Lifestyle Changes to Manage Advanced COPD

Introduction:

Progressive chronic obstructive pulmonary disorder (COPD) is a severe lung disease, and the patient does not respond well to treatment. Studies show that this develops in patients above 40 years. Specific modifications in the lifestyle during the end stage of COPD can help improve the symptoms and carry out daily activities.

What Is Advanced COPD?

Chronic obstructive pulmonary disease is a severe condition that causes breathing difficulty by obstructing the airflow. COPD is classified into different stages based on a lung function test (forced expiratory volume [FEV1] and forced vital capacity [FVC]) that measures the amount of air let out during forced breathing in percentage. The stages of COPD are mild, moderate, severe, and end-stage. The end-stage or advanced COPD severely affects the airflow and causes other systemic complications.

What Causes COPD?

The various factors that irritate or damage the air sacs and lining of the lungs are:

• Chronic Smoking: smoking cigars, pipes, hookah, etc., for a long time, are the main causative factor of COPD.

• Irritants: Long-term exposure to chemical fumes, dust, or polluted air can predispose COPD.

• A genetic disorder like alpha-1 antitrypsin deficiency is found to cause COPD in a few patients.

• Certain infections like acquired immunodeficiency syndrome (AIDS).

What Are the Symptoms of Advanced COPD?

• Severe shortness of breath or dyspnea.

• Whistling sound during breathing.

• Chronic cough.

• Improper sleep.

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• Increased heartbeat.

• Constipation.

• Improper eating habits and weight loss.

• Anxiety and depression.

• Fatigue and loss of ability to move around.

What Are the Complications of Advanced COPD?

The various risk factors of severe COPD are associated with factors like smoking, increased age, and other systemic disorders are:

• An increase in the level of blood pressure in the arteries of the lung and heart.

• Heart disorders.

• Weakening of the muscles involved in respiration leads to its dysfunction.

• Weak and brittle bones.

• Fluid retention in the body leads to edema.

How to Diagnose Advanced COPD?

The various diagnostic methods for the life-threatening disorder are as follows:

• Lung function tests: Spirometry is a type of lung function (LFT) used widely to diagnose COPD. The patient is instructed to blow into the mouthpiece or tube connected to the spirometer. The spirometer then measures the amount of air inhaled and exhaled. It also measures the amount of air let out during forced breathing.

• These measurements are expressed in percentage as forced expiratory volume (FEV1). The average level of FEV1 ranges from 80 % to120 %. In end-stage or severe COPD patients, it is less than 30 %.

• CT scan is taken to determine the extent of damage that occurred on the air-sacs (alveoli) in the lungs, and it will help in deciding the prognosis of the patient to surgery.

• Six-minute walk test: It is performed by the doctor, wherein the patient is asked to walk on a flat floor, and the time is calculated. Regular patients pass this test, however severe COPD patients find it difficult to walk a few steps.

The Other Test to Diagnose Respiratory Failure Due to COPD Are:

• Arterial blood gas analysis measures the level of oxygen and carbon dioxide in blood.

• Pulse-oximetry test measures the amount of oxygen in the blood.

How to Treat Advanced COPD?

Therapeutic Approach:

• Bronchodilators: Long-acting β2-agonists (LABA) are effective in relieving shortness of breath in patients with advanced COPD. Theophylline, a type of bronchodilator, is suggested in certain patients.

• Opioids: Low-dose opioids can be given orally or parenterally to relieve breathlessness. But it is mainly contraindicated due to many side effects.

• Corticosteroids: Inhaled corticosteroids and LABA were also effective in case of flare-ups that occur due to lung infections.

• Anticholinergics: Long-acting anticholinergics can improve lung function when given with long-acting bronchodilators.

• Oxygen Therapy: Breathing difficulties in COPD patients can be relieved with long-term oxygen therapy. Oxygen is administered through a nasal cannula, increasing blood oxygen levels in severe hypoxemic conditions.

• Benzodiazepines: They are used in patients who are anxious and depressed in the end-stage of the disease.

Surgical Approach:

Surgical management is not advised for all patients. It depends on the doctor's treatment plan based on the patient's reports. The various options available in treating advanced COPD patients are:

• Lung volume reduction surgery: It removes a portion of the lung to improve breathing.

• Bullectomy removes air spaces formed inside the lung that interferes with breathing.

• Lung transplantation is also widely done.

What Lifestyle Changes Can Be Made?

Most patients with severe COPD poorly respond to the treatment, and their symptoms may even worsen. Specialized medical care along with lifestyle modifications can increase their quality of life.

• Avoiding Smoking: Tobacco is the main triggering factor of lung disease. Quitting smoking and bypassing passive smoke controls the symptoms of COPD.

• Nutrition: In severe COPD, malnourishment usually occurs. Therefore a diet with good nutritious food is necessary to avoid fatigue and other symptoms.

• Breathing Exercise: Breathing in the fresh air with closed lips and breathing out through whistling action can relieve symptoms.

• Physical Exercise: Little exercise like walking every day and oxygen supply can positively impact the quality of life.

• Avoiding Exposure: Staying in a dust-free place, free from harmful chemical fumes and other allergens, can prevent the acceleration of symptoms.

• Seasonal Alert: Extra care should be taken during the winter season. Wearing a mask and scarf and keeping an inhaler in hand while going out are specific measures to be followed correctly.

• Positive Mind: Most COPD patients in the advanced stage suffer from severe anxiety and depression. Therefore keeping your mind relaxed by being socialized and changing your lifestyle accordingly can help drastically.

• Doctor Visit: Periodic visit with your pulmonologist is essential to discuss medications, dietary supplements, and vaccination against pneumonia, flu, etc.

• Other Therapies: Devices that assist in walking can be used. Electrical stimulation is given to muscles to improve their function. Acupuncture therapy is proven to help in relieving dyspnea in COPD patients. Cognitive-behavioral therapy (CBT) is a treatment that enhances the patient's mental health by identifying and working towards the elimination of factors that disturb the patient's emotional status and calming them.

• Palliative Care: It is the last provided care to comfort the end-stage COPD patients who have decreased life span. This care supports the patient by delivering therapies that improve their quality of life.

Conclusion:

Advanced chronic obstructive pulmonary disease may pose difficulties in carrying out daily activities. Still, various efforts like physical exercise, proper diet, cessation of smoking, and regular doctor's visits help improve the quality of life and lung function. Always a peaceful mind despite a severe illness can play a significant role in the betterment of life.