Each November, for COPD Awareness Month, the focus is to raise awareness and discuss ways to reduce the burden of COPD worldwide.

Today on World COPD Day, our in-house Nurses are here to share their knowledge with you of the symptoms, causes, diagnostics and treatment of patients with chronic obstructive pulmonary disease.

What is COPD?
Chronic obstructive pulmonary disease is an umbrella term for both emphysema and chronic bronchitis. This affects mainly middle-aged or older adults who smoke.

What are the symptoms of COPD?
• Increasing breathlessness, particularly when active
• A persistent chesty couch with phlegm
• Frequent chest infections
• Persistent wheezing

What causes COPD?
The three main causes are:
1. Smoking: Smoking is a major contributing factor, most COPD sufferers have either smoked in the past or currently smoke.
2. Long-term exposure to workplace pollutants such as chemicals, dust or fumes.
3. Environmental exposure to pollutants and second-hand smoke.

What to look out for when nursing patients with COPD
1. There is a higher risk of recurrent respiratory infections: COPD patients are highly vulnerable to bacteria and viruses that may cause infection. Frequent infections may cause more damage to the tissues of the lungs, making it more difficult to breathe.
2. Pulmonary hypertension: COPD may increase the blood pressure in the arteries that carry blood to the lungs.
3. Lung cancer: The study by Durham and Adcock in 2015 showed the relationship between COPD and lung cancer. COPD can contribute to the development of lung cancer as it increases oxidative stress, which causes DNA damage and increase in cellular proliferation.
4. Cardiac issues: COPD may increase the risk for cardiovascular disease, particularly myocardial infarction (heart attack). The connection between COPD and cardiac problems has not been fully studied.

Diagnostic Tests
1. Medical history: Smoking history, family history, occupation, exposure to lung irritants.
2. Arterial blood gas (ABG) analysis: To measure the gas exchange in the lungs.
3. Pulmonary function tests: To measure the level of air during inhalation and exhalation. The most common one is spirometry. Other tests include pulse oximetry and six-minute walk test.
4. Imaging: Chest x-ray and/or CT scan.
5. Genetic testing for AAt deficiency: If the patient has a family history of COPD.

Treatments
COPD is generally irreversible, but through proper treatment, therapy, and lifestyle changes, the patient can have better pulmonary function and thus, experience partial recovery and optimal quality of life.
These treatments include:
1. Smoking cessation: Quitting smoking is one of the crucial steps to combat COPD. This also includes avoiding second-hand smoking.
2. Medications: Bronchodilators such as Ventolin and Ipratropium (Atrovent) work by relaxing the muscles of the airways, making breathing much easier. These usually come in the form of inhalers.
3. Oxygen therapy: Supplemental oxygen may be needed if there is a low level of oxygen in the blood. It is normal for most COPD patients to have an oxygen level between 88 to 92% via pulse oximetry. Oxygen therapy may be required if the patient’s SpO2 drops to less than 88%.
4. Pulmonary rehabilitation program: A healthcare plan for exercise, nutrition advice, counselling, and education need to be customized for each COPD patient.
5. Bilevel Positive Airway Pressure (BiPAP): This is a non-invasive, in-home ventilation therapy that comes with a mask and helps improve breathing as well as reduce hypercapnia (the retention of carbon dioxide in the lungs).
6. Surgical intervention: Lung volume reduction surgery, lung transplant, bullectomy (removal of bullae or large air spaces) are the most common surgical procedures performed to treat COPD.