Treating COPD Symptoms [Dr. Jill Kruse]
I'm Dr. Jill Kruse. I am one of the hospitalists here at Brookings Health System and I work by taking care of inpatients when they're admitted to the hospital here.
What is COPD?
Chronic Obstructive Pulmonary Disorder. And that is kind of one of two conditions where it's either what we call chronic bronchitis, where the passageways of the lungs become inflamed, have lots of mucus, make it harder for people to breathe, or emphysema where the alveoli, which are the air sacs where the actual oxygen exchange occurs, had been damaged or inflamed.
So these two conditions both affecting the lungs, one the passageway and one the end area, affect how someone breathes, and they have a hard time getting oxygen out. So they become very short of breath with activity, they become short of breath with talking, standing, walking. Activities of daily living can be difficult for someone who has COPD. They have lots of coughing, lots of phlegm, lots of mucus.
What causes COPD?
Well, what can cause it is basically irritants to anything in the lung passage. So inhaled toxins, lots of particulates, dust. The most common cause is smoking. So there also is a sub-type that is caused by a genetic mutation called alpha-1 antitrypsin deficiency. And when that happens, that's usually someone who gets COPD younger. Most people that develop it, develop it in their 40s or older. So it's something that comes after years of repeated insults to the lung environment.
What are signs of COPD?
Increased fatigue, weakness, shortness of breath, chronic coughing, chronic mucus, and phlegm production that just doesn't go away.
What complications can arise from COPD?
It can relate to actually causing heart problems. So you're at a higher risk for having heart attacks, high blood pressure, and other heart problems as well as lung problems. So obviously, if you're not able to breathe well, you become short of breath, you're coughing, you have a harder time with activity. But also, we do know that the heart and lungs are intimately related and so anything that affects the lungs can affect the heart.
How can someone prevent COPD?
Well, I would say avoid environments where you're going to be inhaling lots of things. So if you're inhaling like grain dust or particles, or if you're in a dusty environment, shop teachers, you know, having good ways to mitigate all those particulates, dust. Wear a mask. And if you smoke, stop. That's easier said than done, but the most important thing is to stop smoking.
How is COPD diagnosed?
There are several ways that we can diagnose it. We are suspicious when someone comes in and tells me, "God I've this hacking cough and it's been like six months and it hasn't gotten better. And I'm short of breath." So that will start the process of looking into it. We'll often get a chest X-ray, we can see this on a CT scan. There's also something called pulmonary function testing that we can do where we see how big of a breath your lungs are able to take and how quickly you can get that air out. And that can tell us if it's looking something more like asthma, where you have a hard time getting the air in, or emphysema or chronic bronchitis with the COPD where you have a hard time getting the air out.
When should someone see a doctor about COPD?
A concern is a good enough reason for me for anyone to see their doctor. If you are concerned, let's get the peace of mind and find out what's going on. But definitely, if you're becoming more short of breath, if you're having more fatigue, if you're not able to complete your regular active activities of daily living and it's affecting your life, definitely get it checked out.
When is COPD and emergency?
If you feel like you can't get a breath in, if you are concerned, if your fingertips are turning blue, your lips are turning blue, you just feel like you can't catch your breath, that's all signs that you're not getting enough oxygen to your body and that's very dangerous. So we need to get you into the hospital to get that checked out immediately.
When is someone with COPD hospitalized?
So usually when they have what's called a COPD exacerbation, so again, their oxygen levels drop below where they normally are, they have a hard time breathing. And now we run the risk of there becoming an infection because all that mucus is a great place for bacteria and viruses to live and replicate and get stronger. So if that happens, and you end up with an infection, that can lead to pneumonia, it can lead to other sorts of lung infections and conditions. So we need to treat that, bring down the inflammation in the lungs, get the mucus under control, get the infection under control, give supplemental oxygen if needed to keep your oxygen levels high where they're supposed to be. And then once we get you back to your baseline, you're breathing easily, the infection is under control, then we can send you home.
How do you treat COPD?
Some people do need supplemental oxygen so they're on oxygen at home. Sometimes it's just at rest, sometimes it is at night, sometimes it's with activity, sometimes it's all the time that they need it. So it's really individualized to the person who is dealing with this condition. The other thing we do is we use a lot of inhalers or medications that go directly into the lungs either with like a metered dose inhaler, where you kind of push the little puffer, or a nebulizer machine, and we use what are called bronchodilators. So medications that make the lung passageways open and wider so it's easier for the air to get in and out. Also, we will use steroids that also bring down that inflammation so there's less mucus production in the first place.
What goals do COPD patients need to reach before leaving the hospital?
Our goal for someone to be discharged is when they're back to their baseline. So their oxygen levels are back to where they were before they needed to be in the hospital, we have the infection under control, and they are feeling better.
How do you treat COPD at the end of life?
Quality of life with someone with COPD is always our goal. With end of care life, that is no different. Our goal is to make sure that they have the best days possible with the days remaining. So we're looking at symptom control, we're looking at palliation, we're looking at comfort. So sometimes that means additional oxygen through either a face mask, or a non-invasive device such as a CPAP or BiPAP. And sometimes it means a fan, sometimes it means medications to help control some of those secretions. But the goal is always making them pain free, and able to spend quality time that they have left with their family.
Why is it important to diagnose COPD early?
Well, this is a chronic condition, which means there's no cure. So the earlier we catch it, the earlier we start treating it, the less damage we have to deal with and the better the outcomes.
Why should patients choose Brookings Health System?
Well, we have got such a collaborative environment where you've got your doctors talking to your nurses talking to your respiratory therapists, we have respiratory therapy here. And that is a big part of dealing with COPD, learning how to conserve energy, how to breathe properly. You know, working with your doctors here, I know your family doctor, I know your primary care doctor, I probably have their cell phone number, their personal cell phone number, on my phone, where I can call them if I have any questions or concerns. It's family. We're all taking care of family here.