Patricia Robertson couldn’t understand what was happening – everything in her life seemed to be on a vicious downward spiral. “Anything I did that required physical activity – making dinner, doing the laundry or cleaning the house – became an unbearable task,” she recalls. Despite the fact she’d always been a weekend hiker and golfer, these activities soon became a burden. Patricia was now spending most of her time sitting on the sofa, unable to summon the strength – or the willpower – to do anything.
“I let all my friendships slide until I quit going out altogether,” says Patricia. “And it all happened so gradually, I didn’t even notice.”
Barely able to make it through the week at her highly stressful job as a Toronto condominium manager, she’d come home exhausted on Friday. “I had no energy and became depressed and angry at myself – I thought maybe I was just being lazy.”
But there was obviously more to it than that. Patricia vividly remembers the terrible weekend she spent in bed, struggling to breathe – “I felt like I was drowning.” Finally, she visited her doctor, who placed her on oxygen and called for an ambulance. Patric was suffering from a severe respiratory condition known as Chronic Obstructive Pulmonary Disease (COPD).
What is COPD?
Patricia is just one of more than 1.5 million Canadians, most over the age of 50, who have either been diagnosed with COPD or live with the disease without knowing it. The disease affects the airways, causing them to become progressively plugged or damaged, making every breath a huge ordeal. Because much of the air gets trapped in the lungs, some patients compare COPD to breathing through a straw.
The condition is associated with two main breathing disorders – chronic bronchitis and emphysema. Chronic bronchitis is an inflammation of the bronchial tubes, the airways that lead to the lungs, causing patients to experience a mucus-producing cough. Emphysema is usually free from cough and mucus, but the destruction of air sacs (alveoli) in the lungs results in permanent difficulty in breathing.
With either bronchitis or emphysema, air gets trapped in the lungs – patients experience shortness of breath (dyspnea) and are unable to supply their bodies with sufficient oxygen. Without oxygen, the body becomes easily fatigued and COPD patients, like Patricia, often compensate by reducing their physical activity. This further complicates the problem – the muscles weaken and the body begins a downward spiral. If left untreated, COPD could ultimately lead to death.
The number one cause of COPD is smoking, though there are other risk factors, such as genetics or exposure to pollution. Once considered an illness that primarily affects men, COPD now affects more women.1 And it’s an increasingly common condition – one Canadian every hour dies from COPD, which is now the fourth leading cause of death in Canada. 2
Next page: Living with COPD
Living with COPD
Despite the fact that COPD is incurable, Patricia Robertson and many patients like her have learned to make lifestyle adjustments that will help them manage their disease. Patricia credits the COPD rehabilitation program for putting her life back on track. “I may not be able to play 18 holes of golf anymore,” she says. “But I can still play nine.” Best of all she’s got energy now: “I can walk up to one kilometre!” she says, enthusiastically.
“The idea behind the COPD rehabilitation program is to help patients get back on their feet and regain control of their lives,” say Meeran Manji, a registered nurse at the Cardiac/Pulmonary Wellness Centre at Toronto Western Hospital. “First, we find out what their goals are. Some want to get well enough to get out of their wheelchair, others want to swim again,” she says. “Then, we measure the patient’s fitness capacity and provide them with a range of tools that will help them reach their goals.” For some people, goals can be as simple as getting out of bed and going to work or playing with their grandchildren.
COPD rehabilitation programs focus on four key areas: breathing, exercise, nutrition and medication.
Breathing: Patients learn techniques such as “pursed-lip” and “diaphragmatic” breathing that help them conserve energy by decreasing the work of inhaling and exhaling.
Exercise: A daily exercise plan will increase heart and lung function, build strength and reduce shortness of breath. The COPD rehabilitation program monitors patients’ initial workouts to make sure they’re safe and then provides them with an easy-to-follow plan they can do on their own. The long-term goal is to gradually increase their activity levels. Part of the exercise program includes teaching patients to move in smarter, energy-conserving ways. A physiotherapist teaches patients how to properly get in and out of bed, walk up stairs, sit down and stand up, and lift and carry in a way that puts as little strain on the body as possible. Patients are also given tips on how they can organize their houses in such a manner that everything becomes easily accessible.
Nutrition: A diet high in protein, fruits, vegetables and grains that provides high energy.
Medication: Perhaps the most important part of the rehabilitation program, patients with COPD must rely on medication to help overcome breathing difficulties. Inhaled medications that relax and open the airways (bronchodilators) are the most common.
Recent research into new therapies, including convenient once-daily dosing options, is showing significant improvement in shortness of breath and lung function.
“When symptoms of COPD develop, most people reduce their physical activity and spiral into immobility,” explains Dr. Denis O’Donnell, head of the Division of Respiratory and Critical Care Medicine at Queen’s University, Kingston, Ont. Dr. O’Donnell says there are new medications on the horizon that will help COPD sufferers reduce “the air trapped in the lungs, allowing the patient to take fuller breaths and continue to exercise longer without needing to take a break.”
Many people with COPD assume their symptoms are just a sign of age, explaining why Dr. O’Donnell calls COPD an “incredibly under-diagnosed” disease. Like most diseases, the earlier you’re diagnosed, the better your chances of managing your condition.
That’s why it’s so important to visit your doctor if you recognize COPD symptoms. With an early diagnosis, your doctor can prescribe the right medical treatment and refer you to an appropriate rehabilitation program.
Do you have Chronic Obstructive Pulmonary Disease, or COPD?
Answer these questions:
If you answer “yes” to two or more of these questions, ask your doctor to test you for COPD.
1. CIHI, Canadian Lung Association,Health Canada, Statistics Canada. Respiratory Disease in Canada. September 2001. 2. Statistics Canada. Selected leading causes of death, by sex. 1997.
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