Table of Contents
You and COPD: An Introduction.
The Respiratory System: What It Is, How It Works, and What Goes Wrong in COPD.
COPD: The Damage, the Symptoms, the Progression.
Seeking Help.
How Do I Know I Have COPD?.
Stop Smoking!.
Bronchodilators.
The Rest of the COPD Drugs.
Oxygen Therapy.
COPD and....
Conquering the Emotional and Psychological Consequences of COPD.
Physical Therapies for COPD.
Daily Living.
Work and Play.
COPD and Sex.
COPD and Successful Travel.
The Final Phase.
Thoughts on the Present and Future.
Appendix.
Glossary.
Index.
Read a Sample Chapter
The Chronic Bronchitis and Emphysema Handbook
By Francois Haas Sheila Sperber Haas John Wiley & Sons
ISBN: 0-471-23995-X
Chapter One
You and COPD: An Introduction What Is COPD?
COPD means Chronic Obstructive Pulmonary Disease. It is an umbrella name covering pulmonary emphysema and chronic bronchitis. These are both chronic lung diseases that damage the air passageways, interfering with the lungs' capacity to breathe enough air in and out. These two diseases typically occur together, although one or the other often predominates.
Other general terms for these two diseases, all of which point to their chronic nature and their interference with getting air in and out of the lungs, include: Chronic Obstructive Airway Disease (COAD); Chronic Obstructive Lung Disease (COLD); Chronic Airflow-or Airway-Obstruction (CAO); and Chronic Airflow Limitation (CAL).
How to Use This Guide
If you have picked up this book to read, you know or you suspect that you or someone close to you is suffering from emphysema or chronic bronchitis. Perhaps a doctor has told you. Or perhaps changes you've noticed-like breathlessness when walking up stairs, a heavy cough that won't go away, or a lot of mucus from your lungs that doesn't clear up-have aroused your suspicions. (If you haven't mentioned these to your doctor, take a look at the questionnaire at the end of this chapter. Your answers will indicate whether you should see your doctor.)
Before you read further, you should know what you can-and cannot-expect from this guidebook. You cannot substitute it for a doctor. But you can use it to help find the best possible medical treatment. The book gives you an accurate and complete COPD education to help you: learn how to find the right specialists to diagnose and treat you; understand your disease so you can recognize appropriate treatment; know the variety of medical and rehabilitation techniques that will control your symptoms, improve your health, and better the quality of your life.
Why is it necessary to know all this? Successful treatment of COPD combines a broad variety of specialized techniques from pulmonary and rehabilitation specialists. Common sense alone cannot tell you what's right for you. And it's very difficult to learn it all from your doctor. It's a fact of life today that few doctors have the time or staff to educate their patients-and patients' families-in any depth. And many have little practice in translating medical jargon into normal speech.
In addition, many doctors remain unaware of the profound benefits to be gained from lung rehabilitation programs. They mistakenly assume that anyone with a disease that's eventually going to get worse can't benefit very much from rehabilitation efforts. So patients often have to go to bat for themselves. This book gives you the tools and ammunition you'll need. It combines everything you need to know about controlling your disease and improving your life, in language you will understand.
Turning Your Life Around
Here are a few concrete examples of what COPD patients can gain from education and rehabilitation.
Rosa M. had suffered with a mix of emphysema and chronic bronchitis for years. Her family doctor prescribed medication and encouraged her to be increasingly inactive, convinced he was helping her. Whenever one of her frequent respiratory infections became life-threatening, he hospitalized her promptly and gave her the best care. Rosa gradually grew breathless more and more easily. By the time she entered the N.Y.U. Medical Centers' Pulmonary Rehabilitation program, she was a pulmonary cripple who could no longer do any of the things she loved: travel, visit museums or art galleries, attend concerts, take leisurely walks, give dinner parties. At home, she had become frustratingly dependent on her husband.
An evaluation determined that Rosa's pulmonary resources were seriously limited, but not enough to justify the crippled life she was leading. This crucial knowledge guided the rehabilitation program we designed for her.
After conditioning her muscles, learning how to breathe more effectively and how to use her energy economically, Rosa gradually resumed her favorite activities and her participation in life at home. Learning how to avoid major lung infections made hospital stays a rarity. Rosa and her husband-both no longer frightened and depressed-now live with renewed pleasure, vigor, and hope.
Harry D. entered the Pulmonary Rehabilitation program with very moderate COPD that had wrecked his life. He was a 55-year-old skilled furniture refinisher who loved his work and enjoyed the comfortable income it had provided. But the various chemicals his work required, and the dust raised by sanding, were so irritating to his lungs that-even with a protective mask-he could no longer work.
Harry sat around at home, afraid of everything that made him breathless-and angry at the world. His ego was crumbling. The emotional consequences of unemployment accompanied by the pressures of a dramatically lowered income were also destroying Harry's marriage. Harry's doctor suggested he enter the N.Y.U. Medical Centers' Pulmonary Rehabilitation program.
In addition to a program like Rosa's, Harry was also scheduled for vocational and psychological counseling, and both Harry and his wife joined a support group. Harry discovered he has excellent accounting skills, loves the work, and can do it at home if he prefers. He and his wife have achieved a positive adjustment-including satisfying sex-to the unavoidable changes COPD brings. Harry's zesty optimism has returned, his wife's basic emotional strength is flourishing, and their marriage is now responding resiliently to the challenges of his disease.
Leon L. was participating in an experimental pulmonary rehabilitation program in our laboratory. Our initial evaluation of his lungs indicated moderately severe COPD. Several months into the program he was offered a very desirable job in Kingston, Jamaica. Medically, Leon was fully capable of handling the work. Yet he was going to turn down the opportunity because he was, in his own words, "afraid to let go of my safety net." Fortunately, we finally convinced him that his fears were out of line. When he returned to New York City after three and one-half productive years in Kingston, our evaluation showed that his pulmonary status had remained stable.
(You can read Leon's story in much greater detail-and in his own words-at the end of Chapter 13: how his disease developed, how frightening and incapacitating it became, how he learned to take care of himself, and how that turned his life around.)
The Downward Spiral
These examples stand out from among the typical COPD stories because of their happy endings. Sadly, the breathlessness-technically called dyspnea-that becomes one of COPD's hallmark symptoms leads a great many patients to fear a wide range of jobs and satisfying, health-promoting leisure activities-exercise, outings, trips, etc.-that are still within their physical capacity.
When dyspnea first begins, it initiates a downward spiral (see Figure 1.1). Patients so fear becoming breathless that they withdraw from activities they can still pursue. Then they start to lose shape-partly from their disease, and partly from their reduced level of physical activity! They are "deconditioning" themselves.
What happens when your physical conditioning starts to slide? Formerly easy activities become difficult. They leave you winded. But COPD patients are convinced it is only their disease making these activities difficult. Because they are terrified of feeling breathless, they drop those activities from their shrinking repertory, become more deconditioned, experience breathlessness with even lighter physical demands, give them up too, and so on. They react to everything through a filter of fatigue and anxiety. They see their lung disease as an inescapable prison, not realizing that they have helped to build it and lock themselves in.
These needless limitations prematurely turn COPD from a serious disease into a crippling one, significantly diminishing quality of like for the patient and his family. But the harm appears to go beyond emotional impoverishment. The growing view is that these needless limitations may also speed up the actual physical progress of the disease.
Minimizing the Limitations
You should clearly understand that COPD ranges from mild, perhaps unnoticed, forms to severe, debilitating conditions. Whatever the stage of your COPD when it was first diagnosed, the essential goals are the same: (1) to gain a fundamental understanding of what has happened to your lungs, and (2) to determine what can be done to minimize the consequent problems.
These goals are reached via two paths taken simultaneously. One is appropriate medical treatment, which includes far more than pulmonary evaluation and medication. It must incorporate an extensive rehabilitation program involving social, psychological, and vocational counseling as well as physical measures. The other avenue is education. You must make every attempt to educate yourself about your disease. With proper medical intervention and education, the progression of the disease can be significantly slowed. Although existing damage cannot be undone, some of the negative effects may be reversible.
The information in this book is specifically intended to help educate COPD patients and their families. We hope that providing solid, comprehensive, understandable information and a realistic perspective about COPD will help our readers remove needless limitations from their lives. You can live calmly and confidently-and much more fully-with your condition.
Some COPD Facts
Emphysema and Chronic Bronchitis in a Nutshell
Our airways are structured like a many-branching, upside-down tree. The trunk (our trachea) receives air from our mouth and nose. It divides into the main branches entering the lungs' five lobes. With each successive branching, these airways become more numerous and narrower. Each branched pathway finally ends in a cluster of air sacs. This is where the oxygen in fresh air passes into our blood while carbon dioxide passes from our blood into our lungs (to be exhaled).
In emphysema, overstretched and torn air sacs cannot hold much fresh air and cannot fully release their stale, carbon dioxide-containing air for expiration. In chronic bronchitis, chronic airway inflammation leaves them permanently swollen, which narrows them. The airway irritant causing the inflammation also makes them produce great quantities of mucus-which blocks them. Both types of damage limit the amount of fresh air coming in, and stale air going out.
Doctors refer to these two related lung conditions with the same term because of outstanding similarities. They are both typically (although not always) caused by smoking. They usually appear together in the same person (although the degree of each will vary). Most of the symptoms-and their treatment-are similar. And with both diseases, decades usually intervene between the start of damage and the point at which it progresses far enough to be noticed.
The net effects of these obstructive lung diseases include a chronic cough, often with heavy mucus production. In addition, the breathing effort needed to pull air in and push it out through narrowed airways requires a great deal more energy. This is experienced as shortness of breath. Eventually, the lungs' ability to transfer oxygen into the bloodstream and remove carbon dioxide from the blood is damaged. Within this general picture, differences emerge that depend on which disease predominates. (See Chapter 3 for a more detailed look at these differences.)
How Long Have We Known About COPD?
Emphysema was the first of these two chronic lung diseases to be formally recognized. The earliest medical descriptions appeared in the late 1600s. One example is the eminent British physician of that era, Sir John Floyer, describing his examination of the lungs of a "broken-winded mare":
In the thorax, the Lungs appear'd very much swelled or puffed up, and appear'd much bigger in the Broken-winded mare than usual.... I blew up some Lobes of the Lungs and found the Air would not come out again, nor the Lungs subside by themselves; by which it was plain, that the Bladders of the Lungs had been extended or broken... that caused a continual Inflation of the whole Lungs... which causes a continual Dyspnoea [breathlessness], in which the external Air can't pass freely thro' the Trachea and its Branches in Inspiration and Expiration; and this difficulty occasions the great Labour and Nisus [physical effort] of the Respiratory Muscles.
But roughly 150 years passed before emphysema was fully described and defined. Laennec, the great French physician-and inventor of the stethoscope-achieved this in the 1820s. Anatomists of his day first pinpointed the lungs' damaged air sacs and the air that becomes trapped inside them as the typical physical evidence of emphysematous lungs. Laennec mistakenly thought that persistent cough and breathlessness recurring during the winter months-the primary symptoms of chronic bronchitis-were also due to emphysema's structural damage. Now we know that it is a separate, although related, lung disease. So although the symptoms of chronic bronchitis have been recognized as an irreversible lung disease since antiquity, an accurate understanding of the pathology underlying them is quite recent. No medical writings, however, indicate when Laennec's mistaken view was revised.
How Common Is COPD?
The frequency of chronic bronchitis and emphysema has risen so dramatically during the past 50 years that they now constitute a major health problem in industrialized countries-and the rate is still increasing. In the seventeen years from 1979 to 1996, the estimated number of Americans with chronic bronchitis and/or emphysema increased from 9.5 million to over 16 million (from roughly 4.0% to 6.0% of the country's population).
But these figures probably underestimate the actual total. It is suspected that a significant number of COPD patients do not report their condition in national health surveys.
Who Gets COPD?
Because COPD develops slowly-usually requiring 20 to 30 years of smoking before symptoms prompt a person to seek medical help-most patients are in their 60s or older. The typical COPD patient is, or has been, a long-term cigarette smoker.
Because smoking is far and away the single most important risk factor for COPD, the social pressures determining who smokes also influence who is most likely to develop COPD. One factor is sex.
Continues...
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