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COPD progression???


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#1 jarity

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Posted 06 February 2010 - 09:58 PM

Does everyone eventually go on 02? Is copd ALWAYS progressive? Does morphine help in our later stages?

Have asked this question in other forums and never received a "straight answer".

#2 LoganLarry

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Posted 08 February 2010 - 09:07 AM

Okay my friend, straight answers are my speciality!

Lets start by saying there are a tremendous number of variables to any disease and COPD as a classification is no different. The term encompasses many clinical states; Emphysema, chronic bronchitis, or a combination of the two being the most frequent. the progression of the disease also has variables so it would be difficult to get a definitive answer on such a topic. I would encourage you to read other areas of this site for information or google emphysema and read the patient information sections provided by many of the drug companies.

Now that we have the disclaimer out of the way let me share my experience of 30+ years in the field with you.

Lets start with the easy one. In my experience if you have COPD and you continue to smoke 1) The disease continues to progress 2) As you accumulate
"pack years" (pack years is the packs per day you smoke x the years you have smoked) the chances of stabilizing the disease decrease.
So if you are currently a smoker, and do not plan to quit the answer to all of your questions is probably yes.

"Does EVERYONE, ALWAYS, go on O2"
Everyone, always is an automatic NO. Everyone doesn't always do anything.
Depending on the stage of your COPD, and the underlying cause, the disease can often be stabilized with treatment and rehabilitation to delay, or in some cases eliminate the need for oxygen therapy. When O2 is used it is often used due a cardiac condition related to long term low oxygen levels in the blood (congestive heart failure), sometimes it is only used at night to prevent oxygen dips during sleep.......and in many patients it is not used.
Now if your disease has progressed significantly O2 will often be needed as a part of your medical management.

"Is COPD always progressive?"
Well, it is not a reversible disease...........but as above, it can often be stabilized, especially in the early stages. I am a part of the national Lung Health Education Program with my late dear friend & colleague Dr. Petty. The message we send is early PFTs (spirometry) should be available in every physicians office, and a "baseline" test should be given by the age of 40. If this were done, and patients could be identified and treated early, there would seldom be the "off the cliff" progression we now see. Spirometry can identify changes in lung function, before you feel any symptoms, just like an ECG can identify heart problems before you have an incident. Once you have symptoms your lung function is often at 50-60% of what it should be (predicted).

In late stage COPD the disease often has a predictable pattern. Treatment and rehab can slow progression of symptoms, and greatly extend the quaility of ones life, but once you have a loss of 70-80% of functional tissue it will have an impact on your daily functions. Which leads to the next question "Does Morphine help in our later stages?" What morphine will do is decrease the feeling of shortness of breath in end stage COPD. It masks the symptom and allows one to be more comfortable. It also is a respiratory depressant, so it has a limited role in the palliative care of the individual.
There are other medications your physician may chose rather than morphine based on your individual needs.

SO..... often the disease requires more & more treatment to slow or stabilize progression, but often effective therapy can plateau the disease at a level that allows you to function well. Your respiratory "reserves" will be lower than a person your age without lung disease and colds, flu, pneumonias will hit you harder and must be avoided or aggressively treated. Adherence to the treatment program is essential, and maintaining health in other ways (diet /exercise) all contribute to a more age appropriate lifestyle. In my opinion it is important to be treated by a lung specialist in all but the
the earliest stages of the disease.
I Hope this helps .......any other RTs can jump in as well...but that is the straight story in my experience.


Larry

#3 Jane M. Martin

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Posted 08 February 2010 - 11:02 AM

Jarity, great question to start off the day!

Larry, you did a fantastic job of explaining this. I could not agree more. You're right, there are many variables in COPD -- especially when other body systems such as cardiac are involved.

It sounds simple, but --
Stopping smoking, exercising, taking the right medications in the correct way, eating properly for pulmonary disease, wearing your oxygen as prescribed.....and keeping a positive attitude can keep you going for a long, long time! There are some people in pulmonary rehab who (if they were not involved in rehab) would otherwise be stuck in that Lazy Boy chair at home....very short of breath... or worse. It is amazing how well they do with the right care and sticking to these basics. Just keeping on track makes all the difference.

Keep those questions coming!

Jane.
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#4 jarity

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Posted 08 February 2010 - 12:18 PM

View PostLoganLarry, on Feb 8 2010, 10:07 AM, said:

Okay my friend, straight answers are my speciality!

Lets start by saying there are a tremendous number of variables to any disease and COPD as a classification is no different. The term encompasses many clinical states; Emphysema, chronic bronchitis, or a combination of the two being the most frequent. the progression of the disease also has variables so it would be difficult to get a definitive answer on such a topic. I would encourage you to read other areas of this site for information or google emphysema and read the patient information sections provided by many of the drug companies.

Now that we have the disclaimer out of the way let me share my experience of 30+ years in the field with you.

Lets start with the easy one. In my experience if you have COPD and you continue to smoke 1) The disease continues to progress 2) As you accumulate
"pack years" (pack years is the packs per day you smoke x the years you have smoked) the chances of stabilizing the disease decrease.
So if you are currently a smoker, and do not plan to quit the answer to all of your questions is probably yes.

"Does EVERYONE, ALWAYS, go on O2"
Everyone, always is an automatic NO. Everyone doesn't always do anything.
Depending on the stage of your COPD, and the underlying cause, the disease can often be stabilized with treatment and rehabilitation to delay, or in some cases eliminate the need for oxygen therapy. When O2 is used it is often used due a cardiac condition related to long term low oxygen levels in the blood (congestive heart failure), sometimes it is only used at night to prevent oxygen dips during sleep.......and in many patients it is not used.
Now if your disease has progressed significantly O2 will often be needed as a part of your medical management.

"Is COPD always progressive?"
Well, it is not a reversible disease...........but as above, it can often be stabilized, especially in the early stages. I am a part of the national Lung Health Education Program with my late dear friend & colleague Dr. Petty. The message we send is early PFTs (spirometry) should be available in every physicians office, and a "baseline" test should be given by the age of 40. If this were done, and patients could be identified and treated early, there would seldom be the "off the cliff" progression we now see. Spirometry can identify changes in lung function, before you feel any symptoms, just like an ECG can identify heart problems before you have an incident. Once you have symptoms your lung function is often at 50-60% of what it should be (predicted).

In late stage COPD the disease often has a predictable pattern. Treatment and rehab can slow progression of symptoms, and greatly extend the quaility of ones life, but once you have a loss of 70-80% of functional tissue it will have an impact on your daily functions. Which leads to the next question "Does Morphine help in our later stages?" What morphine will do is decrease the feeling of shortness of breath in end stage COPD. It masks the symptom and allows one to be more comfortable. It also is a respiratory depressant, so it has a limited role in the palliative care of the individual.
There are other medications your physician may chose rather than morphine based on your individual needs.

SO..... often the disease requires more & more treatment to slow or stabilize progression, but often effective therapy can plateau the disease at a level that allows you to function well. Your respiratory "reserves" will be lower than a person your age without lung disease and colds, flu, pneumonias will hit you harder and must be avoided or aggressively treated. Adherence to the treatment program is essential, and maintaining health in other ways (diet /exercise) all contribute to a more age appropriate lifestyle. In my opinion it is important to be treated by a lung specialist in all but the
the earliest stages of the disease.
I Hope this helps .......any other RTs can jump in as well...but that is the straight story in my experience.


Larry


#5 Guest_Eileen/MA_*

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Posted 08 February 2010 - 12:20 PM

I've seen this posted before and Jane asked me to post it here:

Fletcher-Peto curve
Posted Image

#6 jarity

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Posted 08 February 2010 - 12:26 PM

Thanx everyone. That was a big help in understanding.

i was wondering because over 3 yrs my fev1 was 45, 47 and 49 premed. i quit smoking immediately and started walking 1 hour/day 7 days a week and except for a short time (depression) never quit. Diagnosed 3 yrs ago and 6 exacerbates later.
I think only 2 were real. the other were self induced because i panicked and did not understand what was happening to me.
The question was because i was wondering what's in store for me in the future.
Thanx again.

#7 Jane M. Martin

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Posted 08 February 2010 - 12:49 PM

Just a quick comment here......

If your FEV1 is in the 40%'s, although that is significantly down from 100% (perfect lung function), it is still not terrible. Many of the patients in our program are in the 20% range, and they are still going strong. The walking exercise will help you tremendously. I probably don't have to be telling YOU that! :lol: Keep it up!

The panic and anxiety is a monster but one that can be put in its place. We have some really good info on our site on this subject that comes from Dr. Vijai Sharma who is a psychologist, certified yoga instructor and also a COPD patient -- the perfect combination for understanding panic and anxiety with COPD! Take a look. There is a wealth of info and practical help here! Click on the following link and then once on our articles page, click on the bullet points for easy-to-read material and practice activities once your doctor has looked it over and approved it for your use. http://www.breathing...om/articles.php


Keep on asking questions -- and learning!

Jane.
B)

#8 LoganLarry

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Posted 08 February 2010 - 01:44 PM

Jarity ...... Lots to learn on this site, great references from Jane.

Talk with your physician, keep on walking, add some strength training, and GO!

FEV1 of 40% is VERY workable, but it is time to get after it my friend......there is a lot you can do to stabilize your condition.
As with most things, "Your future is in your hands!"

Best of Luck, and stop by anytime with other questions

Larry

#9 jarity

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Posted 08 February 2010 - 02:06 PM

View PostJane M. Martin, on Feb 8 2010, 12:49 PM, said:

Just a quick comment here......

If your FEV1 is in the 40%'s, although that is significantly down from 100% (perfect lung function), it is still not terrible. Many of the patients in our program are in the 20% range, and they are still going strong. The walking exercise will help you tremendously. I probably don't have to be telling YOU that! :) Keep it up!

The panic and anxiety is a monster but one that can be put in its place. We have some really good info on our site on this subject that comes from Dr. Vijai Sharma who is a psychologist, certified yoga instructor and also a COPD patient -- the perfect combination for understanding panic and anxiety with COPD! Take a look. There is a wealth of info and practical help here! Click on the following link and then once on our articles page, click on the bullet points for easy-to-read material and practice activities once your doctor has looked it over and approved it for your use. http://www.breathing...om/articles.php


Keep on asking questions -- and learning!

Jane.
:P


#10 jarity

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Posted 08 February 2010 - 02:15 PM

Thanx again people.
Just want to add that Dr. Vijai Sharma was one of the first people i found on the web. I was so glad to be able to buy a CD with info!! I "discovered" PLB thru this CD and began to get an idea of the landscape. I will not go thru the horror stories till i discovered there was something called a pulmo. And even then i had to search till i found a keeper. You see i was in such mental and physically bad shape i thought i had to take anything i could get and be thankful. It was these forums incl. this one that helped me so much. At first I would come and just lurk! Scared to post or ask. COPD?! Is that what they say is wrong with me?

#11 Guest_Eileen/MA_*

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Posted 08 February 2010 - 04:16 PM

Jarity, I think a lot of us could say the same thing. You get diagnosed and left to fend for yourself for in-depth information about COPD. There are times that I will print something out and give it to my PCP because he just doesn't have the most current information that's out there.

Message boards, especially this one, gave me the support and courage to move on with COPD, not just sit around waiting to die!





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