COPD: The Basics - atom Allianceatomalliance.org/wp-content/uploads/2017/11/2017ODL_LAN...The Basics Stephanie Williams, BS, RRT Community Programs Manager COPD Foundation Conflict
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COPD: The Basics Stephanie Williams, BS, RRT Community Programs Manager COPD Foundation
I have no real or perceived conflict of interest that relates to this presentation. Any use of
brand names is not in any way meant to be an endorsement of a specific product, but to
merely illustrate a point of emphasis.
Presenter Stephanie Williams is a recognized leader and educator in respiratory therapy. Over the course
of her career she has designed and implemented pulmonary rehabilitation and respiratory programs
in a variety of patient care settings.
During her tenure as Director of Cardiopulmonary in the acute care setting, she started a support
group for COPD patients in the community as well as a smoking cessation program.
Stephanie’s intellectual curiosity, commitment to patient engagement and hard work has allowed her to play a central role in numerous areas of
respiratory innovation.
She is a Registered Respiratory Therapist and holds a bachelor’s degree in Education from
Tennessee Technological University.
Impact of COPD in the U.S. ─ Quality of Life
Presenter
Presentation Notes
21 states also included an optional module of questions on their BRFSS to get a better understanding of the utilization and qol impact related to COPD Five questions were asked; Have you had a breathing test to diagnose your copd? How many times have you visited your physician for COPD issues in the last 12 months? How many times have you visited the ER/been hospitalized for COPD in the last 12 months? How many medications do you take for your copd? Does copd affect your quality of life? BRFSS also shows that just under 25% reported never smoking, in line with our growing understanding of the additional risk factors and genetic underpinnings of the disease Not pictured but important: BRFSS highlighted the close relationship between COPD and asthma. Nearly 50% of people with COPD reported also having been diagnosed with asthma at some point in their life. -------------- All data comes from 1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm
Impact of COPD in the U.S. ─ Demographics
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Presentation Notes
All data is national averages Data proved that COPD is a disparities issue. It shows that not only do more women die from COPD each year, but more women report a diagnosis of COPD as well. It shows that COPD adversely impacts lower income populations. One good example, if you look only at KY, the average prevalence rate is 9.3% but if you just look at those making less than $15,000 the prevalence rate goes up to over 20%! It also shows it’s not just a disease of the elderly and we should be doing a better job of detecting and treating the disease earlier. --------------- All data comes from 1. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm
What Is COPD
What is COPD?• Chronic Obstructive Pulmonary Disease• Serious lung disease that over time makes
it hard to breathe• Emphysema• Chronic Bronchitis• Refractory Asthma and• Some forms of bronchiectasis
• Blocked (obstructed) airways make it hard to get air in and out
Presenter
Presentation Notes
So what is COPD? It stands for Chronic Obstructive Pulmonary Disease. COPD is a serious lung disease that progresses slowly and over time, makes it very difficult to breathe. You may also have heard it called by other names. Emphysema and chronic bronchitis are forms of COPD. COPD is a general term that includes a spectrum of diseases. Very often a doctor may say “you have emphysema” when the person has elements of both emphysema and chronic bronchitis. In fact, it is common for people to have elements of both, which is why we prefer the term COPD. In people who have COPD, the airways, or tubes that carry air from the nose and mouth into the lungs, are partially blocked—either because of thickening and mucus, or because the airways are floppy and collapse, or both.
COPD Defined
COPD: Definitions of 21st Century1
• Preventable and treatable
• Airflow limitation that is not fully reversible
• Progressive disease• Abnormal
inflammatory response of the lungs
• Subsets of patients
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Presentation Notes
COPD is an umbrella term used to describe a group of patients that suffer from this largely tobacco-causing illness. It is further described and diagnosed with a spirometry test. Three circles represents a more realistic representation of patients suffering from COPD. Many patients have components of both Chronic bronchitis and emphysema as a result of environmental exposures. These are the two most common forms of COPD. Patients with asthma and exposure to ETS are more likely to develop symptoms of COPD. The box represents COPD. It is critical to remember that not all cases of emphysema and chronic bronchitis are COPD. And, most cases of asthma are not COPD. Only those where spirometry is always abnormal, even on a good day is COPD. COPD is: Read Slide
COPD and Breathing
How Does COPD Affect Lungs?
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Presentation Notes
Healthy airways and air sacs in the lungs are elastic—they try to bounce back to their original shape after being stretched or filled with air, the way a new rubber band or balloon does. This elastic quality helps retain the normal structure of the lung and helps move air quickly in and out. In people with COPD, the air sacs no longer bounce back to their original shape. They become floppy and not as elastic. Picture a bag made of cellophane compared with a rubber balloon. The “cellophane” airways—those without support, collapse, blocking the air flow out of the lungs. The harder the person tries to breathe out, the more the airways collapse. The airways can also become swollen or thicker than normal, and lined with mucus.
About COPD
What are the symptoms?• Coughing - “smoker’s cough”• Shortness of breath• Excess sputum or phlegm• Feeling like you can’t breathe• Can’t take deep breath• Wheezing• Not everyone who has COPD has a chronic cough.
Not everyone with a cough has COPD or will develop it in the future.
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Presentation Notes
So as we saw in the diagram, this blockage, or obstruction, caused by COPD can make breathing difficult. So what are the symptoms? Symptoms of COPD include (read list from slide). Coughing—“smoker’s cough” Shortness of breath while doing activities you used to be able to do Excess sputum or phlegm Feeling like you can’t breathe Can’t take a deep breath Wheezing For the millions of Americans with untreated COPD, shortness of breath and other symptoms can get in the way of even the most basic day-to-day tasks—from doing housework, to taking a walk, or even bathing and getting dressed. It’s important to remember that COPD develops slowly, so if you recognize any of these symptoms, no matter how mild you think they are, talk with your doctor as soon as possible.
COPD and Airways
How Does COPD Affect Airways?
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How Does COPD Affect Breathing? (slide) Now we see a cartoon illustration of the delicate lung tissue called alveoli. You can also see a small segment of airways leading into the alveoli. These segments of the lung are microscopic in size. Point to these: The left is normal tissue, bronchitis is in the middle, and emphysema is on the right. When the lungs become injured by tobacco smoke or other irritants, the entire lung is subject to injury. Many patients will ask me, “What is the difference between chronic bronchitis and emphysema?” The really simple answer is . . . location. Chronic Bronchitis affects the airways (breathing tubes) and emphysema affects the alveoli. In normal airways, you can see good expansion and contraction of the alveoli. The airways are large and clear (point to airways). They are not congested with mucous. The picture shows two alveoli (point to alveoli and outline the acinus). Inside these alveoli is a very thin membrane called the acinus. The acinus is rich in capillary blood flow. This is where all the work is done. We call it gas exchange. Oxygen enters the blood vessels and carbon dioxide, the waste product of our cells, passively enters into the alveoli from the capillaries to be exhaled. The acinus allows an alveolus to have multiple units of gas exchange. In this picture, we observe 14 functional units within two alveoli. Now, let’s talk about Chronic Bronchitis. The airways swell and become congested with mucous. In advanced stages of COPD lung tissue loses elastic qualities and become stiffer. There is less expansion and contraction in the picture (point to airways comparing the stiffness to normal). Chronic Bronchitis does not impact the alveoli, so gas exchange is normal (point to alveoli). Breathing medicines like bronchodilators and inhaled steroids work only on the airways. They do not work for injury inside the alveoli. Now let’s talk about Emphysema. The airways are free of mucous and swelling (point to airways). Inside the alveoli acinus are destroyed (point to it) and alveoli stiffen because damage has occurred to the elastic tissue of the lung. Now, instead of having 14 functional units of gas exchange there are only two. This leads to an inefficient respiratory system. What is the drug of choice for people with emphysema? Oxygen. As emphysema advances some people may be required to wear oxygen. Bronchodilators do not work in the alveoli. Some of you may wondering, “Do all patients with emphysema need oxygen?” The answer is no. Some people use oxygen and others do not. Only a doctor can determine who qualifies to benefit from oxygen therapy. It is important to remember that most people have features of both diseases, Chronic Bronchitis and Emphysema. That is why we prefer to use the term Chronic Obstructive Pulmonary Disease, COPD.
COPD Risk Factors
What are the risk factors?• Smoking
• Most common cause, however, as many of 1 out of 4 people with COPD never smoked
As we mentioned earlier in the presentation, many people who are at risk for getting COPD have never even heard of it. That’s why it is so important to be aware of some of the things that put you at risk for COPD. These risk factors include: Smoking—COPD most often occurs in people over age 40 with a history of smoking. That being said, it is also important to note that as many as one out of six people with COPD never smoked. Environmental Exposure—COPD also occurs in people who have had long-term or heavy exposure to things that can irritate your lungs like chemicals, dusts, and fumes. In some people, COPD is caused by a genetic condition known as alpha-1 antitrypsin, or AAT, deficiency. People with AAT deficiency can get COPD even if they have never smoked or had long-term exposure to harmful pollutants. So you’re thinking maybe you may fall into one of these risk categories or you recognize one or more of the symptoms we discussed. What do you do?
How Your Lung Function Changes as You Age
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Lung function measured in FEV1 has a gradual rate of decline as we age. Average smokers do not develop COPD as determined by FEV1 values. However, they generally have lower FEV1 values than non-smokers of the same age. “Susceptible Smokers” develop a decline in FEV1 at a very early age. Even at age 35 to 45 years old, a decline trend is observed. This group is just beginning to develop symptoms of COPD that become overlooked because they are mild, like chronic cough or mild dyspnea with heavy work or exercise. This age group will receive the most benefit from smoking cessation and MAY avoid development of COPD if caught early enough. Dips in the “Susceptible Smoker” group represents severe decline in FEV1 from a small population of people that deviate from the normal because of multiple hits including: heavy tobacco use, other environmental exposures, co-morbidities, or Apha-1 Antitrypsin Deficiency. These groups have severe disease at early stages in life. Disability usually appears with FEV1 values around 1.8 liters (50% pred), average age of 55. Death occurs with FEV1 values approaching 0.5 liters (15% pred), average age of 70. Evidence also reveals that people with sub-optimal care are represented by the dips below the baseline. Poor care often leads to multiple exacerbations and a rapid decline in lung function progression in the last couple years of one’s life. This is indicated by the RED line. What this graph does not show is the quality of life one suffers from while living in the disability zone.
Criteria for Testing
Testing• Current smoker over 40 years old with
symptoms• Anyone with:
• Chronic cough• Excess sputum production• Shortness of breath with mild exertion• Wheezing
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Presentation Notes
If you know anyone that fits this criteria you should recommend that they ask their doctor about this simple breathing test. Read the slide bullets.
COPD Screening Tool
Population Screener
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Presentation Notes
This screener will ask 5 basic questions about you and your lungs. Everyone here today should complete this simple questionnaire. Complete the questions, then place the scores of each question in the spaces below. Finally, add them all up for a total score. Those who scored less than 5 are at low risk for COPD. Those who score 5 or more are at greater risk for COPD. Please share the results of this screener with your doctor and ask for a simple breathing test called spirometry.
COPD Breathing Test
Getting a simple breathing test• Talk with your doctor!• Simple breathing test
known as spirometry (spi-ROM-uh-tree)
• Quick and noninvasive• Can help doctors to
determine if you have COPD and how severe it is
Presenter
Presentation Notes
First and foremost, talk with your doctor about getting a simple breathing test, or lung function test—called spirometry. Spirometry can detect COPD before symptoms become severe. It is a simple test that measures the amount of air you can blow out of the lungs and how fast you can blow it out. It’s fast, noninvasive, and doesn’t require any special preparation. Based on this test, your doctor can tell if you have COPD, and if so, how severe it is. So, let’s say you’ve had the spirometry test and you’ve been diagnosed with COPD. Now, what do you do? Again, first and foremost, talk with your doctor. There are many things that you and your doctor can do together to slow the progress of the disease, manage symptoms, and improve your quality of life.
Care for COPD
Optimal Care Includes1. Lifestyle changes - smoking cessation2. Pulmonary rehabilitation
• Exercise and nutrition• Recognize early signs of infection• Breathing techniques• Coping skills• End-of-Life care
3. Annual check-up and spirometry if indicated 4. Testing for Alpha-1 Antitrypsin Deficiency 5. Medication adherence
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Presentation Notes
Optimal Care is the process of managing several aspects of COPD. Just taking medicine is not the only thing you can do to maintain your baseline lung function as seen in the graph on the previous slide. When a person with COPD is sub-optimized, their lung function is often below baseline. In order to live a healthy life people should implement all components of optimal care to include: Read slide. Summarize by announcing that: Most of these components of Optimal Care are taught by a pulmonary Rehabilitation Program.
Breathing Techniques
Breathing Techniques
• Breathing problems become recurring• De-conditioning occurs
• Teach two breathing techniques1. Pursed-Lip Breathing2. Diaphramatic Breathing
• Teach patient to:1. Stop – activity 2. Reset – sit and purse-lip breathe until you catch your breath3. Continue – activity
Breathing Techniques ─ Pursed-Lip
Pursed-Lip Breathing1. Inhale through the nose2. Pucker your lips like
blowing out candles on a birthday cake
3. Slowly exhale• Exhalation should be twice
as long as inspiration
4. Repeat
Breathing Techniques ─ Diaphragmatic
Diaphragmatic Breathing
1. Place one hand on chest and other on belly.
2. Inhale through nose• Concentrate on belly moving outward
• Hand on chest should remain still
3. Slowly exhale
4. Repeat
Combine with pursed-lip breathing
Relax, close eyes
Summary
Summary for today• Learn optimal care• Stay involved with lifelong care• Attend Pulmonary Rehabilitation• Follow your progression – What stage?
• See your doctor annually – ask if spirometry is indicated.
• Know your FEV1
• End result is hope for decreased hospitalizations & improved Quality of Life
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Presentation Notes
As you can see, the key to self-managing COPD is more than just taking medicine. It involves a good COPD Action Plan to Optimize Care. Those with Optimal Care will be rewarded with the best quality of Life. In order to know what is recommended for Optimal Care, it starts with learning your FEV1 value and the Stage of COPD that you have. We recommend that patients ask for an annual spirometry test on a good day. And, know your FEV1 ! You will be glad you did. Next slide . . . is Thank You
COPD Information Line
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Presentation Notes
Call Our Patients Direct (C.O.P.D.) Information Line The C.O.P.D. Information Line is a toll-free number, 1-866-316-COPD (2673) provided by the Foundation to any member of the public, Monday through Friday from 9AM to 9PM. The Info Line fills an unmet, yet critical niche in the life of an individual with COPD. It is staffed by trained Associates who provide empathy and support to callers, including the access to resources (both online, print, and in their community) that the caller may have been unaware of or without access. (No medical advice is provided.) Presently, the COPDF sends an average of 400-500 fulfillment packages to callers per month, free of charge. The fulfillment packages are designed to address the complete needs of an individual with COPD. Packages include information on (but is not limited to): The 1s, 2s, and 3s of COPD in both English and Spanish, COPD Research Registry brochure and enrollment form, Alpha-1 Antitrypsin Deficiency information and how to get tested, COPDF program information, support groups, and patient organizations. As an expansion of the Information Line, we offer caregiver-to-caregiver support for those individuals who take care of COPDers. In addition, the COPDF has implemented the continuing caregiver program where the Caregiver Associate will follow up regularly with the caregiver caller to offer support. The COPDF advertises the Info Line and its accessibility to resources through all of its activities and partnerships. The Info Line is in its third year of operation. New partnerships, including the project with WebMD increased visibility for COPD and the Info Line.
