The impact of smoking and copd
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The impact of Smoking and COPD. Elaine Fenton Primary Care Respiratory Nurse Specialist Angus CHP Lead 12 th December 2008. Lung anatomy. COPD Includes. Chronic Bronchitis. Small airways disease. Emphysema. Chronic Asthma. Why have I got COPD? .

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The impact of smoking and copd l.jpg

The impact of Smoking and COPD

Elaine Fenton

Primary Care Respiratory Nurse Specialist Angus CHP Lead

12th December 2008



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COPD Includes

  • Chronic Bronchitis

  • Small airways disease

  • Emphysema

  • Chronic Asthma


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Why have I got COPD?

  • It can be hard to tell exactly – different people get COPD for different reasons…

  • …but most cases of COPD are related to smoking

  • The important thing is to stop your lungs getting more damaged and to make the best of the lung capacity you have


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What does ‘COPD’ mean?

  • COPD is short for Chronic Obstructive Pulmonary Disease

  • Chronic means ‘long term’

  • Obstructive means ‘narrowed airways’

  • Pulmonary means ‘affecting the lungs and the airways’

  • Disease means disorder of the body


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What causes the symptoms?

  • The lining of the airway are swollen and inflamed making them narrower

  • The airways are also narrower because the muscle in their walls are squeezing them too tightly

  • The lining of the airways are making too much fluid which is coughed up as phlegm


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Other associated daily symptoms

  • Breathlessness

  • Chronic Cough

  • Regular sputum

  • Wheeze

  • Weight loss

  • Fatigue

  • Chest pain

  • Debility

  • Anxiety + Depression


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What is breathlessness?

  • Any disruption to the process that makes us aware of our breathing can cause distress

  • Response to increased activity

  • Acute breathlessness– sudden onset – severe, debilitating symptoms

  • Chronic breathlessness– gradual onset, developing and persisting over several months or years


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Breathlessness

(Improvement)

Inactivity

(Activity)

Depression

(Improved mood)

Breathlessness and activity cycle

Social isolation

(Social inclusion)

Decreased fitness

(increased fitness)


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What treatment is there for COPD?

Treatment for COPD is in three main parts:

  • Preventing more damage to the lungs

  • Taking medicines to open up the airways

  • Improving fitness

IF YOU HAVE COPD,THE MOST IMPORTANT THING YOU CAN DO TO HELP YOURSELF IS TO STOP SMOKING


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Medicines for COPD: bronchodilators

  • Patients with mild, moderate or severe COPD are prescribed a bronchodilator treatment

  • This is a type of drug that acts quickly to open up the airways and relieve breathlessness; this type of drug is also called a reliever


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Medicines for COPD: bronchodilators

There are many types of bronchodilator drugs

  • Beta-agonists (short acting)

  • Anticholinergics (short acting)

  • Combinations

  • Long acting beta-agonists

  • Tiotropium

  • Theophyllines

    As they work in different ways patients have different trials to see which ones work best for them


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Other medicines for COPD

  • Inhaled steroids may be given to reduce exacerbations in patients with severe disease

  • Tablets containing theophylline are sometimes given for COPD. The tablet acts slowly to open up the airways

  • The doctor will often prescribe antibiotics or oral steroids for chest infections


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Inhalers and spacers

An inhaler allows a person to take medicine by breathing it directly into the lungs.

Different types of inhaler suit different people.

There are three kinds:

metered-dose inhaler (MDI)

breath-actuated inhalers

dry-powder inhalers (DPI)

If a patient does not know how to use their inhaler contact the practice or pharmacist


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Inhalers and spacers

  • A spacer is an empty chamber that is fitted to the mouthpiece of an inhaler, to make the inhaler easier to use, acts as a reservoir

  • It is very important to use an inhaler properly, to get the full benefit of the treatment

  • a valve at the mouth piece keeps the medicine within device

  • wash and air dry prior to use to reduce “static charge

  • wash once per month with washing up liquid do not rinse and air dry - never wipe

  • replace every six months


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Nebulisers

  • A nebuliser is a device used when a patient needs to inhale high doses of a drug or they cannot use other devices

  • Wash the mask and chamber at least once per day with hot soapy water, rinse and dry with a paper towel. Blow compressed air through the system to facilitate drying.


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Oxygen therapy

  • Some patients with severe respiratory diseases benefit from oxygen treatment. This will only be considered if they have STOPPED SMOKING

  • Having long-term oxygen therapy means breathing oxygen for over 15 hours each day. It is best provided from a concentrator, through a facemask or nasal prongs

  • Short-term oxygen is occasionally provided by GPs and is delivered by the community pharmacists


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What is pulmonary rehabilitation?

  • A training programme for people with breathing problems

  • People learn about their illness and how best to cope with problems it causes

  • Includes a supervised exercise routine to help patients get fitter and do more, so that life is less frustrating

  • Allows patients to meet fellow sufferers and have fun


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Exercise

  • The fitter you are, the better you will feel – so make an effort to keep active

  • Take at least one short walk each day, and don’t worry about ‘overdoing it’ – getting out of breath won’t harm your lungs


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Diet

  • Overweight can increase breathlessness often due to inactivity

  • Underweight - poor prognostic sign

  • Avoid big meals try six small meals a day instead of three big ones

  • Drink plenty of water


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Living with breathlessness

  • People with COPD are nearly always short of breath.

  • The most frightening aspect of COPD is exacerbations where breathlessness is unrelenting.

  • 80% of patients admitted to hospital with severe COPD symptoms said the felt ‘worse than death’

    BLF press office 2003


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About 1 in 3 patients with COPD will be admitted to hospital

Of those patients who are admitted:

  • Half will require treatment in an intensive care unit

  • 1 in 10 will die in hospital

  • One third will die within 6 months

  • 43% will be dead within a year


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Management of breathlessness

  • Accurate diagnosis

  • Appropriate disease management

  • Medication management

  • Oxygen therapy

  • Rehabilitation

  • Psychological therapy

  • Complimentary medicine

  • Breathlessness and palliative care


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How to help the breathless patient?

  • Support and reassurance

  • Relaxation and distraction techniques

  • Breathing re-training

  • Panic management

  • Energy conservation

  • Early recognition of problems requiring medical intervention


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