What does it mean when COPD symptoms are controlled? Part 2

Posted on December 17, 2019   |   
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This post was authored by Barbara Yawn, MD, MSc, FAAFP of the University of Minnesota; M. Bradley Drummond, MD of the University of North Carolina at Chapel Hill School of Medicine; and Carol Rubin, MEd, MS of Cliffside Park, NJ.

As a person living with and being treated for COPD you have your own “normal” (or baseline) symptoms, which can change in type and severity over time as your lungs age.1,2 Knowing your baseline symptom level using the COPD Foundation patient app3 allows you and your clinician to understand when the symptoms are getting worse or becoming uncontrolled (See: What does it mean when COPD symptoms are “controlled”? Part 1 for more information). Following your symptoms and what you can do daily may also encourage you to try and improve your ‘normal,’ giving you a better quality of life.

How are you affected over time with the changes in COPD symptoms?

Many of us cut down on our activity level, whether we realize it or not, to avoid certain COPD symptoms like feeling short of breath.4 Cutting down on physical activity like avoiding stairs or even avoid getting up to get a glass of water can actually work against you - decreased activity can lower your ability to do the things you want to do. It can also increase the chances of having a COPD exacerbation or even being hospitalized.5 Exacerbations or COPD “attacks” lead to more decrease in activity, more shortness of breath and then to greater difficulty doing daily activities, and loss of fitness.6

What is the impact of an exacerbation of COPD?

During a COPD flare up or an acute exacerbation, symptoms worsen, and breathing becomes even more difficult. Exacerbations decrease your overall health, comfort, and happiness (also known as quality of life) and can speed up lung function decline.7 Also, exacerbations can increase your risk of future exacerbation or hospitalizations, and can even be life threatening.7 So, all possible steps should be taken to prevent symptoms from becoming uncontrolled (Suggested reading: Avoiding exacerbations and pneumonia; Staying healthy and avoiding exacerbations; Staying healthy and avoiding Pneumonia).

What are the goals of COPD treatment?

There is no cure for COPD, but managing the disease and leading an active lifestyle can help you achieve several goals of COPD treatment.1

  • Relieve and level out symptoms
  • Improve your ability to stay active
  • Slow down symptom progression
  • Reduce exacerbations

What can you do to improve your baseline symptom level?

You can make lifestyle changes, improve your overall health, and improve your lung health by the following ways:

Stop smoking

Smoking is a leading cause of COPD1 and when continued worsens symptoms and increase exacerbation risk.8 Quitting smoking is a proven way to slow down COPD progression9 as well as improve symptoms10 and lower risks of other conditions like heart disease.11 Quitting is hard, so ask for help like referral to a smoking cessation program or medications to support cessation. (Suggested reading: Quitting Smoking).

Be active

An important part of a healthy lifestyle is exercising regularly. Leading an active lifestyle builds muscle strength,12 lessens feelings of shortness of breath,13 and reduces the risk of hospitalization.14 Speak with your doctor to understand what types of activities are safe for you (Suggested reading: Exercise for Someone with COPD). Download the COPD Foundation app for free and watch exercise videos, especially created for people with COPD.

Join a pulmonary rehabilitation program

If you hurt your back, you would go for physical therapy. Try pulmonary rehabilitation to help your lungs (Suggested reading: What is Pulmonary Rehabilitation?)? The main goal of pulmonary rehabilitation is to work on your fitness and breathing to improve symptoms and increase your ability to do what you want.15 It can also support your independence, improve your day-to-day living, and reduce hospitalizations.15,16 Your rehabilitation team—physicians, physiotherapists, respiratory, occupational and physical therapists, exercise physiologists or behavioral specialists, nurses, and dietitians15—will:

  • Help you with physical activity and exercise to improve how your lungs and heart work
  • Educate and provide general information on COPD
  • Teach you breathing exercises like belly breathing, which may strengthen your breathing muscles (Suggested reading: Breathing Exercises and Techniques)
  • Make sure you are using your medications and inhalers correctly
  • Provide life style counseling, and nutritional training, support, and introduce you to others living with COPD

Finally, to help improve your baseline symptom level and to keep your symptoms controlled, ensure that you work with your clinician to make a personalized COPD action plan for yourself,17 complete it at regular visits, and set goals to meet your needs (Suggested reading: Hope and Inspiration Through Goal Setting). Use the COPD Foundation app to monitor your symptoms on a daily basis.


Acknowledgments
The authors meet the criteria for authorship recommended by the International Committee of Medical Journal Editors. The authors received no direct compensation for the development of this manuscript. Writing, editorial support, and formatting assistance was provided by Praveen Kaul, PhD, and Maribeth Bogush, PhD, of Cactus Communications, which was contracted and compensated by Boehringer Ingelheim Pharmaceuticals, Inc., (BIPI) for these services. BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.

Disclosures
Dr. Yawn reports personal fees from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, and Midmark, and grants from the COPD Foundation, Boehringer Ingelheim, and the National Heart, Lung, and Blood Institute (NHLBI) outside the submitted work.

Dr. Drummond reports grants from the NHLBI, the U.S. Department of Defense, and Boehringer Ingelheim outside the submitted work. He also reports personal fees from Boehringer Ingelheim, GlaxoSmithKline, AstraZeneca, Mylan-Theravance, Novavax, Parion, Midmark, and Philips outside the submitted work.

Ms. Rubin reports personal fees from Novartis and the U.S. Department of Defense outside the submitted work. She is associated with the COPD Foundation as a State Captain, which is a non-paid position.

References

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2020 Report. Retrieved from https://goldcopd.org/. Accessed: November 11, 2019.
  2. Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging. 2006; 1:253-60.
  3. Thomashow B, Crapo JD, Drummond MB, et al. Introducing the new COPD pocket consultant guide app: can a digital approach improve care? A statement of the COPD Foundation. Chronic Obstr Pulm Dis. 2019; 6:210-20.
  4. Van Remoortel H, Hornikx M, Demeyer H, et al. Daily physical activity in subjects with newly diagnosed COPD. Thorax. 2013; 68:962-3
  5. Moy ML, Teylan M, Weston NA, et al. Daily step count predicts acute exacerbations in a US cohort with COPD. PLoS One. 2013; 8:e60400.
  6. ZuWallack R. How are you doing? What are you doing? Differing perspectives in the assessment of individuals with COPD. COPD. 2007; 4:293-7.
  7. Qureshi H, Sharafkhaneh A, Hanania NA. Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. Ther Adv Chronic Dis. 2014; 5:212-27.
  8. Cho J, Lee CH, Hwang SS, et al. Risk of acute exacerbations in chronic obstructive pulmonary disease associated with biomass smoke compared with tobacco smoke. BMC Pulm Med. 2019; 19:68.
  9. Wu J, Sin DD. Improved patient outcome with smoking cessation: when is it too late? Int J Chron Obstruct Pulmon Dis. 2011; 6:259-67.
  10. Jiménez-Ruiz CA, Andreas S, Lewis KE, et al. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J. 2015; 46:61-79.
  11. Centers for Disease Control and Prevention (CDC). Smoking and Cardiovascular Disease. Retrieved from https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_CVD_508.pdf Accessed: November 11, 2019.
  12. Spruit MA, Burtin C, De Boever P, et al. COPD and exercise: does it make a difference? Breathe (Sheff). 2016; 12:e38-e49.
  13. Ortega F, Toral J, Cejudo P, et al. Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002; 166:669-74
  14. Garcia-Aymerich J, Farrero E, Félez MA, et al. Risk factors of readmission to hospital for a COPD exacerbation: a prospective study. Thorax. 2003; 58:100-105.
  15. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013; 188:e13-e64.
  16. Özmen I, Yildirim E, Öztürk M, et al. Pulmonary rehabilitation reduces emergency admission and hospitalization rates of patients with chronic respiratory diseases. Turk Thorac J. 2018; 19:170-5.
  17. COPD Foundation. My COPD Action Plan. Retrieved from https://www.copdfoundation.org/Downloads/MyCOPDActionPlan.pdf. Accessed: November 11, 2019.

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