MEDICAL MATTERS:Early diagnosis is the key to improving the quality of life for people with COPD, wrties MUIRIS HOUSTON
I WAS TRAVELLING by train last week when I noticed a rather forlorn figure at the far end of the carriage. The man in his 60s had stood up and was gripping the seat intensely.
Somewhat barrel-chested, he seemed to be breathing heavily. After a few minutes he sat down again. A quarter of an hour later he was up again, this time leaning over the back of the seat. On closer inspection, I noticed he was blue in the face and his lips were pursed as he sought to get more air into his lungs.
Then the diagnostic penny dropped – the man had fairly severe chronic obstructive pulmonary disease (COPD) and was probably in a category of patient referred to in the past as a “blue bloater”. This is a reference to the appearance of a person with airways obstruction who appears blue because he is cyanosed from retained carbon dioxide and is bloated looking.
He had also developed a breathing pattern commonly seen as the disease worsens, whereby some people find it more comfortable to stand with their arms outstretched and with their palms taking their weight. This manoeuvre improves the function of the diaphragm.
I walked up the carriage to ask if he was okay, and displaying the stoicism that is the hallmark of the person with chronic respiratory disease, he waved me away.
From now until next March is the worst time of the year for these patients, when our acute hospitals typically see a 40-50 per cent increase in the number of people admitted due to an exacerbation of COPD.
During an exacerbation, a person with COPD will experience a rapid worsening of symptoms such as severe breathlessness, wheeze, nasal congestion and cough. Infected mucus in the lungs leads to a huge increase in sputum production.
COPD is an umbrella term for two diseases: chronic bronchitis (inflammation and narrowing of the airways) and emphysema (weakening of the structure of the lung). A progressive disease most often linked with smoking, it causes chronic breathlessness that can lead to severe disability.
Essentially, COPD limits the flow of air leading to excess air being trapped in the lungs after a person has breathed out. Known as “airtrapping” it is the main cause of breathlessness in a person with COPD.
Last Wednesday was World COPD day, aimed at improving global awareness of the common condition. Noting it affects more than 300,000 people in the Republic, president of the Irish Thoracic Society (ITS), Dr Terry O’Connor, said: “COPD can be enormously debilitating, with symptoms such as breathlessness restricting a patient’s ability to perform even normal everyday activities such as climbing stairs. Detection, treatment and early intervention in patients with COPD can greatly improve a person’s quality of life.”
And at its recent scientific meeting in Galway, the ITS discussed the latest research involving COPD. Outreach nurse, Niamh McCormack, of the department of respiratory medicine at Beaumont hospital, reported on the impact of giving patients a “respiratory passport”.
Containing essential information about the disease and with individual guidance on how to manage an exacerbation of the condition, McCormack and her colleagues found that those given the “passport” were less likely to experience an exacerbation of their illness.
Meanwhile, researchers at the departments of physiotherapy and respiratory medicine at St Michael’s Hospital, Dún Laoghaire, looked at how a pulmonary rehabilitation programme might be improved.
They put 45 patients with an average age of 69 years through an eight-week programme involving exercise sessions separated by rest intervals and found the participants significantly improved their exercise endurance. They also experienced less breathlessness and their quality of life improved.
How might you know if you had COPD? If you answer yes to three or more of these questions, then it’s worth asking your doctor if you might have the condition.
1. Do you cough several times most days?
2. Do you bring up phlegm or mucus most days?
3. Do you get out of breath more easily than others your age?
4. Are you over 40 years old?
5. Are you a current smoker or an ex-smoker?
And remember, as admirable a quality as stoicism is, the earlier you are diagnosed, the better your quality of life.