The National Institute for Health and Care Excellence (NICE) COPD quality standards, published on 4th February, recommend pulmonary rehabilitation programs for all the patients of COPD within four weeks of being discharged from the hospital.
CSP professional adviser Carley King said that the rehabilitation is the integral part of management for the COPD patients.
What is COPD?
COPD is a chronic disease which causes a gradual destruction of lungs and airways leading to significant shortness of breathing. Its subtypes are emphysema (destruction of the air sacs or alveoli at the end of the small airway passages called bronchioles) and chronic bronchitis (inflammation of the lining of the airways carrying air to and from the lungs).
It contributes to high mortality and morbidity all over the world. It is the third most common cause of death in United States and 5th leading cause of death in Australia in 2012. COPD patients have symptoms of cough, sputum production and breathlessness. There is no cure of COPD but it is preventable and can be managed very well.
Symptoms do not appear until a significant damage to lungs is done. Following are more common symptoms.
- Breathing difficulty at rest or on exertion
- Coughing up phlegm
- Wheezing due to inflammation and constriction of airways
- Feeling of chest tightness
- Lack of energy
What Causes COPD?
- Smoking is the main cause
- Inhaling toxic gases and fumes
- Family history in care cases
Complications Of COPD
Patients with COPD are at an increased risk of the following:
- Chest infection
- Heart problems
- Lung cancer
Airways are comprised of windpipe (trachea) that divides into two large tubes (bronchi) which further divide into several tiny tubes (bronchioles). There are small clusters of air sacs at the end of these bronchioles (alveoli). These small air sacs are covered with blood vessels (capillaries) which absorb the oxygen from the lungs and transport it to the blood. In COPD patient these air sacs are damaged which results in poor supply of oxygen to the blood. Also there is an inflammation of the airways and lungs that causes gradual damage and scarring of air ways which ultimately results in obstruction of air out of the lungs.
If a person has COPD symptoms the doctor may order Spirometry, which basically consisted of pulmonary function tests (PFTs) that measure the obstruction of the airways. This test is quick and usually takes only 15 minutes to complete.
During Spirometry a small clip is placed on the nose of the patient to close the nostrils and then patient is instructed to seal his lips around the mouth piece and take a deep breath and then blow out as fast and as long as he or she can. The test is done at least three times to make sure the results are relatively consistent.
If the readings are abnormal then the patient may be given an inhaler to expand the airways and the test is performed again after 15 minutes of giving the inhaler. Later the new results are compared with the previous ones to see any improvement in the lungs functioning after giving inhaler.
Also the recent NICE recommendations suggest that people above 35 years of age who have a risk factor such as smoking and one or more symptoms of COPD should have post‑bronchodilator Spirometry. http://www.nice.org.uk/guidance/qs10/chapter/Quality-statement-1-Diagnosis-with-spirometry.
2-Chest X-ray—is done to rule out if there is any other lung disease
3-Oximetry—to see the amount of oxygen in the blood
- Most important factor is the cessation of the smoking
- Bronchodilators: They are the mainstay of the treatment and help to expand the airways. There are short acting and long acting bronchodilators. If symptoms are not controlled with short acting then combinations are given to the patient.
The correct technique for the use of inhaler is very important.
- Remove the cap of the inhaler device
- Hold inhaler upright and shake 2-3 times vigorously
- Breathe out slowly
- Seal your lips around the mouth piece
- Start breathing in slowly and press the canister at the same time
- Breathe in slowly and deeply
- Hold your breath for 4-5 seconds
- Remove inhaler from mouth
- Breathe out slowly
- Repeat the process as many times as required
- Replace cap at the end
- Corticosteroids: If the patient is having frequent exacerbations of COPD then steroids are also prescribed as they work as preventers.
- Expectorants: They are used to loosen the plugs of phlegm and cough it up.
- Oxygen: Patients with COPD may have low levels of oxygen in their blood during exacerbations and oxygen should be provided
- Vaccinations: Chest infections are very common in the patients of COPD. Vaccinations can prevent the infections so annual influenza and pneumococcal vaccine should be given to the patients.
- Non-invasive Positive Pressure Ventilation: It is useful in the treatment of acute or severe COPD
- Rehabilitation: It is an exercise program to make the patients breathe better and improve their quality of life. Pulmonary rehabilitation patients learn better breathing techniques and to cope with the physical symptoms of COPD such as shortness of breathing.
Recently NICE recommended that the patients admitted to a hospital with an acute flare up of COPD should be starting a pulmonary rehabilitation program within four weeks of their discharge. And the program should be 6 week long so far as possible.
- Patient Education: It plays a very important role in the management of patients. Education regarding the risk factors, proper inhaler technique, recognising the symptoms of flare ups/exacerbations, making end life decisions, recognition of complications and treatment is very important.
- Surgery: Lung transplantation is the last option if medical treatment fails. However this is a complicated decision and the survival benefit is not very clear.
These quality standards from NICE target to improve the care and the outcomes of the care provided to the COPD patients. Statements on emergency oxygen during an exacerbation are new while all other statements were just updated.
This quality standard includes the assessment, diagnosis and management of chronic obstructive pulmonary disease. However, it does not cover the screening prevention or case finding.
Quality standard should be considered parallel to document catalogued in the sources given by NICE.
We think the quality standards are very important for the better care of the patients of COPD especially where the catering of the services is limited. We hope that with good approach we will be able to control the mortality and morbidity associated with COPD. With numerous studies still under process we look forward to getting the answers of still unanswered queries. We hope that 2016 will be a landmark year for the COPD.