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Division of Medicine Chronic Obstructive Pulmonary Disease A Patient Information Booklet Acknowledgements for information in this booklet go to: The Australian Lung Foundation, State of Queensland. COPD-X Plan – Australian and New Zealand Guidelines for the management of COPD. David K McKenzie, Michael Abramson, Alan J Crockett, Nicholas Glasgow, Sue Jenkins, Christine McDonald, Richard Wood-Baker, Peter A Frith on behalf of The Australian Lung Foundation. The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease, 2010. Accessibility The ACT Government is committed to making its information, services, events and venues, accessible to as many people as possible. • If you have difficulty reading a standard printed document and would like to receive this publication in an alternative format—such as large print or audio—please telephone 13 2281 or email [email protected]. • If English is not your first language and you require the translating and interpreting service—please telephone 131 450. • If you are deaf or hearing impaired and require the TTY typewriter service—please telephone (02) 13 3677, then ask for 13 2281. • Speak and listen users—phone 1300 555 727 then ask for 13 2281. • Internet Relay Users—connect to the NRS, then ask for 13 2281. © Australian Capital Territory, Canberra, October 2011 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from the Territory Records Office, Community and Infrastructure Services, Territory and Municipal Services, ACT Government, GPO Box 158, Canberra City ACT 2601. Enquiries about this publication should be directed to ACT Government Health Directorate, Communications and Marketing Unit, GPO Box 825 Canberra City ACT 2601 or email: [email protected] www.health.act.gov.au | www.act.gov.au | Enquiries: Canberra 13ACT1 or 132281 | Publication No 11/1282 Contents How the lungs work 2 Understanding COPD medications and devices 4 Smoking and COPD 7 Working together with your healthcare team 8 Protecting against chest infections 9 Exercise/Pulmonary Rehab 10 Nutrition 11 Home oxygen 12 You are not alone! 13 A Patient Information Booklet 1 How the lungs work How the lungs work Each time you breathe in, air rushes in through your nose and mouth, and travels down your windpipe. The windpipe divides into two smaller tubes (bronchi) that lead to the right and the left lung. Within each lung these tubes divide and become smaller and smaller – and lead to tiny air sacs (alveoli). It is in these sacs where an exchange between oxygen and carbon dioxide takes place. The oxygen you get from breathing in moves from the air sacs into the bloodstream; and the carbon dioxide moves back into the air sacs from the bloodstream ready to be exhaled. Throat (pharynx) Windpipe (trachea) Lung Voice (larynx) Bronchi and Bronchioles (Picture courtesy of “Better living with COPD – a patient guide” Australian Lung Foundation 2008) Air sacs at the base of the small airways where gas exchange takes place. (Picture courtesy of “Better living with COPD – a patient guide” Australian Lung Foundation 2008). 2 Chronic Obstructive Pulmonary Disease COPD stands for Chronic Obstructive Pulmonary Disease. It is a chronic condition of the lungs where the small airways are damaged. Damage to the airways means they become narrower, making it harder for air to get in and out of the lung. Conditions of COPD include chronic bronchitis and emphysema. All these conditions cause chronic obstruction of airflow through the airways. Symptoms of COPD include: • Shortness of breath during activities • Coughing • Increased mucous production (coughing up phlegm). COPD usually occurs in people who have smoked or continue to smoke cigarettes. Exposure to irritants like dust and fumes can also increase the risk of developing COPD. A very small proportion of COPD cases are caused by an inherited problem. The most accurate way to diagnose COPD is by performing a lung function test called spirometry. This can be done by your GP or respiratory specialist. COPD is a chronic condition. Although there is no cure, there are many steps you can take now to reduce the impact of symptoms and increase your quality of life. Learning as much as you can about what you can do to manage COPD will help you feel more in control of your health and your life. A Patient Information Booklet 3 How the lungs work What is COPD? Understanding COPD medications and devices Understanding COPD medications and devices Managing your medications is very important. It is essential that you take your medications as instructed by your doctor, even when you feel well. When you take medication as prescribed, you may be able to better manage your COPD. Although medications cannot cure COPD, when used as instructed they can go a long way towards reducing your symptoms and preventing flare-ups. Learn how your medications work. This will help you understand why you need to take them. If you are worried or confused about your medications and how to take them, talk to your doctor, pharmacist, and nurse. Do not be afraid to ask questions. Here is a checklist of what you should know about each of your medications: What is the medication for? How does the medication work? When is the best time to take the medication? How long is the dose effective for? What are the possible side effects of the medication and how can you avoid or reduce them? Will the medication cause any problems with other medications you are taking? 4 Chronic Obstructive Pulmonary Disease Relievers Relievers should be used when you experience a sudden increase in your breathlessness. These work by relaxing muscles that may have tightened around the airways, making the tubes wider. This allows the air to move in and out more easily. They work within minutes and their effects last for a few hours. Always make sure you carry a reliever inhaler with you, just in case. Examples include Ventolin, Bricanyl, Airomir and Asmol. Maintenance medication Like relievers, these medications also open up the airway tubes. Maintenance medications usually take a longer time than relievers to start working, but their effects last longer. Examples include Spiriva and Onbrez (effects last 24 hours) and also Atrovent (effects last 4 hours). Preventer medication Preventer inhalers can contain steroids. They help to reduce the number of flare-ups you may experience. Preventers work by reducing the inflammation on the inside of the airway which causes swelling and mucous production in your airways. Just like maintenance medications, preventers must be taken every day to be effective. Examples include Pulmicort, Flixotide, Alvesco and QVAR. Combination medications Some inhalers contain both a maintenance bronchodilator and a preventer (steroid) so that you receive both medications together when you use the inhaler. Examples of this include Seretide and Symbicort. “It is very important that you rinse your mouth out with water after using inhaled steroids, to prevent the common side effects of hoarse voice, irritated throat and oral thrush.” Antibiotics They help the body fight bacterial infections. People with chronic lung disease are more likely to develop bacterial infections in their chest. In the majority of cases, antibiotics are needed to fight the infection. It is important that you take the full course as prescribed, and if you do not feel better by the completion of the course you need to contact your GP. A Patient Information Booklet 5 Understanding COPD medications and devices Types of medication: Understanding COPD medications and devices Using your inhaler There are different types of inhalers and it is important that you learn how to use them correctly. If you do not use the inhaler properly than you will not get the full benefit from your medication. Make sure you read the instructions that come with your inhaler before you use it. Ask someone to watch you while you use your inhaler to check your technique. People who can check your technique include: • • • • Your GP/ Specialist A nurse Your pharmacist someone from your pulmonary rehabilitation team such as your physiotherapist. Spacers should be used with all puffers. Spacers deliver more medication effectively to your lungs rather than into your mouth. Spacers should be cleaned monthly, washed with warm soapy water and left to air dry- do not rinse the soap out or dry with a cloth. (Picture courtesy of http://www.rch.org.au/emplibrary/kidsinfo/largespacer.jpg) 6 Chronic Obstructive Pulmonary Disease Stop smoking is the single most important thing you can do to help your chronic lung disease. It will improve your lung health and help slow down worsening of COPD. Do everything you can to give up smoking for good. Your health depends on it. Most people need help to quit smoking. Ask for help from your doctor, pharmacist or nurse. Nicotine replacement therapy and prescription anti-smoking medications may help you quit. The National Smoking Quit line can provide assistance, contact them by: Ph: 137848 | Website: www.quitnow.info.au The Cancer Council ACT offer smoking cessation information and courses. They can be contacted by: Ph: 02 6257 9999 | Email: [email protected] The Chronic Care Program at Canberra Hospital runs a Quit Now smoking cessation program, phone 02 6244 2273 to see if you are eligible. A Patient Information Booklet 7 Smoking and COPD Smoking and COPD Working together with your healthcare team Working together with your healthcare team Your healthcare team may consist of your doctor, nurse, pharmacist, physiotherapist, family members, friends and anyone else involved in looking after your health. Good communication with everyone in your team will help you to look after your health. Seeing your doctor and other healthcare providers regularly is essential to help you meet your treatment goals. You should go to your appointments even if you are feeling well, so together you can keep track of your health and progress. It is important that you understand what the doctor tells you. Don’t be embarrassed to ask them to explain the information again or ask questions. Doctors know that you have a lot to take in. You may want to take paper and pen with you to write things down in your appointment. It may be useful to write down any questions or concerns that you have before your visit. 8 Chronic Obstructive Pulmonary Disease To lower your chances of contracting a chest infection you should have a flu vaccination every year before winter; and a pneumonia vaccination once every 5 years. These are given free of charge if you have a chronic condition. It is also very important that you learn to monitor your lungs and be familiar with what is normal for you. You can then recognise the signs and symptoms of a chest infection and seek help straight away to treat the infection and avoid going to hospital. The following is a list of symptoms that may indicate that you are having a flare up and need to see your GP: • • • • • • • • more breathless than normal coughing more often less energy for usual activities loss of appetite change in amount of phlegm change in colour of phlegm: yellow, green, brown signs of fever need inhaler/nebuliser more than usual Develop an ‘Action Plan’ with your doctor which includes steps of what to do if you become unwell. Actions plans should be reviewed regularly by your doctor. Your doctor or nurse will be able to provide you with information and forms regarding Action Plans. A Patient Information Booklet 9 Protecting against chest infections Protecting against chest infections Exercise/Pulmonary Rehab Exercise/Pulmonary Rehab Exercise is among one of the simplest and most effective ways to improve your ability to live a full life with a chronic lung disease. Physical activity strengthens muscles, improves mood, increases energy levels, and improves the way the heart and lungs work. Pulmonary rehabilitation is one of the most effective and important treatments you can do for COPD. Pulmonary rehabilitation consists of low impact aerobic exercise e.g. walking, and strength training. Education sessions are also provided once a week covering a range of relevant topics including medications, nutrition, relaxation and breathing. The Canberra Hospital runs an 8 week pulmonary rehabilitation program. Ph: 02 6244 2154. Queanbeyan Hospital holds an 8 week pulmonary rehabilitation program. Ph: 02 6298 9306. The follow-on maintenance program from pulmonary rehab is “Lungs in Action”. This is held at the University of Canberra, Belconnen. Ph: 02 6201 2936. The YMCA of Canberra runs community fitness programs on both the Northside and Southside of Canberra. Ph: 02 6281 0124. Southern Cross health club run rehabilitation classes which are targeted for people who have completed pulmonary rehabilitation. Ph: 02 6283 7340. 10 Chronic Obstructive Pulmonary Disease It is important to stay well nourished to keep your breathing muscles strong and energy levels up. Healthy eating is another step you can take to help you take control of your health. Follow these basic rules: Eat a variety of foods so that the body gets all the essential nutrients it needs to function well. Eat regularly and eat breakfast. It is far better to have 5 smaller meals throughout the day rather than 3 huge meals—eating too much in one go can cause problems such as indigestion and difficulty breathing when the stomach becomes distended and the diaphragm is crowded. There are many people you can talk to if you need assistance with diet and nutrition—these include your doctor, nurse, and dietician. You can self refer to a dietician through Community Health Intake on 02 6207 9977. A Patient Information Booklet 11 Nutrition Nutrition Home Oxygen Home Oxygen Oxygen is prescribed for people with chronic lung disease who have a low blood oxygen level. It is up to your specialist to decide if you need oxygen. You will not be prescribed oxygen if you are still smoking. The ACT Domiciliary Scheme covers the cost of oxygen for people living in the ACT who meet the eligibility criteria. Image below: home oxygen tubing. 12 Chronic Obstructive Pulmonary Disease You are not alone! There are many people who have COPD, and it is great to get out and meet other people experiencing the same things. ‘Lung Life’ is the ACT regions support group; they meet once a month for an educational and fun filled meeting. Their aim is to provide a supportive and informative environment for people with a variety of lung conditions and their carers. They can be contacted on 02 6281 2988. Do a Self Management Course You can participate in a six week self management course titled ‘Living a Healthy Life with Long-Term Conditions’ which can assist you in managing your condition. The course is also open to carers and is taught by a health professional and a person who has a chronic illness. The course leaders teach strategies to assist with symptom management, action planning and problem solving. To register for a free course contact Community Health Intake on 02 6207 9977. A Patient Information Booklet 13 You are not alone! Join a support group Useful contacts ACT Equipment Loan Service Ph: 02 6207 0658 ACT Domiciliary Oxygen and Respiratory Support Scheme Ph: 02 6205 2622 Australian Lung Foundation Ph: 1800 654 301 Web: www.lungfoundation.com.au Canberra Hospital switchboard Ph: 02 6244 2222 Cancer Council ACT Ph: 02 6257 9999 Smoking Cessation Information Email: [email protected] Calvary Hospital switchboard Ph: 02 6201 6111 Carers ACT Ph: 02 6296 9900 Community Health Intake Ph: 02 6207 9977 Email: [email protected] COPD Clinical Nurse Consultant Chronic Care Program Ph: 02 6244 2273 Department of Respiratory and Sleep Medicine Canberra Hospital Ph: 026244 2066 Lung Life Support Group Ph: 02 6281 2988 Email: [email protected] National Quit line Ph: 13 78 48 Web www.quitnow.gov.au Pulmonary Rehabilitation Canberra Hospital Ph: 02 6244 2154 Pulmonary Rehabilitation Queanbeyan Hospital Ph: 02 6298 9306 Quit smoking service ACT Ph: 13 18 48 Web: www.actcancer.org Respiratory ward 6a Canberra Hospital Ph: 02 6244 2732 Self Help Organisations United Ph: 02 6290 1984 Together (SHOUT) ACT Web: www.shout.org.au Southern Cross Health Club Ph: 02 6283 7340 YMCA Canberra Ph: 02 6281 0124 Community fitness programs Email: [email protected] Web: www.canberra.ymca.org.au