Helping You Breathe
Your health care provider will most likely prescribe supplemental oxygen. This will help you breathe easier and give your body the help it needs to get through the exacerbation.
Oxygen can be delivered to your lungs through a nasal cannula, or through a variety of face masks, depending on how much oxygen you need. When you use oxygen in this way you are still doing all the work of breathing. Respiratory therapists will help decide which form of oxygen delivery is best for the amount of extra oxygen you need. When it's time for discharge, be sure to ask if you need to make any adjustments to your home oxygen prescription. You will also need to make arrangements for a family member or caregiver to bring your portable oxygen to the hospital for you to use when you leave the hospital.
Non -Invasive Ventilation (NIV)
If your breathing is very difficult and does not get better with routine treatment, your hospitalist provider may suggest non-invasive ventilation (ven-ti-lay-shun). Non-invasive mean that no tubes or needles are put into your body. This is often called Bi-PAP or CPAP. With this type of breathing device, a soft, snug mask is placed over your mouth or nose It is connected to a machine that pushes air into your lungs. It can give you the help you need to get better, faster.
Sometimes your primary health care provider may suggest you use a set-up like this at home while you sleep. This may help if you have both COPD and sleep apnea (app-nee-uh). Sleep apnea is when you stop breathing for too long, too often or when your breathing is too shallow while you sleep.
Sometimes you may be working so hard to breathe, yet you're not breathing well enough to support your body - and your life. Your hospitalist provider may then decide that you need mechanical (meh-can-ni-cal) ventilation. This involves intubation (in -too -bay -shun), putting a tube through your nose or mouth and directly into your lungs. The tube is then connected to a machine called a ventilator, sometimes called a respirator.
This machine can do all or some of the breathing for you, helping you to rest from working so hard to breathe. This way your body is under less stress and the treatments you're getting have a better chance of working to help you get better, faster. It is important to understand that this kind of breathing support is done only if absolutely necessary, and only if you or your surrogate agrees to it. The hospitalist provider would give you medicine to help you relax and sleep while the ventilator helps you breathe.
In most cases the ventilator is temporary. Usually the breathing tube can be removed within a few days. While this breathing tube is in place you will not be able to talk or eat. During this time a small tube may be placed through your nose into your stomach so you can get the nutrition and medicines you need.
Longer Term Ventilation
If you are taking longer to recover, a decision may be made to take the tube out of your nose or mouth, and put a tube in through your neck. This is called a tracheostomy (tray-key-os-toh-mee). It is not painful and often more comfortable than a breathing tube in the nose or mouth. It can be easier for respiratory therapists and nurses to remove any mucus through this tube. At times you can even talk and eat with this tube in place. The tracheostomy tube is often temporary. It can be taken out once you are well enough to breathe on your own, and the opening in your neck will heal and close.)
Being on the ventilatorl'tas some risks. One is called "ventilator-associated pneumonia (new-moan-ya)" or VAP. This means you could get pneumonia while on the breathing machine. VAP can be harder to treat than other pneumonias, requiring powerful antibiotics. Hospitals now have strict programs in place to decrease the chance of patients getting these pneumonias. These programs have been very successful in preventing VAP.
Making your own decisions
It is important to remember that most COPD flare-ups can be easily treated outside the hospital. Only a small fraction of people with COPD who have to stay overnight in the hospital have to be put on a ventilator. Most patients recover, come off the ventilator and go back home.
However, in severe COPD it's harder to get better. In these severe cases, it might not help to be hooked up to a machine. Simple comfort care may be the best choice.
Other Hospital Stays for People with COPD
Like anybody else, people with COPD may need surgery. There are always risks with surgery, and they are not much worse in people with mild or moderate COPD. In people with severe COPD, however, surgery is more risky especially when operating 0 on the belly or chest.
Ask your health care professional to work with the surgery team to find the safest way to help you sleep during surgery and control your pain as you recover. Planning ahead and working as a team can make surgery safer for most people with COPD, even those with severe or very severe COPD.