How to Identify and Treat the Fourth Leading Cause of Death in the U.S. — COPD

To understand COPD, it helps to visualize a cluster of tightly inflated birthday balloons — balloons that never deflate. They stay taut with stale air trapped inside.

That’s what the lungs can feel like for the person who suffers from chronic obstructive pulmonary disease, or COPD. The lungs, so tightly restricted, agonize to push old air back out and fresh oxygen in. In early stages, COPD is hardly noticeable. Left undiagnosed and untreated, COPD can be a painful and frightening condition that can cripple a person’s physical and emotional health — from fatigue and immobility to depression from missing out on work, friends and family adventures. In today’s blog, we’re going to show you how to recognize and treat COPD.

COPD on the Rise

There are many reasons for the increased cases, from smoking to pollutants. Sixteen million Americans have been diagnosed with COPD, but many more don’t realize they have it until their first emergency room visit. According to the American Lung Association, in 2018, 156,045 people died from COPD, making it the fourth overall leading cause of death behind heart disease, cancer, and accidents and unintentional injuries in the United States. Among diseases only, COPD is the third leading cause of death in the US.

Marquis’ Breath Deep Program

At Marquis, our mission is helping our patients and residents with COPD get better, go home and “live their best lives.”  We’ve watched the alarming rise of COPD, how COVID-19 is affecting COPD and how studies show doctors need and want more education about COPD. We believe it’s important for all of us to understand COPD, watch for the symptoms and treat the disease before it becomes an emergency.  So, in just a minute we’re going to be talking with Vicki Nordby, RN, BSN, and a 13 year nurse consultant with Marquis  Companies. She’s part of the interdisciplinary team of Marquis pharmacists, nurses, dietitians and therapists who developed the Breath Deep Program for reducing rehospitalizations due to COPD. How’s the program working?

Reducing Rehospitalizations

We’re pleased to say that, according to the American Health Care Association’s most recent data, we are among the top three multi-facility corporations for quality. And a big part of that is reducing rehospitalizations due to COPD. For instance, the most recent data (fiscal year 10/1/2019-9/30/2020) shows the national rehospitalization rate at 22.6%; Marquis’ rate is 12.16%. And studies show that self-management lowers the probability of hospitalization and improves quality of life!

First a Few Surprising Facts About COPD

  • COPD is not just an older person’s disease. Most people are at least 40 years old, but COPD can strike younger people too.
  • COPD patients have a 6-8% greater risk of developing COVID-19 and someone with COPD who gets COVID-19 has a higher risk of severe symptoms and death (source studies outlined in Pharmacy Times).
  • COPD patients have a greater risk of contracting pneumonia and shingles (source: COPD Foundation).
  • COPD affects more women than men. Of the yearly, approximately 1.5 million emergency room trips due to COPD, 1 million are women (source: COPD Foundation).
  • COPD cases vary wildly state to state. For instance, in 2018, COPD rates ranged from 4% in Hawaii to 15.3% in West Virginia (source: CDC).
  • Physicians need and want more guidance on how to help identify and treat their patients with COPD (source: COPD Foundation).

Read that last bullet point again. If doctors say they need more information about COPD, then all of us should be aware of how to recognize and treat this disease too. That’s where Vicki is going to help us with a plan.

Q: Vicki, thanks for joining us. Is COPD a new disease?

A: No, we believe what we now know as COPD has been around for centuries. For instance, in the late 1600’s a doctor in Switzerland reported having patients with “voluminous lungs.” In the 1700’s there are reports of patients with “turgid” lungs.

Q: What causes COPD and who is at risk?

A: The normal causes are long term exposure to environmental related pollutants at home or work––secondhand smoke, pollen, dust, gases, fumes and other toxins. I want to point out that while many COPD patients are or were smokers, 1 in four are not. Other risk factors include being older than 40, having heart failure or a genetic predisposition to the disease.

Q: What symptoms should we watch for?

A: Breathlessness is not necessarily part of the aging process. So, watch out for that, fatigue, wheezing or a chronic cough. Those are all responses as your body struggles to move pollutants up and out of your lungs. COPD traps them and that can lead to infection, pneumonia, sepsis and death. There’s an emotional component too. When we are short of breath, we also lose functional ability to engage in our normal activities. Even walking to the store or talking can be a struggle. We become anxious and even more fatigued.

Q: Is there one thing you can advise as a first step if we’re reading this and thinking we have COPD?

A: Continue reading all the information in this blog and if you’re concerned, talk with your health care provider about being tested for COPD using spirometry (a breathing test). Early detection and treatment are key. Immediately avoid smoke and other pollutants.

Q: Let’s get to the Breath Deep Program. Who makes the best participant for this program?

A: I’m glad you asked that. This is for patients who can understand COPD and are able to learn how to treat it on their own or with the assistance of a care giver.   Right now is a good time to go over 7 tips that are part of the Breath Deep Program. Here we go!

#1 Take your Daily Medications

Don’t be afraid to keep asking your doctor or pharmacist  how to precisely take your medications, including those metered dose inhalers, which can be expensive and very easy to use the wrong way. Ask yourself if you understand what these medications do, what time to take them, how they interact with other meds and do you need a tracking system like the med boxes?

#2 Keep Exercising

The worst thing you can do is sit in a recliner and “rest.” That just settles the mucus in the lobes of your lungs, creating a terrific medium for bacteria to grow. Get up and move! Movement helps your lung capacity. For our in-house residents, our therapists always provide great, tailor-made exercise programs to do at home. We know that COPD patients get fatigued. So, we encourage them to have a plan for managing shortness of breath like knowing where to safely stop on a walk and rest. Get up and exercise those lungs! You can get some tips on balance and exercise in our previous Marquis blogs.

#3 Eat a Heart Healthy or Prescribed Diet

Many COPD patients have comorbidity conditions (obesity, heart disease) that require a special diet including lowering your salt intake. We want to make sure people get their questions answered by a dietician who can create a plan based around food budgets.

#4 Avoid Smoke

Not just from smoking or secondhand smoke, but external irritants like dust, pollens and fires season smoke. When pollens and smoke are heavy outside, stay indoors with filtered air.

#5 Wash Your hands

It’s a full 20 seconds with soap or an alcohol based hand sanitizer. An easy way to remember how long is to sing the happy birthday song twice.

#6 Get Your vaccinations

Stay up to date on your vaccinations. Colds and flus, and certainly COVID, affect our lung capacity and are some of the reasons for rehospitalizations. Stay away from anyone who is sick.

#7  Know your COPD “Zone”

If you have COPD, it’s super important to twice daily stop and access what zone you’re in. We’ve identified them in colors in a personal COPD Action Plan.

  • Green Zone
    Here’s where you want to stay. This is the goal. In the green zone, symptoms are under control. You’re sleeping well. You aren’t experiencing shortness of breath or coughing.
  • Yellow Zone
    This is the beginning of the warning period. Symptoms include increased coughing, shortness of breath, swelling of the ankles, less energy, cold symptoms, feeling the need to use your rescue inhaler (separate from the regular inhaler) to quickly open the lungs. If you’re in the yellow zone, call your doctor immediately and provide an update on your condition. Your doctor may order some lab work, chest x rays or change your inhaler and prescribe antibiotics.
  • Red zone
    Symptoms in the red zone include significant shortness of breath, inability to perform basic activities, the rescue inhaler no longer helps, there’s chest pain, fever and even coughing up blood. This may signal a secondary infection from the mucus sitting in the lungs. This is life threatening. Call 911. Go to the emergency room.

Following tips 1-6 will increase your likelihood you live safely in the green zone and you get back to “living your best life!”