Chronic obstructive pulmonary disease (COPD) is a progressive, presently incurable respiratory illness that is characterized by airflow obstruction. For long-term care professionals, knowledge about every aspect of this debilitating disease is critical for effective care and improving a patient’s quality of life.
This is especially true given the prevalence of COPD in nursing home residents. According to a 2012 study from the National Center for Biotechnology Information:
- 21.5% of nursing home residents had a diagnosis of COPD
- 17% of these residents received no respiratory medications – and had significant cognitive and functional impairment and concurrent diagnoses
- 22% of residents experienced at least two exacerbations of COPD during the 12 months of the study
Making a COPD diagnosis relies on clinical judgment based on a combination of history, physical examination and confirmation of post-bronchodilator airflow obstruction using a spirometry test.
To help long-term care patients effectively, follow these steps:
- Encourage patients to quit smoking – This is a key intervention which can include nicotine replacement therapy and drugs such as bupropion.
- Promote effective inhaled therapy – This is essential for patients with stable COPD who remain breathless or have exacerbations despite using short-acting bronchodilators.
- Provide pulmonary rehabilitation – This should be offered to all appropriate patients, including those who are functionally disabled by COPD and those who have recently been hospitalized for an acute exacerbation.
- Use noninvasive ventilation (NIV) – NIV should be used for persistent hypercapnic ventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff members who are trained in its application, experienced in its use and aware of its limitations.
- Manage exacerbations – The frequency of exacerbations can be reduced by inhaled corticosteroids and bronchodilators, as PDE-4 inhibitors, a new class of medications approved for use in treating COPD exacerbations. Vaccinations can decrease the chance of infections, which are a common cause of exacerbations. Exacerbations can be minimized by providing advice about responding promptly to symptoms; starting treatment with oral steroids and/or antibiotics; and using non-invasive ventilation when indicated.
- Screen patients for depression – Because COPD has a significant impact on a patient’s quality of life, health care professionals should screen them for anxiety and depression.
Issues to Watch For
Long-term care professionals should also be vigilant for infection. Warning signs include: increased shortness of breath, wheezing, coughing up increased amounts of mucus, yellow- or green-colored mucus, fever over 101°F, chills, increased fatigue or weakness, sore throat, congestion and headaches.
They should also monitor the patient’s emotional state. Depression is common in COPD patients. Around 40% are affected by severe depressive symptoms or clinical depression. It is not easy to diagnose depression in COPD patients because of overlapping symptoms between COPD and depression. Quality of life is strongly impaired in COPD patients and patients’ quality of life emerges to be more correlated with the presence of depressive symptoms than with the severity of COPD. In patients with mild depression, pulmonary rehabilitation and cognitive-behavioral therapy can be effective.
In order to give COPD patients the best possible care, always focus on improving identification of the condition and increasing the choice of treatments based on the most up-to-date clinical and cost-effectiveness evidence. While COPD is not curable, various forms of treatment can help control its symptoms and increase quality of life for people living with the illness.
John W. Walsh, who was diagnosed with Alpha-1-related genetic COPD in 1989, is president and co-founder of the COPD Foundation, a not-for-profit organization dedicated to preventing and curing chronic obstructive pulmonary disease and improving the lives of all people affected by COPD. He is also the Co-Founder of the Alpha-1 Foundation and AlphaNet, Inc. He can be reached at 1-866-316-COPD (2673) or [email protected]