by helping to control or reduce breathlessness and recondition the body so that you feel less shortness of breath. Whats more, with exercise, education, and breathing retraining, people with COPD can experience some great benets, such as less need for medications and hospital stays and an even longer survival.
It is especially important after an acute exacerbation of chronic bronchitis to have pulmonary rehabilitation, because many people become deconditioned from a hospital stay or bedrest. During an acute exacerbation (AECB), lung function may get worse and breathlessness may increase. Also, steroids, an important and necessary medication used to treat people with acute exacerbations, may have the effect of causing muscle weakness. Fortunately, even after acute exacerbations of chronic bronchitis, these symptoms can be reversed with pulmonary rehabilitation. Patients can become reconditioned, improve their lung function, decrease their breathlessness, and strengthen their muscles.
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You can benet tremendously from pulmonary rehabilitation. Discuss it with your doctor. Good Nutrition
Maintaining good health is impossible without eating the right foods. Speak with your doctor or nutrition specialist if you need help in planning and preparing healthy meals. Some people with COPD have trouble keeping weight on, and it is easy to lose muscle mass when you lose weight. If this is a problem for you, discuss nutritional supplements with your doctor or nutritionist. Staying at a healthy weight is very important for controlling COPD.
It is important to keep your weight just right. Many people with COPD nd it helpful to:
Eat several smaller meals throughout the day instead of three large ones. Because your stomach is directly under your lungs, eating a big meal can push against your diaphragm and make it harder to breathe. Avoid gas-producing foods, such as apples, broccoli, brussel sprouts, cabbage, corn, cucumbers, and carbonated beverages. These foods can cause your stomach to swell and press against your diaphragm. Drink plenty of uids to keep airway mucus thin and free-owing. Talk less while you are eating. Slow down when you are eating.
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Control stress
Feeling stressed can make breathlessness much worse. When you have trouble getting your breath, anxiety can cause you to breathe even faster, tire your chest muscles, and lead you to panic. This cycle is common for people with COPD, but there are steps you can take to stop stress before it overwhelms you.
Learn to relax
Stress is less likely to build to anxiety if you know how to relax yourself when you start to feel tense. Find what works for you. Try yoga, prayer, meditating, or listening to relaxing music. Some people like to get comfortable, close their eyes, and imagine themselves in a relaxing, pleasant place doing something they enjoy doing. Concentrate feel the soft breeze on your face or the warm sand at your feet whatever relaxes you. Dont stop until you feel relaxed. Slowly tense and relax each part of your body. Start with your toes and work all the way up to your scalp. Breathe in as you tighten, and breathe out as you relax. Practice pursed-lip and diaphragmatic breathing.
PANIC
Breathing Muscles Tire Even More Breathing Becomes Even More Rapid Anxiety Increases
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Pursed-Lip Breathing
Pursed-lip breathing not only helps you relax, but it also helps you get more oxygen into your lungs and prevents shortness of breath. Practice this breathing technique until it works well for you.
STEP 1: Relax your neck and shoulder muscles. Inhale (breathe in) slowly through your nose, and count to 2 in your head.
STEP 2: Pucker your lips as if you are whistling. Exhale (breathe out) slowly and gently through your lips while you count to 4 or more in your head. Always exhale (breathe out) for longer than you inhale (breathe in). This allows your lungs to empty more effectively.
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STEP 1: Get into a comfortable position. Relax your neck and shoulder muscles.
STEP 2: Put one hand on your abdomen and one on your chest.
STEP 4: Inhale (breathe in) slowly through your nose to the count of 2. Feel your abdominal muscles relax. Your chest should stay still.
STEP 5: Tighten your abdominal muscles, and exhale (breathe out) while you count to 4. Feel your muscles tighten. Your chest should stay still.
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STEP 1: Sit comfortably in a chair. Take three to ve slow, deep breaths using pursed-lip and diaphragmatic breathing.
STEP 3: Squeeze your chest and abdominal muscles open your mouth and force out your breath while whispering the word huff (sounds like a forced sigh). Some people nd it helpful to press on the lower chest at the same time. Repeat once.
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COMPRESSED GAS IN CYLINDERS Can be used out of the home on shoulder straps or on a wheeled cart.
LIQUID OXYGEN IN RESERVOIRS Can be used out of the home on shoulder straps or on a wheeled cart. Always keep the unit upright. Placing the unit on its side can cause the oxygen to evaporate.
A CONCENTRATOR THAT EXTRACTS OXYGEN FROM THE AIR Most commonly used in the home. It runs on electricity.
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NASAL PRONGS
TRACHEOSTOMY TUBE
Oxygen will not explode or burn, but it does cause things to burn faster. The plastic tubing can also catch re. Be careful not to use the oxygen near a ame of any kind, including a lighted cigarette or gas range.
Do not use aerosol sprays, such as air fresheners, hairspray, vapor rubs, or petroleum-based jelly near your oxygen unit. These items are all very ammable. Travel With Oxygen
Traveling with oxygen can be done with ease, but it takes planning to ensure enough oxygen for the trip and for use at your destination. Air travel requires more planning and coordination with the airline. Talk with your doctor and oxygen supplier for advice about traveling.
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Colds and the u are caused by a virus but may lead to a bacterial infection in people with COPD, which will require treatment with an antibiotic. It is very important to recognize early symptoms to prevent bad attacks or hospitalization. Participate in a treatment plan with your doctor and become the master of your disease. HOW TO MANAGE AN ACUTE EXACERBATION: Follow prescription directions carefully and nish all your medicine every time your doctor prescribes an antibiotic, even if you start to feel better. Use expectorants to bring up extra mucus. Talk to your doctor about your oxygen therapy; your oxygen therapy needs may change during this time. Take other medicines, such as steroids and bronchodilators, that may be needed during an acute exacerbation even if you do not normally take them.
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Surgical Options
You may have heard about surgical treatments for COPD, primarily for people with emphysema. These surgical treatments are called lung volume reduction and lung transplantation. Some people have improved function from these procedures, but many will not benet. A small percentage of people with COPD can be considered for these surgical options.
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Lung Transplantation
Lung transplantation involves replacing one, or sometimes both, of your diseased lungs with a donor lung. To be considered a candidate, generally you must: Be oxygen dependent. Have severe COPD that no longer responds to medical treatment and may be fatal in 2 years. Be physically able to undergo surgery and the treatment that follows. Be under the age of 65 and, at some centers, you must be under the age of 60.
If you are considered a candidate, you will undergo many tests and procedures to assess your physical and emotional condition. If the assessment goes well, you will be placed on a national lung donor list to wait for a donor lung. Lung transplantation has many risks, and donor lungs are not readily available. Waiting for a donor lung can sometimes take 2 or more years. Also, after surgery, you will need to take many different medications to prevent rejection of the transplanted lungs and to prevent infection.
With this surgery and lung volume reduction surgery, you must very carefully weigh all the issues involved. Make sure you discuss this with someone who is an expert in surgical options.
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COPD (chronic obstructive pulmonary disease) A term to describe two diseases, emphysema and chronic bronchitis with airow obstruction. Patients may experience either or both of these conditions. Corticosteroids (glucocorticoids, steroids) Medications that work to decrease inammation and swelling of the airways. They can be taken in pill form or inhaled. Corticosteroids are not to be confused with anabolic steroids used by athletes to build muscles. Diaphragm The large muscle underneath the lungs that moves down when breathing in to allow air with fresh oxygen to be pulled into the lungs and moves up to force waste with carbon dioxide out of the lungs when breathing out. It is the main breathing muscle in the body. Emphysema Part of COPD that involves the tiny air sacs in the lungs (alveoli). In emphysema, the lungs lose elasticity, which causes the air sacs to become enlarged, making breathing difcult. In advanced emphysema, there are large empty spaces in the lung. Hypoxemia Having too little oxygen in the blood. Lung volume reduction surgery An operation in which damaged parts of the lung are removed, allowing the healthy, remaining parts to work better and ll the space inside the rib cage. Mucus (phlegm) A slippery substance produced by certain membranes in the body. In normal, healthy people, mucus moistens and protects these mucous membranes. However, in COPD, too much mucus is produced in the lungs, resulting in clogging, blocking, and coughing, which make breathing more difcult. Nebulizers (atomizer) A machine that can produce an extremely ne spray for deep penetration of medicine in the lungs. Oxygen (O2) A gas that provides the body with energy. When breathed in, it is pulled into the lungs, where it is transferred to the blood through the air sacs (alveoli). People who do not get enough oxygen into their systems may need oxygen therapy. Pulmonary rehabilitation A multidisciplinary program of exercise, education, and breathing retraining meant to help people with COPD stay conditioned, reduce symptoms of breathlessness, and improve lung function and attitude in order to improve quality of life. Reactive airway disease Often referred to as asthma, people with this disease have airways that are very sensitive to irritants, causing tightening of muscles and more mucus production. Some people with COPD also have reactive airway disease. Spirometry A way of measuring the amount of air entering and leaving the lungs. This is one of the ways doctors and other health-care providers can diagnose COPD. Windpipe (trachea) Air ows through this tube from the mouth and nose, down the throat, and into the lungs.
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Other patient education guides available from the ACCP in print and on the ACCP Web site (www.chestnet.org) are: Controlling Your Asthma (English and Spanish versions available) Flexible Bronchoscopy Cough: Understanding and Treating a Problem With Many Causes Mechanical Ventilation Beyond the Intensive Care Unit Pulmonary Rehabilitation: A Team Approach To Improving Quality of Life
Additional Resources: www.thoracic.org www.goldcopd.com www.nationaljewish.org www.smokefree.gov/talk.html www.yourlunghealth.org www.copdresourcenetwork.org www.lungusa.org www.centerwatch.com
This publications content does not replace professional medical care and physician advice, which always should be sought. Medical treatments vary based on individual facts and circumstances. The information provided herein is not intended to be medical advice. The American College of Chest Physicians specically disclaims all responsibility for any liability, loss, or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the material herein.
Printing of this patient education booklet was made possible by an unrestricted educational grant from:
www.chestnet.org
Product Code: 5032