Treatment of Chronic Obstructive Pulmonary Disease

Stopping smoking is probably the best decision you can make. Although it is difficult, it is not impossible and has many beneficial effects. Go to your Primary Care Centre, since there are many health professionals that will be able to help you to quit this habit and it will be easier to achieve it.

Where to start

• Why do I smoke? Ask yourself why you smoke every time you light up a cigarette, and remember that smoking is the first cause of avoidable death in the developed countries.
• Look for motivation. Write a list with the reasons, think again about how much and when you smoke and make a daily record sheet: day, time, place / activity, reason.
• Avoid situations that are associated with smoking.
• Time of making the decision to stop smoking. Go over the list of reasons for stopping smoking; think of a date within the next four weeks; try not to choose a conflictive date, and fix a day for stopping.
• Tell everyone in your closest circle. Once the decision is made, tell your family, friends, work colleagues.
• Calculate what you are saving. It is advisable to calculate the money that you spend on smoking; think about what you will be able to do with what you save.
• Support. Look for support from a relative or friend who smokes, to try to stop at the same time.
• Avoid the temptation. Remove everything associated with tobacco: ash trays, lighters, cigarettes.

What must I do?

• Get up in the morning a little earlier than usual, do some physical exercises and drink plenty of water and fruit juices. You have to try to be active all day and make the decision not to smoke each day.

The perseverance of not smoking

• Practice any physical activity. It is advisable to have a diet rich in fruit and vegetables. Try not to drink, for now, drinks that are usually accompanied by tobacco, such as coffee, for example.
• If the desire to smoke is very strong. You must not worry. You have to relax, breathe deeply, concentrate on what you are doing, and remember that the desire to smoke only lasts 2 minutes and then its disappears.
• Replacements. There are chewing gums, patches or drugs that can help, but you should remember that to achieve success the most important is the personal commitment. In any event, if you need help you can always consult the health professionals.
• Do not give in not for a single cigarette. The desire to smoke decreases after the second or third week.
• Congratulate yourself every day that you pass without smoking.

The administration of drugs by inhalation is increasing. The possibility of using drugs in very small doses and make them reach the respiratory system (target organ), the place where they are going to develop their action, provide tranquillity to the patient and the prescribing physician. The positive effects are rapid and effective and have few undesirable effects.

There are many commercial devices used for the administration of the drug, which leads to a more personalised care when proposing a device that better adapts to the needs of the patient, together with proper instruction on the technique. Furthermore, each inhalation device may contain one or several drugs within it. The duration of the dose of each drug is different. Therefore, to know the different inhalation systems and the different possibilities of the drugs available, are important aspects to take into account.

• Bronchodilators. Increase the diameter of bronchi when these have narrowed. The short-acting ones are taken every four or six hours, and the prolonged action ones, every twelve hours.
• Anticholinergics. Act like the bronchodilators: Short-acting (every 4 or 6 hours) and Long-acting (every 24 hours)
• Anti-inflammatory drugs.
• Corticosteroids. Reduce inflammation of the bronchial mucosa. The effect of these medications is noted after several days and last for 12 hours.

In the case of chronic respiratory diseases it is important to take the prescribed medication. Avoid self-medication and stopping the treatment. Do not increase or decrease the doses. The medical team will instruct you when you must take them.

One important aspect is taking the medication every day and done it correctly. Many patients believe that, as they have used sprays for many years they already know how to use them. But this is not the case. Only a small group of patients know how to correctly perform the inhaler technique.

Home oxygen is a treatment that is administered always using the arterial blood gases results when the patient is in a clinically stable condition. The blood specimen is taken when the patient breathes room air (at least 30 minutes after having stopped taking the oxygen).

The current recommendations for the indication of continuous home oxygen therapy in the stable phase of COPD are: patients that have an arterial blood oxygen level (PaO2) less than 55 mmHg or between 55 and 60 mmHg, if they have an increase in red blood cell volume (polycythaemia), heart disease or heart failure. In any case, all patients with COPD must receive oxygen for a minimum of 15 hours/day (including sleeping hours). The doctor who prescribes the oxygen therapy indicates the amount required, measured in litres per minute (L/m) and the time that it should be used. The most usual oxygen flows that are used vary between 1-3 litres/minute.

There is no evidence that continuous home oxygen therapy has a long-term benefit if it is administered to patients with COPD that only have a nocturnal decrease oxygen pressure or induced by exercise. Oxygen is not addictive or toxic, so it is very important to use it continuously as prescribed by the doctor.

Home mechanical ventilation (HMV) is a type of ventilation that can be safely used outside the hospital, and is used to boost, or even replace, spontaneous ventilation.The administration of oxygen is passive, that is to say, it offers a higher oxygen concentration that the patient inhales with their own effort. In mechanical ventilation, the different types of devices actively assist spontaneous breathing.

To carry out HMV, an apparatus that generates the airflow (called a ventilator) has to be used, as well as a mechanism that connects the apparatus with the airway. In the majority of cases, this connection is achieved using a nasal or facial mask, or a mouthpiece. In other cases, this type of ventilation has to be carried out through a tracheotomy.

HMV improves the survival of patients with neuromuscular diseases and those of the thoracic cavity, as well as improving anomalies in gas exchange and the quality of life of patients with obesity-hypoventilation syndrome (OHS).

Its role in COPD is controversial and recent studies do not appear to show any improvement in survival. Its effects on lung mechanics, breathlessness or shortness of breath (dyspnoea) or the quality of life are still being studied.

Hospital at home is an alternative care program for COPD patients who suffer decompensations. There is evidence that shows that to treat COPD decompensations at home in well-selected patients is as safe as in hospital. The impact on the patient is very positive and also has a great impact on the health system. The absence of a competent carer or clinical instability contraindicates this alternative.