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Sufferings of COPD Patients and its
Solutions
Chronic Obstructive Pulmonary Disease (COPD) is a major upcoming public health
problem,one of the leading cause of death in elderly males. Now a days COPD is
coming forward in the line of accidents,cancer,acute coronary events,and
tuberculosis as a cause of death in our country. Recognition of COPD is often
missed or delayed in primary health care. Once recognized, COPD is often
undertreated or episodically treated, focusing on acute exacerbations without
establishing maintenance treatment to control ongoing disease.
From 40% to 50% of patients with COPD discharged from hospitals are readmitted
during the following year, and 17% of patients discharged from emergency
departments require hospitalization. Although reasons for hospital admission are
complex, acute exacerbation is the major cause of hospitalization in patients with
COPD.Despite optimal pharmacologic therapy, patients with COPD often have
symptoms severe enough to limit normal physical activities of daily living and
affect quality of life.Proactive diagnosis and evidence-based management can
alleviate the impact of COPD on patients' lives.
Nowadays public is aware that tobacco usage can cause lung cancer. Butmajority
are unaware of the nature of disease called COPD caused mainly by habit of
smoking.The fact that it is preventable and smoking cessation has been proven to
slow the rate of lung function decline is also not known to many.Men are just
merely relating their cough as a part of their smoking habit. That’s why most
COPD patients is presenting with complaints only in later stages of their disease.
For many, the first episode of exacerbation may be their first encounter with a
hospital or a doctor.This delay will increase their sufferings due to the disease.To
solve this there must be more awareness programs and screening strategies for
COPD in primary health care level.
Maintenance treatment with long-acting inhaled bronchodilators is appropriate
beginning in moderate COPD to maintain airway patency and reduce
exacerbations. The actual effectiveness achieved in practice with any COPD
therapies depends on patients' inhaler technique, adherence, and
persistence.Unacceptance to the inhaler usage add to the difficulty in managing
COPD,which is decreasing now a days. There is lack of continuous follow up and
treatment also, where most of the patients showing tendency to stop medication
after exacerbations and will present with another episode of exacerbation. Many
physicians also not taking enough time to recheck the adherence to medication
and inhaler techniques,may be due to busy OPD or patients not bringing their
inhalers in each visit.Due to the elderly age group the effective use of inhalers
even with spacer and repeated training cannot be ensured. So education about
proper inhaler techniques, and rechecking in every visit still holds importance.
There should me posters/fluxes demonstrating inhaler use techniques in every
OPDs.
Due to the systemic nature of the disease, COPD likely to increase the sufferings
to the patient in the form of Acute coronary events,
Diabetes,Hypertension,Osteoporosis,Cerebrovascular accidents etc. The
symptoms may get masked with the preexisting dyspnea and poor general
condition of the patient. Active screening for multisystem involvement should be
done.We can conduct specialized clinics for COPD patients apart from usual OPD
so that their problems can be more attended. This will help to reduce the
inpatient burden. Other complications of COPD either due to disease
pathophysiology or due to its chronic symptoms like, Cough
fractures,pneumothorax,Right heart failure, Hernias all can increase sufferings of
patient,also increases hospital visits.
Prevent exacerbation is one of the main goal in COPD management. Advice
about vaccinations to reduce infections must be given to all COPD patients.
Gastro Esophageal Reflux Disease, one of the non-infectious cause for
uncontrolled respiratory symptoms and exacerbations in COPD should be
addressed along with.There are overlap syndromes associated with COPD,like
Obstructive Sleep Apnea,Asthma etc. This can increase the morbidity and cause
frequent or prolonged hospital stay.This also should be identified and adequately
treated. More sleep labs may be needed in our present hospitals with adequately
trained technicians.
Nutrition is one of the least attended area in COPD management. There
are lot of preexisting religious/cultural believes in society about the types of food
which a patient with respiratory disease can take. They many reluctant to take
protein rich food. Treating doctors also may forget to look in to the dietetic
practice of the patient and give necessary advice. There should be a written diet
formula for each patient,like that of a diabetic patient which can be done with the
help of a dietitian.
In its final stages, COPD is a severely disabling condition that is characterized by
dyspnea, which causes substantial anxiety/depression. Anxiety/depression is
associated with an impaired quality of life and increased hospital admissions.
Untreated comorbid anxiety/depression can have devastating consequences for
both patients and their relatives. Non-pharmacological interventions, including
Cognitive-Behavioral Therapy, have been effective in managing anxiety and
depression. If needed patients must be referred to a psychiatrist in proper time
for pharmacological/non pharmacological management.
COPD, as in any chronic disease, day-to-day care responsibilities fall most heavily
on patients and their families. He may be the earning member and the particular
disease makes him not only unemployed but also dependent. Cost of the
medications may one reason for non-adherence to treatment. Even now, our
medical community is unaware of the use of oxygen as a medication. It is still
considered as a terminal line of management. So long term oxygen therapy is not
much popular in our society compared to western world. More talks and seminars
must be conducted on this topics. There must be more government programs for
making this LTOT, much more available for low economic class patient too.
Self-management education improves health-related quality of life and reduces
inpatient and emergency care usage. New research and evidence-based selfmanagement programs are now emerging in chronic obstructive pulmonary
disease. Patients with moderate-to-severe chronic obstructive pulmonary disease
who receive a self-management education with supervision and support of a case
manager, have better outcomes than patients receiving standard care. These
benefits are worth considering since self-management could also be cost saving.
Self-management should be an integral part of the long-term care of chronic
obstructive pulmonary disease patients.
Self-management is a formalized patient education program.It may include basic
information about COPD, breathing and coughing techniques, warm-up and
stretching exercises, muscle exercises, and cardiovascular exercises (stationary
bicycle, walking, or climbing stairs); preventing and controlling symptoms through
inhalation techniques; understanding and using a plan of action for acute
exacerbation; adopting a healthy lifestyle (smoking cessation, nutrition, sleep
habits, managing emotions); and long-term home oxygen therapy when
appropriate.Disease-specific self-management program and the ongoing
attention and communication by a trained health professional could significantly
reduce the number of hospital admissions for patients with advanced
COPD.Rather than telling the patient to learn to live with their disease, they
should be taught to self-manage. This also should be taken as physician’s
responsibility and must be done diligently.
Dr. Anjana A R
Government Medical College
Thrissur.