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Understanding A COPD Diagnosis: Key Facts

If you or someone you know has recently been diagnosed with COPD, you may be wondering what exactly that means. COPD stands for Chronic Obstructive Respiratory Disease. COPD is composed of different respiratory diseases that cause troubled breathing.

The term COPD can be used to describe a singular respiratory disorder, or more than one. COPD encompasses chronic bronchitis, emphysema, asthma, and some forms of bronchiectasis, as well as any combination of the four. According to the American Lung Association, over 16 million Americans are diagnosed with COPD as of October 2020, but millions more suffer from it without being diagnosed.

The group of diseases in which COPD refers to cause airflow obstruction and trouble with breathing. COPD is chronic, meaning it is long-lasting and constantly present. Each individual case of COPD is different, and some cases are more severe than others. The most common cases of COPD include symptoms of both chronic bronchitis and emphysema.

COPD Explained

What is Happening in Your Body?

Your particular case of COPD will determine what is happening within your body. Cases that include chronic bronchitis will cause swelling and increased mucus production in the lung airways, or bronchial tubes. This causes breathing to become more difficult since your airways are inflamed and narrowed with mucus blocking them. Cases including emphysema cause destruction of the air sacs, or alveoli. The air sacs are responsible for oxygen exchange within the lungs, and they lose their elasticity by becoming destroyed. This causes breathing difficulty since the loss of elasticity leads to air being trapped inside the air sacs, making it harder to get oxygen in and carbon dioxide out.

Symptoms of COPD

Some of the most common symptoms include:

  • Increased shortness of breath
  • Frequent coughing (with or without mucus)
  • Wheezing
  • Tightness in the chest

Remember, not all cases of COPD will have the same symptoms. Other symptoms include frequent respiratory infections, lack of energy and unintended weight loss.

What Causes COPD?

COPD is mainly caused by inhaling lung irritants, and smoking is the #1 cause. People, however, do not realize that other potential lung irritants that can also cause COPD include exposure to air pollution, fumes, chemicals, secondhand smoke and dust particles. Oftentimes, inhaling these irritants can be work-related. Working in construction, mining or welding are examples of occupations that increase the risk of obtaining COPD due to increased exposure to lung irritants. A rare genetic factor called alpha-1 antitrypsin deficiency is also known to cause COPD and is passed from parents to their children.

Comorbid conditions seem to be more common in people with COPD than in people with other medical problems. These conditions may include:

  • High blood pressure
  • High cholesterol
  • Heart disease
  • Diabetes
  • Osteoporosis
  • Depression
  • Arthritis
  • Sleep Apnea
  • Cancer
  • Other medical problems

One reason for these additional problems may relate to the lung inflammation that occurs in people with COPD.

What is a Flare-Up?

A COPD flare-up, or exacerbation, is when your symptoms are considerably worse than usual. Some can be treated at home, but more severe flare-ups can require a visit to the hospital. Flare-ups are triggered by further lung inflammation. This can be from exposure to smoke, pollution or allergens as well as contracting the flu or pneumonia. Symptoms to look out for include:

  • Shortness of breath without physical activity
  • Increased mucus
  • Excessive coughing or wheezing
  • Lower blood  oxygen saturation level than normal

Those symptoms can usually be treated at home with antibiotics or inhalers, but the following list of symptoms require professional help.

  • Increased heart rate
  • Being unable to catch your breath
  • Lips or fingernails turn blue or gray
  • Treatments are not working

Does COPD Have a Cure?

COPD is a progressive disease, which means that it gets worse over time. Unfortunately, there is no cure, but luckily many treatment options are available to improve the quality of life. Bronchodilator and steroid medications are available through inhalers to relax the lungs, as well as oral anti-inflammatory medications. Oxygen therapy is also a popular treatment option to help patients achieve healthy blood oxygen levels, which is difficult to maintain when you have COPD. Oxygen therapy allows you to still be active and live a normal life while getting the oxygen into your body that you need, especially with the availability of portable oxygen concentrators. Pulmonary rehabilitation is another option for those with COPD. It helps patients adjust to and get educated about their conditions. Pulmonary rehabilitation programs often provide support and exercise training as well as breathing techniques that are personalized based on specific patient needs.

Living with COPD

Activities of daily living, such as completing chores or bathing, can be harder to accomplish due to shortness of breath. You may have to take constant breaks to catch your breath. Activities will take your energy to perform, so you will get physically exhausted more easily. Living with COPD means slowing down in order to control your breathing and to prevent tiring yourself too quickly. Living with COPD has its challenges, but modifying some activities of daily living can improve your quality of life and help you better manage your disease.

Takeaway

Although COPD is a life-long condition, you can still live a fulfilling life with the help of treatment options, although you may have to slow your pace. COPD takes a toll on your body, so taking care of yourself, monitoring your symptoms and following your doctor’s orders are top priorities.

Sources

https://www.cdc.gov/copd/features/copd-symptoms-diagnosis-treatment.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ffeatures%2Fcopd-awareness-month%2Findex.html

https://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx

https://www.hse.gov.uk/copd/causes.htm

https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd#:~:text=With%20COPD%2C%20the%20airways%20in,the%20waste%20gas%20carbon%20dioxide.

https://medlineplus.gov/copd.html

https://www.nhlbi.nih.gov/health-topics/copd

https://www.nps.org.au/consumers/chronic-obstructive-pulmonary-disease-copd-explained

Pulse Oximetry and its Importance in COVID-19

Patients with conditions such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and various cardiac conditions have utilized pulse oximeters as tools in monitoring their supplemental oxygen use. Pulse oximeters have become essential diagnostic tools because of ease of use, portability, and applicability in a wide range of clinical settings. In the face of the current pandemic, pulse oximeters have gained popularity with patients and physicians alike. Could early pulse oximetry monitoring be utilized in COVID-19?

Globally as of today,  09/23/2020, there are now approximately 31,375,325 confirmed cases of COVID-19 according to the World Health Organization (WHO). Since the outbreak, there have been roughly 749,069 cases in Texas with a significant spike in cases just days ago on 09/21 of 9,853. That is the most significant jump in new daily cases since mid-July when cases climbed to 14,916 on 07/17/2020.  While the number of daily new cases is trending down, we should remain cautious and continue to wear masks, social distance, and avoid large gatherings when possible.

When oxygen levels are low, the organs in our body receive less oxygen which can negatively impact their bodily function. Knowing baseline oxygen saturation levels at rest and with activity can help trend changes among various health conditions. In the presence of COVID-19, monitoring pulse oximetry levels can help monitor oxygenation and warn of impending or silent hypoxemia. While only a few independent studies have assessed the performance of pocket oximeters and smartphone-based systems, future studies could be performed to determine their accuracy.

Common Questions regarding Pulse Oximeters:

What is a Pulse Oximeter?

A pulse oximeter is a small, battery-powered device that is used to measure how much oxygen your blood is carrying. The blood oxygen level measured with an oximeter is called your oxygen saturation level (SpO2) and is displayed as a percentage. The device works by sending two wavelengths of light into the finger through the nail bed and measures what is absorbed by the blood. It can also calculate your pulse and that is displayed as beats per minute (bpm).

How are Pulse Oximeters used?

A pulse oximeter comes as a small unit with a built-in finger/toe clip. All you must do is place your finger inside the pulse oximeter. The pulse oximeter delivers a calculated value and will display it once the reading stabilizes. It is normal for the value to fluctuate so do not worry if you see it changing constantly. Remember to keep working batteries in your oximeter to limit interruptions in your monitoring.

What is a Normal Oxygen Saturation Level?

The American Thoracic Society (ATS) recommends you ask your health care provider what oxygen saturation level they want you to maintain. ATS suggests most people need an oxygen saturation level of at least 89% to keep their cells healthy. COPD patients are advised to maintain a pulse oximetry level between 88-92%. Normal oxygen saturation levels run between 95% and 100%. Medical professionals should be consulted if a patient with suspected or confirmed COVID-19 has SpO2 ≤90%. Having a pulse oximeter will allow you to monitor your blood oxygen level, know if you are within your recommended range, and whether you need to increase your supplemental oxygen level.

How Accurate is a Pulse Oximeter?

The oxygen level from a pulse oximeter is reasonably accurate. Most oximeters give a reading 2% over or 2% under what your saturation would be if obtained by arterial blood. A pulse oximeter may also be less accurate with very low oxygen saturation levels (below 80%).

Factors affecting accuracy to read include:

  • Dark-colored nail polish
  • Cold fingers or poor circulation
  • Tremor or movement
  • Too much pressure on the probe
  • Low blood pressure

Closing Thoughts

For patients and health professionals alike, it will be imperative to be vigilant in the use of new technology advances, such as the way consumer tech companies are marketing health capabilities and promoting pulse oximetry monitoring among their devices. What they can do and what they can reliably do may in fact be two separate things. The use of these devices could potentially threaten and jeopardize a person’s health if the user relies on its accuracy to dictate when they seek medical care. Recently, Brian Clark, a pulmonologist and professor at the Yale University School of Medicine was featured in an article in the Washington Post speaking on the topic of emerging tech companies diving into the medical space. He commented, “I agree with you that it is a dangerous trend for technology companies to release medical devices that don’t meet FDA standards and claim that they are not medical devices”. Dr. Clark also adds, “But the more concerning and potentially dangerous scenario is when the devices provide false reassurance and people don’t seek health care when they really need it”.

Patients suffering from respiratory health conditions will continue to use pulse oximetry monitoring devices for the unforeseeable future. Hand-held pulse oximeters have become a common assessment tool and according to various studies, have been useful as diagnostic tools for the assessment of COPD. They can be used during both stable phase and exacerbations, as well as confirming the need for oxygen therapy.

Worldwide, people are looking to health monitors for any clue that they may have COVID-19, the illness caused by the novel coronavirus. For regular supplemental oxygen users that notice oxygen levels trending low, it will be important to speak with your healthcare provider or respiratory therapist as to when to increase or decrease your oxygen level based on pulse oximetry readings. Regardless of preexisting conditions, monitoring yourself for COVID-19, or recovering from recent hospital admission, its important to seek immediate medical attention if you notice significant changes in your oxygen levels. If you are caring for a patient with COVID-19 and their SpO2 ≤90%, refer to their primary care provider for further evaluation and possible treatment.

Sources:
  1. Adler JN, Hughes LA, Vivilecchia R, Camargo CA Jr.Effect of skin pigmentation on pulse oximetry accuracy in the emergency department. Acad Emerg Med1998596570
  2. Fowler, G. (2020). Washington Post [Editorial]. Https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/. Retrieved September 23, 2020, from https://www.washingtonpost.com/technology/2020/09/23/apple-watch-oximeter/
  3. Luks AM, Swenson ER. Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance. Ann Am Thorac Soc. 2020 Sep;17(9):1040-1046. DOI: 10.1513/AnnalsATS.202005-418FR. PMID: 32521167; PMCID: PMC7462317.
  4. Lipnick, Michael S. MD*; Feiner, John R. MD*; Au, Paul BS*; Bernstein, Michael BS†; Bickler, Philip E. MD, Ph.D.* The Accuracy of 6 Inexpensive Pulse Oximeters Not Cleared by the Food and Drug Administration: The Possible Global Public Health Implications, Anesthesia & Analgesia: August 2016 – Volume 123 – Issue 2 – p 338-345 DOI: 10.1213/ANE.0000000000001300
  5. WHO Coronavirus Disease (COVID-19) Dashboard. (n.d.). Retrieved September 23, 2020, from https://covid19.who.int/

Alta demanda; Suministro corto. Satisfacer las necesidades de oxígeno de los pacientes COVID-19 en el área de Río Grande y más allá

Si bien nos centramos en el tratamiento de los pacientes COVID-19 más enfermos en el hospital, ¿cómo vamos a dar la misma importancia a la gestión del alta hospitalaria de la enfermedad. Las hospitalizaciones de pacientes con COVID-19 han sido una métrica clave tanto del peaje del coronavirus como de la capacidad del sistema de atención médica para lidiar con él.

Read more

High Demand; Short Supply. Meeting the Oxygen needs of COVID-19 Patients in the Rio Grande Area & Beyond

While our focus remains on treating the sickest COVID-19 patients in the hospital setting, how will we place equal importance on managing the disease post-hospital discharge. Hospitalizations for COVID-19 have been a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.

Globally as of 08/25/2020 , there were 23,518,343 confirmed cases of COVID-19, including 810,492 deaths, reported by the World Health Organization (WHO). Coronavirus cases continue to grow in Texas. From cities to rural towns, COVID-19 is spreading and affecting families, commerce, and travel. Texas is the second largest U.S. state by both area and population and has reported 588,761 cases and 11,391 deaths.

The number of hospitalized patients remains high despite recent decline over the past few weeks. What is important to keep in the forefront of our minds is, what happens now to patients who were once mechanically ventilated or required high levels of oxygen therapy during their treatment? For some patients with pre-existing medical conditions, their new reality will be to be sent home with oxygen and perhaps need it for the short term.

Patients that have been discharged from the hospital or those who treated their symptoms in the hospital are now being called “long-haulers”. While it is unclear how many survivors become long-haulers, a recent study from the United Kingdom found 1 in 10 people are sick for a least three weeks. People are starting to experience the effects post recovery. Andre Sofair, MD, MHS, a Yale Medicine internal medicine physician was interviewed and states that an estimated 20 to 50% of patients continue to face health challenges after being discharged from the hospital. Yale Medicine is in the process of opening a post-COVID clinic. The concept is much like existing outpatient clinics that treat specific diseases and the focus will be to help relieve residual symptoms, which are mostly but not exclusively pulmonary.

Families In Line for Oxygen

Photo Credit Ruptly: Relatives of patients stand in line to fill oxygen tanks to care for COVID-19 patients.

The Monitor, a local news outlet in McAllen, TX covering Starr and Hidalgo counties, reported that hospitals in the area are experiencing challenges related to COVID-19 and discharging patients on oxygen. “One of the things that we have experienced is oxygen concentrators that are in high demand and short supply,” said Maritza Padilla, Assistant Chief Nursing Officer at DHR Health. While oxygen cylinders are the gold standard for most patients and often is what is readily available at discharge, they may be the only option for home use if the demand continues to grow. When discussing the topic further Dr. Robert Martinez, Chief Medical Officer for DHR Health, stated “I think that has been a big misconception, the inside of the hospital is not short of oxygen. The home — that’s where our challenge has been.”

In a recent July trip to Weslaco, TX, Gov. Greg Abbott told Hidalgo County Judge Richard F. Cortez that the county would be sent oxygen concentrators, additional beds and IV pumps. It remains unclear, though, how many were sent or whether the additional supply was enough to cover the need. A local DME owner told The Monitor that he has never seen a situation where so many patients needing oxygen are being discharged home at the same time. He has been inundated with calls to meet the needs of oxygen patients from San Antonio, TX, and bordering towns in Mexico. He is seeing the effects in his business, experiencing some back order from oxygen concentrator companies.

Case managers and social workers are working tirelessly to ensure that a patient has a safe discharge however it becomes challenging when patients do not have adequate coverage or the means to get oxygen. With COVID-19, the lungs are greatly affected as are other organ systems that rely on the supplemental oxygen that can delivered with an oxygen concentrator. Veronica Silva, Nursing Director of DHR Special Infectious Disease Unit-2 in Edinburg, TX shared that DHR has developed a charity through which they donate needed oxygen to patients and will continue to do so until resources are exhausted.

Other areas of Texas are also experiencing challenges related to COVID-19 and discharge delays due to shortages in oxygen availability. Last month, the Texas Department of State Health Services responded to the call for help that more than 70 hospitals around the state were pleading for.

The Rio Grande Valley area has been overwhelmed with COVID-19 patients and Doctors from Starr County Memorial spoke out. Hospital President, Dr. Jose Vazquez shared in an interview how greatly affected the population has been in the area, most of which are Mexican Americans with high rates of diabetes and obesity. Dr. Vazquez shared his hospital was lacking even the basic medical necessities, oxygen. He said five patients had a delayed discharged and remained admitted to the hospital because they could not get the oxygen they need for their homes.

“You know, when you live in America an oxygen tank or an oxygen concentrator should not be the reason why a patient is not discharged, when you are needing those beds for somebody sicker than you,” Vazquez said. State officials were working on getting oxygen concentrators to the region to free up more beds, however the status of that remains unknown yet.

While the United States of America may not be experiencing an extreme shortage of oxygen in the hospital settings due to more advanced infrastructure, lower-income countries such as Mexico, Peru, Brazil, and India are experiencing such challenges. Shortfalls include extreme measures such as patients and their family members buying overpriced oxygen on the black market for their sick loved ones in Peru. Or as seen in Reynosa, Mexico there is a shortage of oxygen for coronavirus-infected patients who must be treated at home due to the lack of hospital bed availability. Families in Mexico often wait in long lines to have their oxygen tanks filled, waiting for several hours at times, and are paying inflated cost due to demand. A Rental of a tank costing them $400 a month and additionally $200-300 per refill which is needed about every 3 days depending on the level of oxygen needed.

According to information published by the WHO, they are partnering with the United Nations and are working with manufacturers to buy oxygen concentrators for countries that need them most. This has allowed the WHO to buy 14,000 oxygen concentrators, which will be sent to 120 countries. Additionally, it identified 170,000 more that will be available over the next 6 months at a cost of $100 million.

We now know the vital role that oxygen plays in the treatment of COVID-19. Now more than ever it will be imperative to ensure patients that are discharged home post COVID-19 have the appropriate resources, oxygen therapy, available to them and work to meet the growing demand worldwide.

References:
https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/state/texas
https://www.themonitor.com/2020/07/29/lack-oxygen-concentrators-delays-discharge-virus-patients/
https://www.keranews.org/post/inside-rio-grande-hospital-no-icu-during-covid-19-outbreak
https://www.cidrap.umn.edu/news-perspective/2020/06/covid-19-demands-intensify-efforts-ease-oxygen-shortages
https://covidtracking.com/data/us-daily
https://www.yalemedicine.org/stories/covid-19-recovery/
https://www.univision.com/univision-news/covid-19-patients-in-reynosa-mexico-facing-oxygen-shortage-video
https://www.cidrap.umn.edu/news-perspective/2020/06/covid-19-demands-intensify-efforts-ease-oxygen-shortages
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/index.html

 

Oxygen and Wound Care

Oxygen plays a vital role in our daily lives. We breathe because our bodies need oxygen to produce energy. However, in addition to enabling us to function, oxygen’s ability to produce energy plays an important role in wound healing. Wounds that are infected and inflamed have poor blood flow. Exposure to high concentrations of oxygen (e.g. topical or hyperbaric oxygen therapy) helps accelerate healing by reducing inflammation, promoting collagen formation and stimulating the growth of new cells and blood vessels.

Although many factors affect the wound healing process, a study published in the Journal of Wound Care found that the use of topical oxygen therapy helped nearly half of the previously non-healing wounds close.

Traveling with Supplemental Oxygen

Summer vacation time is here, but people with COPD often feel reluctant to travel far from home. However, with proper preparation, even the patients who use supplemental oxygen can safely and easily travel wherever they wish to go, even by air. Here are a few tips:

  • Speak to your doctor about your travel plans.
  • Contact your airline, bus/train carrier or cruise line before your trip to learn their requirements for people traveling with oxygen. Some may require a signed release or documents from your doctor.
  • Portable oxygen concentrators (POC) are approved for air travel and are easy to carry. Be sure to pack additional fully charged batteries for your POC.
  • When choosing a place to stay, be sure it is smoke-free. Be cautious of activities that can trigger a COPD flare up – e.g. if you’re going to be outdoors, take your allergy medications before you leave the house.

The American Lung Association offers information on staying safe and healthy while traveling: https://www.lung.org/about-us/media/top-stories/traveling-with-copd.html

Is there a link between COPD and diabetes?

According to a recent study, there may be a link between COPD and type 2 diabetes. People with COPD suffer from the inflammation of the lungs which causes a chronic obstruction of the airflow, and research suggests that the type of inflammation typical of COPD could be responsible for the development of type 2 diabetes. In turn, the high levels of blood sugar that people with diabetes have due to their high resistance to insulin affect lung function and could potentially increase the risk of developing COPD.

Although more research is needed to better understand the connection, as well as how to best approach the treatment of patients that suffer from both diseases, researchers emphasized that doctors should screen patients for COPD and type 2 diabetes together to improve patient care. Learn more: https://copdnewstoday.com/2019/04/30/type-2-diabetes-copd-increasing-researchers-look-links/

State of the Air – how does your city rank?

The American Lung Association State of the Air 2019 report ranks metropolitan areas based on air quality data. See the list of the cleanest cities (summer vacation time?) and find out which cities are the most polluted: https://www.lung.org/our-initiatives/healthy-air/sota/city-rankings/

 

 

Seasonal Allergies and COPD

Seasonal allergies are very common, but people who have COPD and allergies suffer from worsened respiratory symptoms such as coughing and wheezing. Here are a few tips on avoiding serious complications:

Stay indoors on days with high pollen and mold levels. Many weather sites provide information on the allergen levels in your area. If levels are high, try to stay indoors to reduce symptoms.

Stay indoors during poor air quality days.  Check the air quality index in your area – high amount of air pollution can worsen respiratory symptoms. If you cannot stay indoors, wear a mask to filter out the pollutants and irritants.

Treat your symptoms. If you have runny nose, itchy eyes or other allergy symptoms, talk to your doctor about allergy medications or decongestants to help lessen breathing difficulties.

Get more tips on avoiding COPD complications during allergy season: https://www.healthline.com/health/copd/seasonal-allergies-tips-avoid-complications#1

 

Failure to vaccinate children from measles could lead to chronic lung disease in adulthood

A recent case study report demonstrated the possible future increase in non-Cystic Fibrosis Bronchiectasis (NCFB) cases due to more US adults choosing not to vaccinate their children from measles. Diseases such as pulmonary tuberculosis, measles and whooping cough are strongly associated with NCFB developing in affected people later in life.

NCFB is a chronic condition where the airways are damaged and have become widened with scarred and thickened walls. As mucus builds up, bacteria can grow and the airways can become infected, making it more difficult to clear them. This can ultimately lead to the loss of lung function over time, as well as serious health problems such as respiratory failure, heart failure, and atelectasis.

There is no cure for NCFB. The disease often is treated with medicines, hydration, and chest physical therapy (CPT). Your doctor may recommend surgery if the bronchiectasis is isolated to a section of lung or you have a lot of bleeding. If the bronchiectasis is widespread and causing respiratory failure, your doctor may recommend oxygen therapy.

Learn more: http://bit.ly/2vIKvTe and http://bit.ly/2vH6eLq