Incontinence/ End Stage COPD

#1 Dee

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07 June 2010 - 08:37 AM

Q. Incontinence/ End Stage COPD

I have end stage COPD. I am wondering about a time line. When I have an attack it starts...then it exacerbates ..when it gets bad I peee myself and that's mi 911 trigger. is that too late or a good guide? after that point if I black out and loose bowel function how long do I have to get emergency breathing before I die.


A. Hi Blair,

Your problems are classic for someone who has resorted to sitting more than moving as moving provokes increasingly difficult breathing and so is to be avoided. That, while being a very understandable response to increasing difficulties, is ALSO the recipe for disaster and early demise. Your question cannot be answered as you ask it because you make certain assumptions that are in error which renders the rest of your conditional question inaccurate. End stage COPD, while used a lot and rather cavalierly bandied about is a meaningless term, a primary reason why it has been abandoned and replaced with a well-defined “staging” system through the efforts of the WHO and the GOLD classification.

It has been my frequent observation that when folks lose urinary continence, it is because they have become hypoxic AND they have succumbed to a significant degree of anxiety and panic. I would wonder is you are not becoming hypoxic and THAT is why you lose continency. It does not ‘necessarily’ follow that after losing urinary continence you would go on to worsen to lose bowel continence and/or black out. That is just not predictable. As such, there is no way to say that you would then go on to die, OR that you would have any other predictable response of so serious a nature. But, the likelihood of you dying from such a sequence as you present it is simply not there. Death is NOT that predictable.

I would urge you to have your oxygen measured WHILE YOU WALK for at least 2 minutes to see if your saturation is dropping a lot. If it is and you are not currently using oxygen, you SHOULD be started on it. If you ARE using oxygen, then you need to learn how much it needs to be increased in order to keep you from dropping so low as to lose continence.

Best Wishes, Mark
Mark Mangus, Sr. BSRC, RRT, RPFT, FAARC


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