Chronic Obstructive Pulmonary Disease

A diagnosis of chronic obstructive pulmonary disease (COPD) presents numerous challenges for you or your loved one. It often remains undiagnosed and today it is the third-leading cause of death in the United States.

While there is no cure for COPD, Kindred Hospitals offer a variety of strategies and COPD care plans for improving your quality of life, including techniques for easing symptoms, minimizing complications and ultimately helping you make the transition from hospital to home.

“With COPD, early detection likely means less long-term damage to the lungs and more effective treatment of symptoms, so that’s always the medical community’s first priority,” says Dr. Dean French, Chief Medical Officer. “Once a patient transitions to a Kindred Hospital for recovery, our goals are to mitigate their symptoms as much as possible, prevent or treat complications, and help them reach their fullest potential so that they can return home.”

COPD Causes and Symptoms

COPD stands for chronic obstructive pulmonary disease. It is a disease of the lungs that can manifest in two ways: chronic bronchitis, which is characterized by a long-term cough with mucus; or emphysema, which damages the lungs over an extended period of time. Most COPD patients have a combination of both.

Statistically, between 85 and 90 percent of people diagnosed with COPD are or have been long-term smokers. However, only 20 to 30 percent of all smokers will be diagnosed with COPD. Environmental factors, such as exposure to dust, chemicals, and burning fuels, as well as genetic disorders and protein deficiencies, are also among the known COPD causes.

Symptoms of COPD include shortness of breath, wheezing, mucus build-up in the throat (as indicated by the need to clear your throat upon awakening each morning or a persistent mucus-producing cough), chest tightness, lack of energy, discoloration of the lips or fingernail beds, weight loss and swelling in the ankles, feet, and/or legs.

What Are the 4 Stages of COPD?

The disease progresses through four stages, from mild to severe:

• Stage 1 COPD — Mild. At this stage, there are infrequent and barely noticeable symptoms. There is limited disruption of breathing, and coughs that produce mucus are rare.
• Stage 2 COPD — Moderate. Generally, it becomes more difficult to breathe, and even normal activity can result in shortness of breath. Mucus-producing coughs become more frequent. This tends to be the point at which medical assistance is sought.
• Stage 3 COPD — Severe. It becomes much more difficult to breathe, and shortness of breath is a common occurrence. It is no longer possible to complete a normal exercise routine without struggling for breath. Symptom flare-ups known as exacerbations now occur frequently. Quality of life begins to decline.
• Stage 4 COPD — Extremely severe. Airflow is limited, and breathing becomes exceptionally difficult. Flare-ups occur more regularly and are more intense. Emergency medical treatment or hospitalization is often required. At the end stage of COPD, what to expect varies by patient and should be discussed further with your medical team.

Possible Complications with COPD

In addition to breathing problems and a mucus-producing cough, COPD is associated with other health problems. Concurrent conditions commonly include:

• COPD and heart problems — A diagnosis of COPD increases your risk for heart disease, heart failure, and related complications, such as heart attacks. To decrease this risk, you are encouraged to stop smoking cigarettes, cigars and pipes. The Lung Institute recommends that people with COPD also avoid vaping, as initial research suggests a link between COPD and vaping, as well as smoking marijuana.
• COPD and pneumonia — Those with COPD are more susceptible to colds, the flu and/or pneumonia. All of these illnesses may cause further damage to the lungs. An annual flu shot and pneumococcal (pneumonia) vaccine can minimize that risk. In addition, frequent hand washing and minimizing exposure to people who are sick are recommended.
• COPD and lung cancer — A diagnosis of COPD increases your risk of lung cancer. This risk can be decreased by stopping smoking any substances that irritate the lungs, including cigarettes, cigars and marijuana, as well as vaping.
• COPD and depression — COPD’s dramatic impact on your lifestyle and daily routine may lead to depression. It is important to seek medical intervention if you or your friends or family members notice any of the following behaviors: Pervasive sadness, severe mood swings, unrelenting guilt, a loss of hope, no desire to eat, problems sleeping or suicidal thoughts.
• COPD and high blood pressure — COPD may interfere with the ability of the heart to pump blood into the lungs. While pulmonary hypertension is not curable, it is manageable. Appropriate treatment can improve symptoms and slow the progress of the disease.

COPD Treatment and Recovery

COPD care plans are designed to best fit your individual lifestyle and medical needs. Kindred Hospitals offer a variety of pathways to treat COPD.

Your personalized COPD treatment options may include:

• Rehabilitation — Nutritional counseling and tailored exercise programs can support healthy lifestyle changes, which have been found to ease the symptoms of COPD as well as slow its progression.
• Medication — While there is no cure for COPD, and the damage to the lungs and airways is permanent, there are medications that can reduce inflammation and make breathing easier. They include bronchodilators, corticosteroids, methylxanthines and phosphodiesterase-4 inhibitors. Sometimes, medications are combined for the best results.
• Respiratory care — Oxygen therapy may alleviate symptoms and help maintain optimal arterial oxygen saturation. Research has found that supplemental oxygen boosts energy, improves sleep, heightens mood, improves sexual relationships, prolongs life and reduces the chance of heart failure. However, there are some safety concerns, including the danger of fire if the oxygen tank is in a confined space, near an open flame or near someone who is smoking. There may also be some side effects, such as nosebleeds, dryness or irritation around the face mask or nasal cannula, and tiredness or headaches when waking in the morning. Generally, oxygen therapy is used as long as it benefits the COPD patient.
• Surgery — Depending on the severity of COPD, lung surgery may be warranted. There are two main surgical treatment options for COPD: a bullectomy; or lung volume reduction surgery (LVRS). In a bullectomy, surgeons remove the bullae or air sacs damaged by COPD. In LVRS, the size of the lungs is reduced by removing some of the tissue damaged by emphysema. This makes it easier for the healthy lung tissue to absorb oxygen.
• Smoking cessation classes — Smoking of any kind irritates the lungs. If you have been diagnosed with COPD and you currently smoke, you will be encouraged to quit as quickly as possible. Because smoking is often an addiction that can be very challenging to break, Kindred Hospitals provide multiple assistive resources, including counseling, hypnotherapy and medication.
• Palliative care — If you have end-stage COPD, you may experience severe shortness of breath even when at rest. Palliative or supportive care focuses on managing COPD symptoms to achieve the highest possible quality of life. Palliative care may include medication to manage the disease, therapy to relieve the discomfort and anxiety caused by the shortness of breath, and counseling on appropriate lifestyle changes.

The COPD life expectancy will vary depending on your stage of illness. Chronic obstructive pulmonary disease is a chronic, progressive condition. COPD care plans are designed to slow its progression and improve your quality of life. The five-year life expectancy for COPD ranges from 40 to 70 percent, depending on the severity of the disease. This means that, after five years, 40 to 70 percent of people with COPD will be still be alive. The two-year survival rate for those suffering from severe or end-stage COPD is 50 percent, meaning only 50 out of 100 people at this stage will survive past two years.

Regardless of the stage and severity of your COPD, Kindred Hospitals are here to assist you in addressing and alleviating the symptoms of chronic obstructive pulmonary disease. It is our goal to ensure life after a diagnosis of COPD is comfortable and of the highest possible quality.

Success Spotlight: Santo's Story

Santo was admitted to a local hospital suffering from respiratory difficulty related to his COPD and had to be placed on a ventilator as his condition deteriorated. Once physicians had stabilized his condition he was transferred to Kindred Hospital to receive respiratory therapy, medical support and rehabilitation. He was unable to make much progress at first due to elevated anxiety levels and additional complications, but his respiratory team slowly guided his recovery and, as his lungs became stronger, his anxiety decreased and he started participating in early mobility therapy sessions in his bed.

With help from his entire team of caregivers, Santo continued to improve day by day. His speech pathologist enabled him to communicate with a speaking valve at first, and when he was finally able to be taken off the ventilator completely, helped him regain his voice and ability to swallow so he could begin to drink and eat a normal diet once again. Severely weakened after his prolonged hospitalization, Santo slowly began to regain his strength, progressing until he was able to once again stand up and walk with the aid of a walker and take care of his daily needs.

As a result of the high level of interdisciplinary care he received, Santo was able to be discharged to his home where he lives with his wife to continue his recovery. "I really thought that if I ever was admitted to the hospital again there was a good chance that I would not survive,” Santo reflected just before leaving Kindred. “You guys did an awesome job and I can't thank you enough."

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