What are the end-stage symptoms of COPD. How does COPD progress through its stages. Can emphysema cause death. What treatment options are available for end-stage COPD. How can palliative care help COPD patients.

Understanding COPD: A Progressive Respiratory Condition

Chronic obstructive pulmonary disease (COPD) is a group of progressive respiratory conditions, primarily including emphysema and chronic bronchitis. As COPD advances, it significantly impairs the body’s ability to absorb oxygen, potentially leading to fatal outcomes. The Centers for Disease Control and Prevention (CDC) reports that chronic lower respiratory diseases, with COPD being the most prevalent, ranked as the third leading cause of death in the United States in 2014.

COPD’s progression is relentless, and understanding its stages and symptoms is crucial for patients and caregivers. How does COPD impact a person’s quality of life as it progresses? The disease gradually diminishes lung function, making breathing increasingly difficult and affecting daily activities.

The Stages of COPD: From Mild to End-Stage

COPD progression is typically categorized into four stages, based on lung function tests and symptom severity:

1. Mild (Stage 1): FEV1 above 80% of normal
2. Moderate (Stage 2): FEV1 between 50-80% of normal
3. Severe (Stage 3): FEV1 between 30-50% of normal
4. End-stage (Stage 4): FEV1 below 30% of normal

FEV1, or forced expiratory volume in one second, measures the amount of air a person can forcefully exhale in one second. As COPD progresses, this value decreases, indicating worsening lung function.

Symptoms Across COPD Stages

• Mild: Subtle symptoms, often unnoticed
• Moderate: Chronic cough, excess mucus, shortness of breath
• Severe: Chronic cough, difficulty with daily activities, fatigue
• End-stage: Severe impact on daily life, frequent flare-ups

End-Stage COPD: Recognizing Critical Symptoms

End-stage COPD presents with a range of severe symptoms that significantly impact a person’s quality of life. How can one identify the signs of end-stage COPD? Key clinical indicators include:

• Low blood oxygen (hypoxemia)
• Hypoxia (low oxygen in body tissues)
• Cyanosis (bluish skin discoloration)
• Chronic respiratory failure

Beyond these clinical signs, patients may experience:

• Severe limitations in physical activities
• Frequent and severe flare-ups
• Increased hospitalizations
• Confusion or memory loss
• Anxiety or depression
• Changes in breathing patterns

The Link Between Emphysema and Mortality

Can emphysema cause death? As a form of COPD, emphysema is indeed a potentially fatal condition. It progressively destroys the air sacs in the lungs, reducing their ability to transfer oxygen to the bloodstream. This gradual decline in lung function can ultimately lead to respiratory failure and death if left untreated or poorly managed.

However, it’s important to note that many COPD patients, including those with emphysema, may not die directly from oxygen deprivation. Cardiovascular complications are also a significant concern. Studies have shown that within five years of diagnosis, COPD becomes an independent risk factor for sudden cardiac death.

Treatment Options for End-Stage COPD

While COPD is a terminal condition, various treatment options can help manage symptoms and improve quality of life in the end stages. What treatments are available for patients with end-stage COPD?

• Supplemental oxygen therapy
• COPD-specific medications
• Palliative care for pain and distress management
• Hospice care for end-of-life support

It’s worth noting that while supplemental oxygen and COPD medications may continue to provide some relief, their effectiveness might decrease in the later stages of the disease.

The Role of Palliative Care in End-Stage COPD

Palliative care plays a crucial role in managing end-stage COPD by focusing on symptom relief and improving quality of life. How can palliative care benefit COPD patients? This approach offers:

• Assistance with daily activities
• Pain management medications
• Techniques to alleviate breathlessness
• Treatment for anxiety, depression, or insomnia
• Mind-body therapies like yoga
• Complementary therapies such as massage

Palliative care aims to address not only the physical symptoms of COPD but also the emotional and psychological challenges that patients face.

Hospice Care: Prioritizing Comfort in End-Stage COPD

For many patients with terminal conditions like end-stage COPD, hospice care provides invaluable support. What does hospice care offer to COPD patients? Hospice services focus on:

• Ensuring patient comfort
• Alleviating distress and pain
• Providing emotional and spiritual support
• Helping patients and families come to terms with the end of life

Hospice care prioritizes the overall well-being of the patient, aiming to provide a peaceful and dignified end-of-life experience rather than pursuing aggressive life-prolonging treatments.

Addressing Psychological Aspects of End-Stage COPD

The psychological impact of end-stage COPD can be as challenging as the physical symptoms. How does end-stage COPD affect a patient’s mental health? Many patients experience:

• Anxiety about death and dying
• Concerns about their legacy
• Worry about family members left behind
• Spiritual or existential questions

Addressing these psychological aspects is crucial in providing comprehensive care for end-stage COPD patients. Mental health support, counseling, and spiritual care can significantly improve a patient’s quality of life and help them find peace in their final days.

Coping Strategies for COPD Patients and Caregivers

Coping with end-stage COPD can be challenging for both patients and their caregivers. What strategies can help in managing this difficult time?

• Open communication about fears and concerns
• Seeking support from mental health professionals
• Engaging in relaxation techniques or meditation
• Participating in support groups for COPD patients and caregivers
• Planning for the future and discussing end-of-life wishes

These strategies can help alleviate anxiety, improve emotional well-being, and foster a sense of control during a challenging period.

Advanced Care Planning in End-Stage COPD

Advanced care planning is an essential aspect of managing end-stage COPD. Why is advanced care planning important for COPD patients? It allows individuals to:

• Express their wishes for end-of-life care
• Designate a healthcare proxy
• Make decisions about life-sustaining treatments
• Ensure their values and preferences are respected

By engaging in advanced care planning, patients can maintain a sense of autonomy and ensure that their care aligns with their personal values and desires.

The Importance of Communication in End-Stage COPD Care

Effective communication between patients, families, and healthcare providers is crucial in managing end-stage COPD. How can communication improve end-of-life care for COPD patients? Open and honest discussions can:

• Clarify treatment goals and expectations
• Address fears and concerns about the dying process
• Ensure that the patient’s wishes are understood and respected
• Help families prepare for the loss of their loved one

Healthcare providers play a vital role in facilitating these conversations and providing clear, compassionate information about the progression of COPD and available care options.

Research and Future Directions in COPD Treatment

While COPD remains a terminal condition, ongoing research offers hope for improved treatments and management strategies. What areas of COPD research show promise? Current research focuses on:

• Novel anti-inflammatory medications
• Stem cell therapies for lung regeneration
• Gene therapy approaches
• Improved inhaler technologies
• Personalized medicine strategies

These research directions aim to slow disease progression, improve symptom management, and ultimately enhance the quality of life for COPD patients at all stages of the disease.

The Role of Prevention in Combating COPD

While much focus is placed on treating end-stage COPD, prevention remains a critical strategy in combating this disease. How can COPD be prevented? Key preventive measures include:

• Smoking cessation and avoidance of secondhand smoke
• Minimizing exposure to air pollutants and occupational hazards
• Regular exercise and maintaining a healthy weight
• Early detection and management of respiratory infections
• Vaccination against influenza and pneumococcal disease

By emphasizing prevention and early intervention, the medical community hopes to reduce the incidence and severity of COPD, potentially decreasing the number of patients reaching end-stage disease.

Living with End-Stage COPD: Maintaining Quality of Life

Despite the challenges of end-stage COPD, many patients can maintain a meaningful quality of life with proper care and support. How can individuals with end-stage COPD improve their daily life? Strategies include:

• Adhering to prescribed treatment plans
• Engaging in pulmonary rehabilitation programs
• Practicing energy conservation techniques
• Maintaining social connections and pursuing enjoyable activities
• Utilizing assistive devices to aid in daily tasks

By focusing on what they can do rather than limitations, patients with end-stage COPD can find ways to enjoy life and maintain a sense of purpose.

The Impact of COPD on Families and Caregivers

End-stage COPD not only affects patients but also has a significant impact on families and caregivers. How does caring for a COPD patient affect family members? Caregivers often experience:

• Emotional stress and burnout
• Physical exhaustion from providing care
• Financial strain due to medical expenses and lost work time
• Social isolation as caregiving responsibilities increase
• Anticipatory grief as the patient’s condition worsens

Recognizing and addressing the needs of caregivers is crucial in providing comprehensive care for COPD patients. Support groups, respite care, and counseling services can help caregivers manage the challenges associated with caring for a loved one with end-stage COPD.

Ethical Considerations in End-Stage COPD Care

The management of end-stage COPD often involves complex ethical considerations. What ethical issues arise in end-stage COPD care? Key considerations include:

• Balancing quality of life with life-prolonging treatments
• Respecting patient autonomy in treatment decisions
• Managing resource allocation for high-cost interventions
• Addressing cultural and religious preferences in end-of-life care
• Navigating family disagreements about care decisions

Healthcare providers must navigate these ethical challenges while ensuring that patient dignity and preferences remain at the forefront of care decisions.

The Role of Multidisciplinary Care Teams

Managing end-stage COPD requires a comprehensive approach involving various healthcare specialists. How does a multidisciplinary team benefit COPD patients? A collaborative care team typically includes:

• Pulmonologists for respiratory management
• Nurses specialized in respiratory care
• Respiratory therapists for breathing treatments and education
• Physical therapists for mobility and exercise programs
• Nutritionists for dietary guidance
• Social workers for psychosocial support
• Palliative care specialists for symptom management

This team-based approach ensures that all aspects of a patient’s health and well-being are addressed, leading to more comprehensive and effective care.

The Global Impact of COPD: A Public Health Perspective

COPD is not just a personal health issue but a significant global public health concern. How does COPD affect populations worldwide? Key global impacts include:

• High mortality rates, particularly in low- and middle-income countries
• Substantial economic burden due to healthcare costs and lost productivity
• Strain on healthcare systems, especially during exacerbations
• Reduced quality of life for millions of affected individuals
• Increased focus on tobacco control and air quality improvement initiatives

Addressing COPD on a global scale requires coordinated efforts in prevention, early detection, and improved access to care, particularly in resource-limited settings.

Emerging Technologies in COPD Management

Technological advancements are opening new avenues for COPD management, even in end-stage disease. What innovative technologies are being developed for COPD care? Promising areas include:

• Telemedicine platforms for remote monitoring and consultations
• Wearable devices for continuous lung function and oxygen saturation tracking
• Smart inhalers that track medication usage and provide reminders
• Artificial intelligence algorithms for predicting exacerbations
• Virtual reality applications for pulmonary rehabilitation

These technologies aim to improve disease management, enhance patient engagement, and potentially reduce hospitalizations for COPD patients at all stages of the disease.

COPD and death: End-stage symptoms

Chronic obstructive pulmonary disease, or COPD, is a category of conditions that includes emphysema and chronic bronchitis. COPD is a progressive condition that gets steadily worse. Over time, the body becomes less able to take in enough oxygen. This can ultimately result in death.

According to the Centers for Disease Control and Prevention (CDC), chronic lower respiratory diseases — of which COPD is the most prevalent — were the “third leading cause of death in the United States in 2014.”

Recognizing the end-stage symptoms of COPD can help a person cope and say goodbye to loved ones, make peace with their life, seek hospice care, and discuss their final plans.

In this article, we cover the signs and symptoms that may indicate that a person is nearing the end of their life. We also discuss how to help people feel calmer and more comfortable during this stage of their life.

COPD is terminal. People with COPD who do not die from another condition will usually die from COPD.

Until 2011, the Global Initiative for Obstructive Lung Disease assessed the severity and stage of COPD using only forced expiratory volume in 1 second (FEV1).

FEV1 is a measure of how much air a person can exhale in a single breath. When it falls below 30% of the normal amount, a person may be in the end stages of COPD.

The new standard also looks at shortness of breath, as well as a person’s history of acute COPD episodes, the impact of COPD on a their life, and other factors.

The stages of COPD are as follows:

• Mild, or stage 1: FEV1 is above 80%. A person’s symptoms are mild, and they might not even notice that they have the condition.
• Moderate, or stage 2: FEV1 is 50–80%. A person may notice a chronic cough, excess mucus, and shortness of breath.
• Severe, or stage 3: FEV1 is 30–50%. A person may have a chronic cough and struggle to exercise or do daily activities. They may also feel tired or sick.
• End stage, or stage 4: FEV1 falls below 30%. This is the final stage of COPD, and it will severely affect a person’s daily life.

There are two ways to measure end-stage COPD. Clinical symptoms are those that testing at a doctor’s office can reveal.

These symptoms can include:

• low blood oxygen, or hypoxemia
• hypoxia, which is low oxygen in the body’s tissues
• cyanosis, a bluish hue to the skin due to oxygen deprivation
• chronic respiratory failure, which occurs when the respiratory system cannot take in enough oxygen or release enough carbon dioxide

During late-stage COPD, a person tends to experience more severe flare-ups. They may need to stay in the hospital during these flare-ups. Although a person will get a little better between flare-ups, they tend not to return to their previous condition.

Therefore, a person’s health becomes steadily worse with each flare-up, and each flare-up tends to be worse than the last.

Some other symptoms a person might notice in late-stage COPD include:

• severe limitations in physical activities, including difficulty walking
• shortness of breath
• frequent lung infections
• difficulty eating
• confusion or memory loss due to oxygen deprivation
• fatigue and increased sleepiness
• frequent severe flare-ups
• more frequent trips to the hospital
• longer hospital stays
• anxiety or depression
• changes in consciousness
• trouble swallowing
• twitching or muscle weakness
• changes in the way a person breathes, or their pattern of breaths
• increasingly loud breathing

Although COPD is terminal, people may not always die of the condition directly, or of oxygen deprivation.

Some people with COPD have other medical conditions, particularly cardiovascular disease. In fact, within 5 years of diagnosis, COPD is also an independent risk factor for sudden cardiac death.

Many treatment options are available to help a person with end-stage COPD cope with the pain and discomfort associated with the condition.

Although supplemental oxygen and COPD medications may help, they may not be as helpful as they were in the earlier stages.

Palliative care helps with pain and distress but will not treat the underlying condition.

Some palliative care options include:

• help with daily activities, such as getting dressed
• medications to relieve pain
• blowing air into the face to help with breathlessness
• medication for anxiety, depression, or insomnia
• mind-body therapies, such as yoga
• complementary remedies, such as massage therapy

Many people with terminal conditions find significant help from hospice care. Hospices provide end-of-life care that focuses on helping the person feel comfortable, easing their discomfort, and supporting them to make peace with death.

Hospice providers prioritize the well-being of the patient and their desire for a good death, rather than preserving life at all costs.

For some people, anxiety about death is more painful than the physical discomfort of COPD. A person might worry about their legacy or their family, about spiritual matters, or whether they have lived a good life.

Some strategies that may help include:

• Talking about emotions: It is normal to feel angry, afraid, or both. Discussing these emotions may help the person feel some relief.
• Discussing life or wishes with loved ones: People can talk to their family about the legacy they want to leave, the lessons they want to share, and the love they hope to leave behind.
• Talking to people who have experience with death: Hospice providers, religious leaders, and other people who have watched many people die may have a different perspective on death than family and friends. People can try talking through their emotions with them.
• Religious rituals: If a person is religious, they can consider talking to a religious leader about end-of-life rituals. Spiritual leaders can offer insight and advice, and they may share their perspective on spiritual matters.
• Getting affairs in order: If possible, people with end-stage COPD should ensure that their will is up-to-date. If they hope to leave something to their loved ones, they should make sure the relevant people know this. If the person has young children, they may want to appoint a guardian.
• Support groups and therapy: The emotions associated with being near the end of life can be overwhelming and too significant to process by oneself. People can try seeking the help of a therapist who specializes in such situations. Support groups for terminal conditions may also help.

End-stage COPD can be overwhelming. Seeking appropriate palliative care can help with the physical discomfort of COPD.

It is normal for people to feel afraid or angry, and those who are close to death should not feel ashamed of these emotions.

A compassionate medical team and supportive hospice care can help a person feel comfortable and comforted during this stage of their life.

Read the article in Spanish.

Can Emphysema Cause Death? – Lung Health Instititute

The moment that someone receives the diagnosis of emphysema, often the first question that comes to mind is, “Can emphysema cause death?” The answer is yes, but while it is progressive and there are varying degrees of it, there are ways to continue to live with it and do so comfortably. It all depends on how you fight back against the disease and if you focus on treatment and improve your lung capacity and lessen the impact of symptoms.
When you have emphysema, the damaged air sacs, known as alveoli, are unable to exchange oxygen and carbon dioxide between the lungs and the blood, which causes shortness of breath, exhaustion, the deterioration of lung tissue.

Causes of emphysema

While smoking is the cause of 80 to 90 percent of emphysema cases, air pollution and constant exposure to dust can also cause the disease. There is also a genetic abnormality called alpha-1-antitrypsin deficiency that can also be a cause. While symptoms don’t appear immediately, due to the deterioration of air sacs in the lungs over time, there is no way to reverse the damage once the symptoms begin to show, there is only the ability to manage the disease and its impact on your physical health.

Symptoms

While symptoms can vary from person to person, each symptom impacts the patient’s ability to breathe. Symptoms include:

• Shortness of breath
• Persistent cough
• Chronic bronchitis
• Cough accompanied by excess mucus
• Wheezing

Treatment

Based on the severity of your emphysema, your doctor may give you a variety of treatment options. While the disease is irreversible, everything from medication to exercise, and quitting bad habits can all help slow down the progression of the disease.
Medications can help open your airways and reduce inflammation. Exercise can help strengthen your damaged lungs naturally and improve your heart rate and blood pressure.

If you’ve been diagnosed with emphysema, contact The Lung Health Institute to learn how cellular therapy could improve your quality of life. Our dedicated patient coordinators will answer any questions you might have and can even put you in contact with former patients who will share their personal experiences from their time at the Lung Health Institute.  

What do chronic obstructive pulmonary disease patients die from? Amultiple cause coding analysis

Abstract

Information on obstructive lung disease (OLD) deaths is generally derived from the underlying cause of death on the death certificate. This neglects information on other conditions mentioned and may underestimate the burden of disease.

Descriptive analyses of all conditions mentioned on the death certificate for all decedents where OLD (chronic obstructive pulmonary disease or asthma) was mentioned as a contributing cause of death were conducted for England and Wales for 1993–1999.

OLD was mentioned in 312,664 or 8.0% of all deaths. OLD comprised the underlying cause of death in 59.8% of deaths with any mention of OLD. Where OLD was not the underlying cause of death, the leading causes by the International Classification of Disease version 9 chapter were diseases of the circulatory system, neoplasms, and non-OLD diseases of the respiratory system. The top single causes were acute myocardial infarction, other ischaemic heart disease, and lung cancer.

The current analysis confirms that using the underlying cause of death underestimates the contribution of obstructive lung disease to mortality in England and Wales, in contrast to myocardial infarction where underlying cause of death captures most (94%) mentions on the death certificate.

A. Hansell was funded by a Wellcome Trust Research Fellowship in Clinical Epidemiology.

Chronic obstructive pulmonary disease (COPD) is a condition with significant morbidity and mortality and was estimated as the third leading cause of mortality worldwide in 1990 1 and fourth leading cause of death in the USA in 1996 2. Work in the USA 3 has suggested that using underlying cause of death as an indicator of the health burden from severe COPD may dramatically underestimate the impact of the disease, with nonrespiratory causes accounting for >50% of the underlying causes of death in COPD patients in the USA 3. Most studies on the mechanisms and causes of death in COPD have been conducted on small groups of patients 4. One of the largest such studies involved 215 decedents with COPD and on long-term oxygen therapy. This found that the major causes of death were acute-on-chronic respiratory failure, heart failure, pulmonary infection, pulmonary embolism, cardiac arrhythmia and lung cancer 5. Much less is known of the circumstances of death and the specific causes of death of COPD patients in the community 4.

Data on all conditions mentioned on the death certificate inEngland and Wales became available electronically from 1993 6. This study aimed to quantify the extent to which obstructive lung disease (OLD) made a significant contribution to the death in the opinion of the certifying physician by examining the extent to which OLD was mentioned anywhere on the death certificate. The study also aimed to better characterise the specific causes of death in OLD patients in England and Wales, where OLD was mentioned on the death certificate but not the underlying cause.

Methods

Mortality and population statistics for England and Wales in 1993–1999 were obtained from the Office for National Statistics. The medical certificate of cause of death in England and Wales is in the format recommended by the World Health Organisation (WHO), with a part I and part II. Part I has three lines (Ia, Ib and Ic) relating to the immediate cause of death (Ia) and going back through the sequence leading directly to the death in Ib and Ic. Part II is for other conditions that contributed to the death but were not part of the direct causal sequence 6. The underlying cause of death, chosen by coding rules, is generally the condition entered in the lowest completed line of part I.

All conditions listed on death certificates were obtained for1993–1999, where there was at least one mention of OLD (COPD or asthma, International Classification of Disease version 9 (ICD‐9) codes 490–493, 496) on the certificate. Asthma codes were included because of the difficulty in distinguishing between the two conditions, particularly in later life 7.

Descriptive analyses were conducted for the multiple cause data for 1993–1999, including a determination of the causes of deaths for decedents where OLD was mentioned on the death certificate, but where OLD was not the underlying cause of death. Time trends used rates directly age-standardised to the population in 1999. A Chi-squared test for trend was used to examine for statistically significant linear trends. Confidence intervals were not presented for rates because a 100% sample was used.

Results

Over the 7‐yr period 1993–1999 OLD was mentioned anywhere on the death certificate for 312,664 decedents and the underlying cause of death was coded to an OLD in 59.8% (186,852) of cases. OLD comprised the underlying cause of death for just under 5% of all deaths and was mentioned anywhere on the death certificate (including underlying cause of death) for 8% of all deaths (table 1⇓). These proportions varied by sex. OLD was the underlying cause of death in 5.7% of male death certificates and 3.8% of female death certificates and it was mentioned on 9.9% of male death certificates and 6.2% of female death certificates.

Table 1

Numbers and percentages of deaths in England and Wales 1993–1999 where obstructive lung disease (OLD) or asthma is mentioned anywhere on the death certificate by age group

Rates for OLD mentioned anywhere on the death certificate and as underlying cause of death increased with age, with highest rates in the oldest age-groups and lowest in the youngest. The age-specific rates for OLD as underlying cause of death for 1993–1999 combined ranged from 0.37 per 100,000 for males and 0.23 per 100,000 for females aged 0–9 yrs to 1,324 per 100,000 for males and 359 per 100,000 for females aged ≥90 yrs.

The commonest code used for OLD in 1993–1999 was chronic airways obstruction, not elsewhere classified (ICD‐9 496), comprising ∼80% of codes where an OLD was the underlying cause of death or where OLD was mentioned anywhere on the death certificate (table 2⇓). The next most common code was chronic bronchitis (ICD‐9 491) comprising ∼10% of male and 7% of female codes. Emphysema (ICD‐9 492) and bronchitis unspecified (ICD‐9 490) were less commonly used and appeared more frequently as a mention on the death certificate than as the underlying cause of death (table 2⇓). Bronchitis codes (ICD‐9 490–491) and COPD unspecified (ICD‐9 496) were more commonly used in the oldest age groups (fig. 1⇓).

Table 2

Numbers of deaths (% of decedents) in England and Wales 1993–1999 by International Classification of Disease version 9 (ICD‐9) code where obstructive lung disease (OLD) was the underlying cause of death or mentioned anywhere on the death certificate

Asthma accounted for ∼6.8% of deaths with any mention of OLD and 0.5% of all deaths in England and Wales for 1993–1999. The use of asthma codes varied by age and sex: asthma was mentioned more often in female death certificates (10.1% of female decedents with any mention of OLD versus 4. 6% of males) and in younger age groups. Asthma was the commonest OLD reported on death certificates for those aged 1–44 yrs (table 1⇑, fig. 1⇑) and became less common with increasing age.

Multiple mentions of OLD on the death certificate

Of death certificates where there was any mention of OLD from 1993–1999, a total of 15,295 (8.5%) males and 6,864 (5.4%) females had more than one OLD mentioned (usually two). The commonest combinations were chronic bronchitis (ICD‐9 491) with emphysema (ICD‐9 492), followed by emphysema (ICD‐9 492) with chronic airways obstruction (ICD‐9 496) then asthma (ICD‐9 493) with chronic airways obstruction (ICD‐9 496).

Time trends 1993–1999

Trends in deaths with any mention of OLD on the death certificate paralleled those where OLD was the underlying cause of death (fig. 2⇓) and Chi-squared tests suggested these were statistically significant linear trends (p<0.001). The proportion of all death certificates with any mention of OLD decreased in males from 10. 4% in 1993 to 9.9% in 1999 and increased in females from 6.0% in 1993 to 6.5% in 1999. Since mentions of COPD comprised the majority of OLD mentions, the trends for COPD closely paralleled those for OLD. However, age-standardised rates for any mention of asthma fell faster than those for COPD and the rates for asthma as an underlying cause of death fell faster than those for any mention of asthma (table 3⇓).

Fig. 2.—

a) Age-standardised (to 1999 population) rates of a) male and b) female deaths per 100,000 in England and Wales where obstructive lung disease (OLD) is cited as the underlying cause of death and where OLD is mentioned anywhere on the death certificate. ♦: OLD any mention; ▴: OLD as underlying cause.

Table 3

Age-standardised (to 1999 population) mortalityrates per 100,000 for asthma (ICD‐9 493) or chronic obstructive pulmonary disease (COPD) (ICD‐9 490-2, 496) mentioned anywhere on the death certificate or as underlying cause of death

Characterisation of deaths 1993–1999 by ICD chapter and by single cause where OLD was mentioned but not the underlying cause of death

Examination of the underlying cause of death for decedents where OLD was mentioned but not the underlying cause by ICD chapter showed that the most frequent causes of death for all years and for both males and females were diseases of the circulatory system, followed by neoplasms and diseases of the respiratory system (table 4⇓). A disease of the circulatory system (ICD‐9 Chapter 7) was listed as the underlying cause of death in approximately a quarter of all deaths that had an OLD mentioned on their death certificate, with a further 8% of males and 5% of females having a neoplasm (ICD‐9 Chapter 2) and 4% of male and female deaths with a respiratory system disease (excluding OLD) as the underlying cause of death during the study period.

Table 4

Commonest underlying causes of death for decedents where obstructive lung disease (OLD) was mentioned on the death certificate but not the underlying cause of death, 1993–1999

Analysis by three-digit ICD‐9 code (table 4⇑) showed that the commonest causes of death where OLD was mentioned but not the underlying cause were ischaemic heart disease, followed by lung cancer and bronchopneumonia. These rankings were fairly stable over 1993–1999, but “Acute, but ill-defined cerbrovascular disease” (ICD‐9 436), a code used for stroke was one of the top five causes in 1993 only for both sexes. Heart failure (ICD‐9 428) also featured in the top five causes of death (with different rankings for males and females) and this may have included some cases of cor pulmonale, if not clearly specified by the certifying doctor. The specific code for chronic cor pulmonale (ICD‐9 416.9) was the 19th most common underlying cause of death in females and 27th most common in males in 1993–1999 in this group of decedents and became progressively less common over time, falling from 94 cases in 1993 to 44 cases in 1999 in males and 62 to 34 cases in females.

The most frequent four-digit codes for both males and females were 410.0, acute myocardial infarction and 414.9, other forms of chronic ischaemic heart disease, unspecified (table 4⇑). The top five four-digit ICD causes of death generally occurred in the same order in each year. The percentage of cases with “other forms of chronic ischaemic heart disease” as the underlying cause of death remained fairly stable over the study period, but the percentage attributed to acute myocardial infarction fell (from 9. 5% in 1993 to 6.7% in 1999 in males and 8.1% in 1993 to 5.1% in 1999 in females).

Discussion

This multiple cause analysis of death certificates in England and Wales for 1993–1999 found that OLD was mentioned on 8.0% of death certificates and that in 59.8% of these, the underlying cause of death was attributed to OLD. Two similar multiple cause analyses of death certificates have beenconducted in the USA. Mannino et al. 3 examined mortality trends 1979–1993 and found that OLD was mentioned on 8.2% of all decedents, while the National Mortality Followback Survey in 1993 found that COPD was mentioned in 10.6% of decedents 8. Both these studies found a much lower percentage for the underlying cause of death: 43.3% of deaths with any mention of OLD in the 1979–1993 study 3 and 42.2% for deaths with any mention of COPD in the 1993 study 8. One likely explanation for this is certification differences between the USA and England and Wales. Co-morbidities are better recorded in the USA than in UK hospitalisation data 9, and this may extend to death certification. Also inadequacies in training of doctors in England and Wales with relation to death certification have been documented 6. An alternative and speculative explanation may relate to severity of OLD. If there were similar underlying prevalences in the two countries, but OLD was more severe or less aggressively treated during the study period in the UK one might expect a greater percentage of decedents with OLD as underlying cause of death. Treatment differences are described: for example, low intubation rates and higher mortality in COPD patients compared with the USA and some European countries were noted 10 in a UK study of noninvasive ventilation conducted in 1996–1998, while noninvasive ventilation was not available in half the hospitals in the UK in a 1997 survey 11. An international population survey conducted in 2000 12 did indeed find similar prevalences of COPD in both countries. OLD was also mentioned on a similar percentage of all death certificates in this analysis as in the USA analyses 3, 8 which could indicate similar prevalence of more severe disease. However, both survey and death certificates relied on doctor-diagnosed disease and this explanation would not hold if doctors were more willing to diagnose or detect OLD in the USA.

Underlying cause of death may be a reasonable measure of certified deaths for some conditions such as myocardial infarction: underlying cause comprised 93.6% of any mentions of myocardial infarction on the death certificate in a recent English study 13. However, the present analysis demonstrated that use of underlying cause of death may substantially underestimate the contribution of OLD to mortality in England and Wales. Despite this, time trends for OLD as an underlying cause of death should be similar to those for deaths to which OLD has contributed.

Not all patients with OLD in life will have OLD mentioned on the death certificate, for example, because it did not contribute to the final illness or because of poor recording of comorbidities. The Tucson Epidemiologic Study of Airways Obstructive Diseases 14 suggested that patients with spirometric evidence of airways disease in life only had airways disease reported on the death certificate in 13% (9 of 71 cases), but that the percentage was much higher (77%) in cases with moderate-to-severe disease (patients with forced expiratory volume in one second % <50). A 22‐yr follow-up of 5,542 adults in the first National Health and Nutrition Examination Survey (NHANES I) found that 47.7% of patients with severe COPD at baseline had COPD listed on the death certificate and 23.1% had COPD as the underlying cause of death 15. However, COPD diagnosis was based at spirometry at baseline only, percentages would almost certainly have been higher if information on COPD progression during follow-up had been available.

Ischaemic heart disease, lung cancer and bronchopneumonia (table 3⇑) formed the major underlying causes of death in England and Wales, where OLD was mentioned on the certificate but not the immediate cause of death. These findings are broadly in agreement with those in the Tucson study 14: where airways obstructive disease was mentioned on the death certificate (86 decedents), the underlying cause ofdeath was cardiovascular (ICD‐9 410.9–414.9) in 42% of cases, other pulmonary diseases (ICD‐9 485‐6, 512–516 and 799.1) in 26% and malignancy (ICD‐9 153. 9–197.7) in 9%. Minor differences may relate to the time periods covered (1972–1986 for the Tucson study) and the smaller numbers involved for the Tucson study. Zielinski et al. 5 examined causes of deaths in 215 patients on long-term oxygen therapy in seven European countries. They found that the major causes of death were acute-on-chronic respiratory failure (38%), cor pulmonale with oedema (13%), pulmonary infection (11%), pulmonary embolism (10%), fatal arrhythmia (8%) and lung cancer (7%). While it is difficult to make direct comparisons as ICD coded (underlying) causes of death were not given, the European patients with severe COPD had higher proportions of death from cor pulmonale and from lung cancer than this British general population sample (table 3⇑).

Mortality data for England and Wales are nearly 100% complete and almost all registered deaths have been certified by a medical practitioner or coroner 6. In 1993, automated coding for cause of death was introduced, incorporating software developed in the USA and applying the American interpretation of the WHO rules, which aids some international comparisons 6. However, <10% of deaths certified by doctors in England and Wales include information from a post mortem 6 and this may lead to some inaccuracies in the certified cause of death. Studies of death certificates suggest that a label of asthma may be preferentially applied to females with COPD and that some asthma deaths are recorded as COPD and vice versa 16, 17. Because of this and variations in physician preferences for the various COPD codes, the current authors chose to analyse OLD comprising all COPD and asthma codes. Other limitations of death certificate data are the lack of information on the severity of disease and riskfactor information such as occupational exposures and cigarette smoking 3.

Few analyses on the validity of UK death certificates in OLD have been conducted in recent years. Two studies conducted within 10 yrs of the present analysis found reasonable agreement of death certificates with hospital and case notes. Guite and Burney 18 convened an expert panel to review deaths in 1988–1992 occurring in a cohort of 2,382 patients previously hospitalised for asthma, to see if these might have been due to asthma. The panel identified 26 asthma deaths, of which 24 (92%) were certified as asthma, two (8%) had been attributed to COPD and two (8%) to cardiovascular disease. Smyth et al. 17 reviewed case notes of decedents in Northern Ireland in 1987 aged <75 yrs where asthma or COPD was mentioned anywhere on the death certificate. The panel found the same number of deaths where OLD was the underlying cause as had been certified to OLD, but these were differently distributed. Of the 174 deaths where OLD was certified the underlying cause of death, 125 (72%) were confirmed as OLD. Of 176 deaths where OLD was mentioned but not the underlying cause, the panel considered that OLD should have been the underlying cause in 49 (28%) of cases. It is unclear how relevant these finding are to the present analysis as coding was not computerised and the authors commented on the variable application of coding rules to determine the underlying cause of death by the registering officers.

In conclusion, this study aimed to better determine the epidemiology of deaths from obstructive lung disease in England and Wales. Underlying cause of death data are commonly used when looking at the burden of lung disease 19 but were found to substantially underestimate the number of deaths to which obstructive lung disease makes a contribution. Where obstructive lung disease was mentioned but not the underlying cause of death, the commonest causes were other smoking-related conditions such as heart disease and lung cancer. Formal medical record review of decedents isnow needed to definitively determine the degree to whichdeath certification underestimates the contribution of obstructive lung disease to mortality.

• Received March 20, 2003.
• Accepted June 29, 2003.

References

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   Murray CJL, Lopez AD. The Global Burden of DiseaseHarvard, Harvard University Press, 1996.

2. ↵

   Hurd S. The impact of COPD on lung health worldwide: epidemiology and incidence. Chest 2000;117: Suppl. 1S–4S.

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   Mannino DM, Brown C, Giovino GA. Obstructive lung disease deaths in the United States from 1979 through 1993. Am J Respir Crit Care Med 1997;156:814–818.

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   Zielinski J. Circumstances of death in chronic obstructive pulmonary disease. Proc – COPD Manag 1998;53:324–330.

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   Zielinski J, MacNee W, Wedzicha JA, et al. Causes of death in patients with COPD and chronic respiratory failure. Mon Arch Chest Dis 1997;52:43–47.

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   Devis T, Rooney C. Death certification and the epidemiologist. Health Stat Quarterly 1999;01(Spring):25–33.

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   Hunt LW, Silverstein MD, Reed CE, O’Connell EJ, O’Fallon WM, Yuginger JW. Accuracy of the death certificate in a population-based study of asthmatic patients. J Am Med Assoc 1993;269:1947–1952.

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   Meyer PA, Mannino DM, Redd SC, Olson DR. Characteristics of adults dying with COPD. Chest 2002;122:2003–2008.

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   McKee M, Coles J, James P. “Failure to rescue” as a measure of quality of hospital care: the limitations of secondary diagnosis coding in English hospital data. J Publ Health Med 1999;21:453–458.

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    Plant PK, Owen JL, Parrott S, Elliott MW. Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial. BMJ 2003;326:956–960.

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    Doherty MJ, Greenstone MA. Survey of non invasive ventilation (NIPPV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) in the UK. Thorax 1998;57:192–211.

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    Rennard S, Decramer M, Calverley PMA, et al. Impact of COPD in North America and Europe in 2000: subjects perspective of Confronting COPD International Survey. Eur Respir J 2002;20:799–805.

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    Goldacre MJ, Roberts SE, Griffith M. Multiple-cause coding of death from myocardial infarction: population-based study of trends in death certificate data. J Publ Health Med 2003;25:69–71.

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    Camilli AE, Robbins DR, Lebowitz MD. Death certificate reporting of confirmed airways obstructive disease. Am J Epidemiol 1991;133:795–800.

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    Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax 2003;58:388–393.

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    Jones K, Berrill WT, Bromly CL, Hendrick DJ. A confidential enquiry into certified asthma deaths in the North of England, 1994–96: influence of co-morbidity and diagnostic inaccuracy. Respir Med 1999;93:923–927.

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    Smyth ET, Wright SC, Evans AE, Sinnamon DG, MacMahon J. Death from airways obstruction: accuracy of certification in Northern Ireland. Thorax 1996;51:293–297.

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    Guite HF, Burney PGJ. Accuracy of recording of deaths from asthma in the UK: the false negative rate. Thorax 1996;51:924–928.

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    British Thoracic Society. The Burden of Lung Disease. A statistics report from the British Thoracic SocietyLondon, British Thoracic Society, 2001.

Living With End-Stage Emphysema | Franciscan Health

Every breath we take is often taken for granted. But for the 3.8 million Americans living with emphysema, each shortened breath, cough and wheeze is a reminder of this devastating lung disease.

End-stage emphysema, or stage 4 emphysema, can mean living with a decade or more of breathing problems, tiredness, heart problems or other health concerns that impact your ability to live your life to your fullest.

Because emphysema, like other forms of COPD, reduces the amount of oxygen that can reach your bloodstream, the heart works harder to spread oxygen throughout the body. A person with severe emphysema may get tired easily, may have chest pains or palpitations, or experience headaches, sleep problems, and irritability.

“There is no cure for emphysema or COPD, but our goal is to help slow the progression of the disease,” said Faisal Khan, MD, a Greenwood pulmonologist who practices at Franciscan Health Indianapolis.

What Is Emphysema?

Emphysema is a lung disease that damages the air sacs in the lungs, leading to shortness of breath and reducing how much oxygen is delivered into the bloodstream.

Emphysema permanently damages the alveoli, or air sacs, in your lungs, making it harder for your body to breathe. Emphysema weakens and ruptures these air sacs. With less air sacs there is less area for oxygen to reach your bloodstream.

Although treatment may slow progression of the condition, it can’t reverse the damage.

What Is The Difference Between Emphysema And COPD?

Emphysema, along with chronic bronchitis, falls under a group of lung diseases known as COPD (chronic obstructive pulmonary disease). These lung diseases cause airflow blockage and breathing problems.

How Common Is End-Stage Emphysema?

Stage 3 emphysema is when you have less than 50% lung function remaining, and stage 4 (or end-stage emphysema) is when you have less than 30% lung function left.

More than 140,000 people in Indiana and about 65,000 people in Illinois have emphysema, and about one-third of those patients have severe emphysema (stage 3 and 4).

In all, COPD is the third-leading cause of death in the US and affects 373,000 people in Indiana.

What Causes Emphysema?

Smoking is the leading cause of emphysema, which makes it one of the most preventable respiratory diseases. Emphysema is most common in men between 50 and 70 years of age. Cigarette smoking is the cause in about 9 in 10 people with emphysema. A smoker is 10 times more likely to die from COPD than a nonsmoker.

If a smoker quits before emphysema develops, the decline levels off until it is nearly normal for the person’s age. Smokers who quit also see an improved life expectancy.

Scientists believe that other factors are involved in the disease, because only 3 in 20 to 1 in 5 smokers develops emphysema. Other factors that may contribute to emphysema include air pollution, fumes, and dust in the workplace.

There is also a rare, inherited form of the disease called alpha 1-antitrypsin (AAT) deficiency-related pulmonary emphysema or early onset pulmonary emphysema.

What Are The Symptoms Of Emphysema?

Emphysema usually comes on slowly, as the disease destroys lung tissue gradually. Early emphysema symptoms include occasional shortness of breath and fatigue, but the lung disease is often not diagnosed for years, until it has damaged more than half of your lungs’ air sacs.

Symptoms of emphysema include:

• Shortness of breath, particularly during light exercise
• Long-term cough
• Feeling of not getting enough air
• Mental fog
• Wheezing
• Ongoing mucus production
• Constant fatigue
• An enlarged heart because of damaged lungs
• Swelling of the ankles, legs or abdomen
• A bluish tinge to skin, lips and nails due to poor oxygen supply.

How Do You Treat Emphysema In The Lungs?

“Our goal when treating people with severe emphysema is to help them live more comfortably with emphysema, control emphysema symptoms, and prevent emphysema from advancing to a later stage, or getting worse,” Dr. Khan said. Oftentimes antibiotics, inhalers or other medications can help relieve shortness of breath.

There is no way to repair or regrow the damaged lung tissue.

Depending on the severity of your emphysema, your treatment plan may include:

• A pulmonary rehabilitation program to strengthen the muscles you use for breathing and exercise the rest of your body. “It’s tempting to not exercise when you have emphysema, but regular physical activity can actually improve your health,” Dr. Khan said.
• Antibiotics for bacterial infections
• Staying away from the smoke of others and removing other air pollutants from your home and workplace
• COPD medicines (bronchodilators) that widen the airways of the lungs, and can be either taken by mouth or inhaled
• Getting the flu and pneumococcal vaccines
• Nutritional support since you may develop malnutrition and lose weight
• Other types of oral and inhaled medicines that are used to treat symptoms such as coughing and wheezing
• Oxygen therapy when medications are not doing enough for you.
• Quitting smoking, whether from traditional cigarettes, cigars or vaping.

How Do You Treat End-Stage Emphysema?

As emphysema becomes more severe and the disease progresses to later stages, surgical options may be considered. These include surgery to remove the damaged area of the lung or a lung transplant if lungs are too damaged to benefit from surgery. However, lung reduction surgery and lung transplants are only helpful in a small group of patients with end-stage emphysema, and there is severe risk in these surgeries. There is no way to repair or regrow damaged lung tissue.

However, a new, less invasive procedure is now available for people with severe or end-stage emphysema (stage 3 or stage 4 emphysema). Franciscan Health now offers an endobronchial valve system to treat breathing problems. The Zephyr® valve procedure is for people with severe emphysema. Patients report being able to take full breaths immediately after the procedure and within a few days are back to doing everyday tasks with ease.

Can Emphysema Be Cured?

Emphysema cannot be cured, as lung tissue cannot be regrown, but treatment may slow the progression of the disease.

Emphysema

US Pharm. 2018:43(7):13-14.

Emphysema is a type of chronic obstructive pulmonary disease (COPD), which is the third leading cause of death in the United States behind heart disease and cancer. Emphysema is caused by damage to the air sacs of the lungs (alveoli) after long-term exposure to airborne irritants. Over time, the damaged alveoli weaken and rupture, creating a smaller lung surface area and, consequently, causing less oxygen to reach the bloodstream. Emphysema is a chronic condition that develops slowly and worsens over time. People with emphysema have significant trouble breathing, which can impact their work, ability to exercise, quality of sleep, and other daily activities.

The primary risk factor for emphysema is smoking, although extended exposure to air pollution or chemical fumes, as well as a rare genetic deficiency, can also lead to disease. About 85% of all people with emphysema are current smokers or have smoked in the past. The risk of developing emphysema increases with the number of years of smoking and the amount of tobacco smoked. While cigarette smokers are at highest risk, pipe and cigar smokers also have an elevated risk of disease. People who do not smoke but who live with a smoker are also at risk because of exposure to secondhand smoke.

The symptoms of emphysema occur gradually and often go unnoticed for many years. Because of the damage to the lung tissue, persons with developing emphysema require more effort to breathe and, as a result, tire sooner. This leads to shortness of breath with even minor exertion. People with emphysema also experience such symptoms as chronic cough, chest tightness, and wheezing. For long-term smokers, symptoms usually become noticeable between ages 45 and 60 years.

Combined with a thorough medical history and assessment of symptoms, physicians use a series of pulmonary function tests (PFTs) to assist in the diagnosis of emphysema. PFTs measure lung size, airflow, the transfer of gases (like oxygen) into and out of the blood, and inflammation. Also, chest x-rays, CT scans, blood tests, and lung biopsies may be performed to rule out other causes of lung dysfunction, such as lung cancer.

Treatment Manages Symptoms

There is no cure to reverse the damage to the lung tissue that leads to emphysema. The primary goal of treatment is to slow the progression, relieve the symptoms, and prevent complications of the disease. The most critical intervention for the treatment of emphysema is smoking cessation. Evidence shows that quitting significantly improves lung function. Patients with emphysema who quit smoking can reduce their decline in lung function to match the function of others of the same age, weight, and sex who are nonsmokers.

Medications are used to improve the symptoms of emphysema and to treat complications such as infections. Bronchodilators are inhalers that can relieve shortness of breath and breathing problems by opening the constricted airways. Inhaled corticosteroids are sometimes given to reduce inflammation and improve shortness of breath. Antibiotics are given if the patient experiences a bacterial infection, such as pneumonia or acute bronchitis.

Other treatments include instruction in effective breathing exercises, oxygen therapy, and nutrition therapy. In more severe cases, surgical options include removal of the damaged lung tissue to allow the remaining healthy tissue to expand and lung transplantation.

Complications and Prognosis

The prognosis for those with emphysema depends on the severity of the disease, the symptoms, and the presence of complications. Having emphysema can lead to complications of the lung and the heart. High blood pressure, enlargement of the heart, and potentially heart failure can result from the constant strain on the heart caused by reduced oxygen. People with COPD are also at increased risk for respiratory infections during cold and flu season. Lastly, difficulties in adjusting to changes in health and lifestyle can lead to clinical depression.

If you have any questions about treatments for emphysema, speak with your trusted local pharmacist or another healthcare provider.

To comment on this article, contact [email protected].

End-of-Life Signs with COPD: Symptoms of End-Stage COPD

According to the American Lung Association, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. More than 11 million Americans have been diagnosed with the disease, and many others may have COPD without knowing it.

Although some people live for years with COPD, there is no cure. That’s why it’s important to learn the end-of-life signs of COPD and understand when hospice should be contacted.

What are the end-stage symptoms of COPD?

If you feel that your loved one is nearing the end, or that they are exhibiting the COPD end-of-life signs listed below, the best thing to do for them is contact a hospice. Crossroads Hospice can assess the patient within 24 hours if you’d like to contact us. Hospice professionals will help your loved one manage their COPD symptoms and will also address their physical and emotional needs at the end of life.

COPD End-Stage Symptoms:

• FEV1 Less Than 30% of Normal: FEV refers to “Forced Expiratory Volume” and is the measurement of how much air a person exhales during a forced breath. This volume drops lower and lower through the four stages of COPD.
• Chronic Respiratory Failure: Carbon dioxide is expelled from the blood when we exhale. Chronic Respiratory Failure occurs when your respiratory system is no longer capable of expelling the carbon dioxide. However, it can also develop when the body is no longer able to take in enough oxygen.
• Shortness of Breath (dyspnea): While shortness of breath is something that can occur throughout every stage of COPD, shortness of breath at the end-of-life occurs even when the patient is at rest.
• Anxiety & Depression: As their condition worsens, the patient is unable to do some of the tasks and daily activities they were doing previously. Because of this, as well as their worsening condition, many report an increase in anxiety and depression. Some stop eating all together.
• Delirium: Many patients with advanced diseases experience delirium to some degree. The patient may be in and out of consciousness, restless, or incoherent.

Tips for managing end-of-life COPD.

As the family caregiver, you have a very special role in managing the end-stage symptoms and signs of your loved one’s COPD. One of the most important things that you should be doing is remaining in communication with their doctors, nurses, and healthcare professionals. It’s important to keep the physicians informed of the patient’s symptoms, as well as administering medicine if need be. Additionally, you can help ease your loved one’s anxiety by talking with them, watching their favorite movies with them, or some other activity that will help keep their spirits up.

Try not to get frustrated or upset with them if they forget to take their medicine, or try to perform an activity on their own that you’ve told them not to do. We know how trying and stressful this time is for you, and it can seem like your loved one is actively trying to make it harder. But accepting their mistakes, their confusion, even their anger is all part of being a caregiver.  

Also consider palliative care. Separate from hospice care, which is for someone no longer pursuing curative treatment, palliative care can be administered at any time, and actively treats the pain, discomfort, and other symptoms of COPD, to make life better.

What else you can do for your loved one.

In addition to helping manage the end-of-life COPD signs, there are other things you can do for your loved one to help them get their affairs in order:

• Discuss their financial affairs and make sure they have everything in order.
• Ask them about their final wishes, including their funeral (is there a particular reading they would like? Music? Etc. )
• If they aren’t already on hospice, talk to them about the benefits of hospice care and how it can help ease their pain and discomfort, thus making their remaining time better.

Learn about hospice eligibility & COPD.

If you believe your loved one is eligible for hospice, please review the COPD hospice eligibility requirements. Additionally, you can speak privately with a hospice expert by choosing one of the options in the blue Help Center bar on this page.

End-of-Life signs by disease.

Learn about the specific end-of-life signs of common diseases and illnesses:

More end-of-life resources.

Physical signs of the end of life

How can you tell when someone with a long-term lung condition is entering the last stage of life? On this page, we explain the physical signs of the final stages and ways these symptoms can be controlled. We also explain what to expect in the final days.

On this page:

What are the signs someone is approaching end of life?

As people reach the final stages of long-term lung disease there are often typical physical changes. But it’s not always easy to predict when life will come to an end.

Each person’s experience at the end of life is different. Experiencing these symptoms doesn’t necessarily mean someone is close to death.

Most long-term lung conditions get gradually worse over several years. The most common symptom is feeling increasingly out of breath. Some people’s breathing might get worse much more quickly, over weeks or months. This is particularly true of interstitial lung diseases, such as IPF.

For those in the final stages of a lung condition, breathing becomes noticeably worse. After each flare-up, or exacerbation, their lung function doesn’t quite get back to the level it was before and breathing becomes more difficult.

Your lungs become less efficient as long-term lung disease develops. Any exertion, even just changing your position, talking, or eating, might make you feel out of breath. It can become uncomfortable to breathe if you lie flat, so you could try sleeping in a fairly upright position. Reduced lung function may result in low levels of oxygen in the blood. This can cause fluid retention in your legs and tummy, which can be uncomfortable. Flare-ups usually reduce oxygen in your blood further and can make these symptoms worse.

Other symptoms might include a troublesome cough, poor appetite, chest pain and disturbed sleep patterns.

The most common physical symptoms are:

• feeling more severely out of breath 
• reducing lung function making breathing harder
• having frequent flare-ups 
• finding it difficult to maintain a healthy body weight due to loss of appetite
• feeling more anxious and depressed.

You, your family, and carers can ask your health care team for more advice and information about what to expect in your particular circumstances.

Controlling symptoms at the end of life

Pain is a common symptom in any advanced physical disease and can be part of the normal dying process. It can usually be well controlled using the right medications. These medications may include opioids (morphine-like pain killers). You might be worried about having opioids if you or a loved one has a respiratory condition, but they are safe for people with lung disease to use.

You’ll be given drugs in a way that causes the least amount of discomfort, pain, or stress. Your doctor may suggest trying a low dose of liquid morphine that is short-acting. This is to see initially how much you need help with your symptoms. If it helps, your doctor might suggest you have a longer acting morphine pill or morphine-like patch.

Breathlessness might be improved by using inhalers, tablets and occasionally nebulisers. It can be helpful to use a hand-held fan when you feel breathless. The feeling of air on your face can make it feel easier to breathe. But if your breathlessness is more severe and blood oxygen is low, long-term oxygen might improve your breathing and quality of life.

Long-term home oxygen is needed when your lungs can no longer maintain enough oxygen in your blood. This oxygen is normally delivered from a machine that concentrates the oxygen from the air called an oxygen concentrator. You need to use this machine for at least 15 hours a day. The amount of oxygen needed is carefully assessed and monitored and may need to be increased over time. Read more about oxygen therapy.

Oxygen is only available by prescription and is provided by a local oxygen supplier. Normally, your local respiratory team will assess your need for oxygen. Portable oxygen, usually from small cylinders, is also available and allows you to travel and go on outings.

Your GP can only prescribe palliative oxygen. This is for people who are reaching the end stage of life and have low blood oxygen levels.

Oxygen therapy used to treat low blood oxygen may not always relieve breathlessness. If your breathlessness becomes very distressing despite using oxygen, a number of medications are available to reduce the feeling of breathlessness. These include low doses of sedatives such as diazepam or lorazepam, as well as painkillers called opioids such as morphine.

Anxiety and depression can be common if your breathing gets more difficult and can make it feel worse. Loneliness and isolation are also common problems if you are housebound with a long-term lung condition.

If you struggle to leave the house because of breathing difficulties, ask for support from a health care professional. Anxiety and depression may become so severe that they require treatment in their own right.

You may also find relaxation or breathing techniques help to ease your feelings of tension and anxiety. We have more information on breathing techniques online.

Fluid retention can be treated with water tablets called diuretics. Frequent trips to the toilet may become a problem if you feel breathless and have difficulty moving about. Ask your health care professional about using a urinal or commode. Catheters are tubes that allow urine to pass from the bladder out of the body. They can be useful in end of life care, but there are risks of complications including infection and discomfort.

Loss of appetite is a common issue and is often a natural part of the disease process. A little of what you fancy can help increase the amount you eat, bring you pleasure and ultimately boost quality of life. If you find swallowing difficult, choose softer, moister foods.

Sometimes, smaller meals plus snacks throughout the day work well. Higher calorie snacks can include cakes and biscuits, cheese, and full-cream yoghurts. Choose nourishing drinks such as full-fat milk, hot chocolate, malted drinks, smoothies, fruit juice and fortified soups.  Over-the-counter fortified soups and milkshakes are available in most supermarkets and pharmacies.

If you use oxygen, try using a nasal cannula when you eat. If you use a face mask, remember to replace it between mouthfuls so your oxygen levels don’t drop as you eat.

If eating is really difficult, nutritional supplements might help and can be prescribed by your doctor or nurse.  You could also be referred to a dietician. You can buy some nutritional supplements over-the-counter but always ask for advice to find the best one for you. Read more about eating well with a lung condition.

Top tips for caring for someone who needs help eating:

• Face the person so they can see you and their food.
• If the person normally wears glasses or hearing aids, help them to put them on. This will help them to see what you’re doing and to hear what you’re saying.
• Offer smaller meals or portions that don’t overwhelm the person. 
• Let the person eat slowly. Allow plenty of time for them to chew their food and swallow it. They might need to catch their breath before each mouthful.
• Watch for clues to help you tell when they have finished swallowing. If it’s hard to tell, ask the person if they’ve finished or to open their mouth to see if there is any food left inside.
• For drinks, use a wide cup or glass, so the drinker doesn’t have to tilt their head back. You could also use a straw, for cold drinks.
• Don’t rush the meal. This could increase the risk of food entering the person’s airways.
• Look out for signs of tiredness. If the person is getting sleepy, it is best for them to stop eating even if they haven’t finished their meal. This is because people are more likely to cough or choke on food.
• If possible, try and make sure the person waits at least 15 minutes before going back to bed or lying down. This reduces the chances of food and drink coming back up the throat and causing them to choke.

Coughing could be a problem. Sit as upright as possible, supported by pillows. There are medicines that can help stop a distressing cough. Your health care team can prescribe them. Coughing attacks and severe breathlessness may also produce incontinence. This can be managed by reducing drinks containing caffeine such as tea and coffee, and also reducing alcohol intake. There are also a number of continence products that can help, including a bladder tube and bag called a urinary catheter. Speak to your health care team about whether this may help.

Hiccups, indigestion and reflux can be difficult to manage if you have a terminal illness. Treatment is available to help manage these symptoms and there are things you or your carer can do to help you feel more comfortable. Marie Curie has more information about this on their website. 

Fatigue (tiredness) and disturbed sleep are common as lung disease progresses. Fatigue may be due to a combination of anxiety, depression, poor sleep, and low-calorie intake. Lack of sleep may also be caused by symptoms, such as breathlessness, pain, and coughing, which disturbs sleep. Napping during the day may also make it difficult to sleep at night. Fatigue may never fully resolve but there are techniques that can help you to manage it and sometimes medications that can help with some of the causes. Talk to your health care professional about the possible causes and how to deal with them.

A flare-up may occur if you catch a chest infection. Having a chest infection means you will have a worse cough with discoloured, yellow, or green phlegm and you will feel more breathless. This should be treated promptly and usually improves with antibiotics and a short course of steroids.

If you have severe flare-ups you might be admitted to hospital and may need non-invasive ventilation to help improve the level of oxygen taken into your lungs. This is delivered by a mask and a portable machine that supports breathing by providing air or oxygen under slight pressure.

What should I expect in the last few days?

As the end of life approaches, you might experience a number of physical and emotional changes. These are different for everyone. You might notice changes over weeks, days or even hours. Some of the changes might be the same as signs of a flare-up, so discuss them with your doctor or nurse.

Signs to look out for include:

• Not wanting to eat or drink very much or at all. Swallowing may become difficult
• Losing physical energy, the ability or desire to talk and signs of withdrawing from family and friends.
• Feeling sleepy or drowsy most of the time, being very inactive and eventually becoming unconscious. It is not unusual to stay in bed or a comfortable chair rather than getting up.
• Changes in breathing rate or pattern. As the body becomes less active, the need for oxygen reduces. There may be long pauses between breaths and the tummy may move up and down more than the chest. Breathing in and out might cause gurgling or rattling sounds, because of a build-up of phlegm that can’t be coughed up. Remember, this noisy, moist breathing might be more distressing for others than for the person affected. Medication is available that can help to dry up the phlegm.
• Changes in skin colour and temperature. Skin may become pale, moist, and slightly cooler just before death.
• Involuntary twitches. These are normal and don’t mean that someone is distressed or uncomfortable. If you notice these it’s best to mention them to whichever health care professional is involved at the time.
• Needing oxygen, if it’s not already being used, and the support of other medical equipment. This doesn’t need to get in the way of physical contact. Don’t be afraid to touch and be close to each other.

Use of medical equipment in the final stages

Oxygen therapy might become burdensome in the final days and hours of life. This is because the blowing in the airways can cause soreness and as the person become less aware of their surroundings it can cause distress. If this happens, oxygen therapy can be removed, even if oxygen levels are low. This is with the knowledge that doing so will help relieve discomfort in the person who is dying, rather than contribute towards death.

Overall, the use of medical equipment in the final stages of is focused on comforting the person who is dying and is minimised as much as possible, to disturb them as little as possible.

Your health care professional can also prescribe ‘just in case’ medicines to keep at home. These are generally injectable medications a community nurse will give you if needed for symptoms like pain or breathlessness, where oral medications aren’t the best choice. Sometimes it can be difficult to access medicines quickly at night or weekends. Having a box of ‘just in case’ medicines means your health care professional can quickly control symptoms if you are in pain or start to feel sick.

Read next: Caring for a loved one in the final stages

Download our end of life information (PDF, 490KB)

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90,000 Pulmonary emphysema: first symptoms, diagnosis, prognosis

Pathology of the lungs, in which there is a violation of ventilation of the lungs and blood circulation is called emphysema. Men are most susceptible to the disease, but women can develop emphysema against a background of hormonal imbalance. The disease is complex, dangerous for its complications, often becomes the cause of death, therefore, at the first symptoms, it is imperative to consult a pulmonologist in Yeisk in order to undergo examination

Symptoms of emphysema

Emphysema develops gradually, and as this expands the chest and intercostal spaces.In addition, the following symptoms appear and progress:

• cyanosis (blue discoloration) of the nail plates, the tip of the nose, earlobes;
• dyspnea with shortness of breath;
• Noticeable tension in the muscles of the diaphragm during inhalation;
• swelling of the veins in the neck;
• weight loss;
• pain in the right hypochondrium;
• during coughing, a person’s face turns pink, a small amount of sputum is separated.

Over time, the patient’s neck becomes shorter, the chest takes a rounded shape, and the supraclavicular fossae bulge strongly, the abdomen sags.

Classification and causes of emphysema

Primary emphysema, which occurs due to congenital abnormalities in the body, is the most difficult to treat. In newborns, it may appear due to obstruction of one of the bronchi. Secondary emphysema is a milder form, and at first it can even proceed without obvious symptoms, the patient goes to see him already when the disease has become chronic.

Tuberculosis can cause emphysema, its focal type, which causes changes in the parenchyma around the foci of tuberculosis.Senile emphysema occurs as a result of the appearance of age-related changes in blood vessels and a deterioration in the elasticity of the walls of the alveoli.

Diagnostics for emphysema

If emphysema is suspected, first of all, a study of the respiratory function is carried out. Several methods are used for this.

1. Peak flowmetry: performed using a peak flow meter, into which the patient breathes at rest. The result will help to assess how narrow the bronchi are, and from this data the doctor can conclude whether it is about emphysema, or the patient has bronchial asthma or bronchitis.

2. Spirometry: diagnostics for measuring the respiratory volume of the lungs, also carried out using special equipment.
3. X-ray: allows you to see the cavities in the pulmonary regions, and when the dome of the diaphragm moves and tightens it, it is possible to determine the increase in lung volume as a result of the pathologist.

Treatment of pulmonary emphysema

Treatment is prescribed by a pulmonologist in Yeisk in the Sensitiv clinic. First of all, they treat the primary disease, due to which emphysema began, in this case, a course of antibiotics is possible.Also, bronchodilators are prescribed in the form of tablets or inhalation. Oxinogen therapy has proven itself well, which must then be supplemented with diuretics.

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Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a progressive and ultimately debilitating lung disease, which means the condition gets worse over time. The disease usually causes coughing, wheezing, and shortness of breath, making it difficult to breathe.According to the National Institutes of Health, COPD is the third leading cause of death.
COPD is most common in people over the age of 40 and who have a history of smoking. Various factors can contribute to the development of COPD, including long-term exposure to air pollutants and dust. However, cigarette smoking is the main cause of the disease. In fact, smoking causes about 90% of COPD cases.

COPD: Causes of the disease

COPD is most commonly caused by smoking. Most people are long-term smokers, and research shows that smoking cigarettes increases the risk of disease.
COPD is often a combination of two diseases: chronic bronchitis and emphysema. Both of these diseases are caused by smoking. You may have a mixture of both, though.
Chronic obstructive pulmonary disease (COPD) is a long-term lung disease. It consists of two diseases: emphysema and chronic bronchitis.Long-term coughing is often a symptom of COPD. There are other symptoms that can occur as lung damage progresses.
Many of these symptoms can also develop slowly. More complex symptoms appear when significant lung damage has already occurred. Symptoms can also be episodic and vary in intensity. If you have COPD, or are wondering if you have a medical condition, inquire about your symptoms and talk to your doctor.
Main symptom
Cough is often the first symptom of COPD. According to the Mayo Clinic, chronic bronchitis associated with COPD is diagnosed if your cough persists for three months or more for a year, for at least two years. A cough can occur every day, even if there are no other symptoms of the disease.
A cough is how the body clears mucus and other irritants such as dust or pollen and secretions from the respiratory tract and lungs.Usually people cough mucus, it is clear, but often it is yellow in people with COPD. The cough is usually worse in the early morning, and you may cough more when you are physically active or smoke.
Other common symptoms of COPD
As COPD progresses, you may experience other symptoms besides coughing. They can occur in the early and middle stages of the disease.
Wheezing
When you exhale and air is forced through narrow or obstructed air passages in your lungs, you may hear a wheezing or musical sound called wheezing.People with COPD are more likely to have excess mucus that blocks their airways. This is due to muscle tightening, which further narrows the airways.
Sweeping can also be a symptom of asthma or pneumonia. Some people with COPD may also have a condition that includes symptoms of both COPD and asthma.
Shortness of breath
As the airways in the lungs become swollen (inflamed) and damaged, they may begin to narrow. You may find it harder to breathe or catch your breath.This symptom of COPD is most noticeable with increased physical activity. It can make even daily tasks challenging, including:
• Walking
• Simple household chores
• Bathing
In the worst case scenario, it can even happen while on holiday.

Fatigue

You often cannot get enough oxygen in your blood and muscles if you have difficulty breathing. Your body slows down and fatigue starts without the oxygen it needs. You may also feel tired because your lungs are working too hard to get oxygen and carbon dioxide.
Frequent respiratory infections

People with COPD have less reliable immune systems. COPD also makes it difficult to clear light pollutants, dust, and other irritants. When this happens, people with COPD are at greater risk of lung infections such as colds, flu, and pneumonia. It can be difficult to avoid infections, but practicing good hand washing and getting the right vaccinations can reduce your risk.
What are the serious complications associated with COPD?

For people living with COPD, breathing can be difficult. People with COPD can be at risk of serious complications that can not only put their health at risk, but can also be fatal. Here are a few of these complications, along with some tips to prevent them.

Pneumonia

Pneumonia occurs when bacteria or viruses enter the lungs, creating an infection. According to the Centers for Disease Control and Prevention, bacterial pneumonia is the most common form of pneumonia. It is ranked evenly with the flu as the eighth leading cause of death. The disease is especially dangerous for people with a weakened lung system, such as those with COPD. For these people, pneumonia can further damage the lungs. This can lead to a chain reaction of diseases that can further weaken the lungs. This downward spiral can lead to a rapid deterioration in the health of people with COPD.

Overall, good health is the key to preventing infection in people with COPD. Here are some tips to reduce your risk of infection:
• Drink plenty of fluids, especially water, to maintain healthy bronchioles by thinning mucus and secretions.
• Quit or avoid smoking to maintain a healthy immune system and lung health.
• Wash your hands consistently.
• Avoid contact with people who are sick.
• Discourage sick friends and family from visiting your home.
• Get pneumonia vaccines and a yearly flu vaccine.

Chronic heart failure

One of the most important complications of COPD is heart failure. Because people with COPD have lower blood oxygen levels, their heart often suffers. According to the American Thoracic Society, this can lead to severe pulmonary hypertension in a small percentage of patients (less than 10%).For many patients, COPD treatment can help prevent the disease from progressing to the point that it causes heart failure. Unfortunately, since many of the symptoms of heart failure can be the same as those of COPD, it can be difficult for patients to realize that they are having heart problems until it is too late.

Lung cancer

Since COPD can often be attributed to smoking, it is not surprising that people with COPD often develop lung cancer.However, researchers have actually identified a link between COPD and lung cancer that is separate from the person’s smoking history. This is most likely due to chronic inflammation in the lungs. Genetics can play a role as well. Because lung cancer is often fatal, it is important that people with COPD remove factors that further damage their lungs, especially smoking.

Diabetes

COPD does not cause diabetes, but it can make it harder to manage difficult diabetes symptoms.One of the significant complications associated with both COPD and diabetes is the deleterious interaction between COPD and diabetic drugs. People with diabetes and COPD may find that their symptoms have worsened because diabetes can also restrict their cardiovascular system. Smoking can worsen the symptoms of both diabetes and COPD. It is imperative to stop smoking as soon as possible. Learning to manage blood sugar, usually with the help of your doctor, can help keep COPD symptoms from becoming overwhelming.Uncontrolled diabetes, which causes persistently high blood sugar, can decrease lung function. Work with your doctor to make sure the medications they are prescribing will work together to treat both conditions. It can help you manage these two diseases at once.

Dementia

The gradual mental decline in many severe COPD patients can be difficult for loved ones. Dementia is especially common in patients older than COPD, making it difficult to manage symptoms.COPD is an intrinsic risk factor for developing dementia. Conditions such as low oxygen, high carbon dioxide levels, and damage to blood vessels in the brain due to smoking play a role in dementia in COPD.
Respiratory failure is the most common cause of death from COPD. After several months, years, or even decades of struggling with lung problems, the patient’s lungs stop working. Heart failure is also a contributing factor to death from COPD, with COPD often contributing to heart problems.
Treatment options

Although there is no known cure for chronic obstructive pulmonary disease (COPD), treatment can help relieve your symptoms and slow its progression. The main goals of COPD treatment are:
• Improving your well-being
• Improving your quality of life
• Helping you stay active
• Preventing and treating complications
• Improving your overall quality of life
Lifestyle changes

Quit smoking

First and the most important thing you should do is quit smoking or not start if you don’t already smoke. You must also minimize air pollution in your environment. Avoid secondhand smoke and avoid getting dust, fumes and other toxic substances that you may inhale.
Diet and exercise
Eating healthy foods is also important. The fatigue and shortness of breath that comes with COPD can make it difficult to consume. Eat less food more often. Your doctor may suggest nutritional supplements. It can also be helpful to rest before eating.
Exercise is important, but for some it can be difficult.Physical activity can strengthen the muscles that help you breathe. Talk to your doctor about physical activities that are right for you. Pulmonary rehabilitation can also be a way to improve endurance and help with breathing problems, so ask your doctor about your options.
Drugs for smoking cessation
Quitting smoking can improve your health and quality of life, with or without COPD. Because nicotine is highly addictive, many doctors offer patients nicotine replacement therapy to ease their cigarette cravings.Recommended nicotine replacement procedures are in the form of gums, patches, and inhalers.
Several antidepressants have been clinically proven to reduce or eliminate smoking, but you should be aware of the side effects. If your doctor prescribes medication, be sure to ask what to expect

COPD: When to seek help?

Call a doctor or other emergency services now if:
• Breathing stops.
• Moderate to severe breathing difficulties. This means that the person may have trouble speaking fully or breathing during exercise.
• Severe chest pain, or chest pain gets worse quickly.
• You are coughing up large amounts of bright red blood.
See your doctor right away or go to the emergency room if you are diagnosed with COPD and:
• Cough up a couple tablespoons of blood.
• You have shortness of breath or wheezing that gets worse quickly.
• Chest pains recur.
• The cough is deeper or more frequent, especially if you notice an increase in mucus (sputum) or a change in the color of the mucus.
• Increased swelling in the legs or abdomen.
• You have a high fever (38. 3 ° C)
• You develop flu symptoms.
Call your doctor soon if:
• Your medication is not working as well as it did.
• Your symptoms are gradually getting worse and you have not seen a doctor for a long time.
• You are cold and:
o Your fever lasts longer than 2-3 days.
o Difficulty occurs or becomes markedly worse.
o The cough gets worse.
• You are not diagnosed with COPD, but you have symptoms. A smoking history (even in the past) significantly increases the likelihood of getting sick.
• You cough up any amount of blood.

21.11.2018 Psychiatrist – narcologist Tretyakov E.A.

90,000 Chronic obstructive pulmonary disease (COPD)

A progressive disease characterized by impaired bronchial patency.It is accompanied by shortness of breath – first after exertion, then at rest, cough with phlegm. Chronical bronchitis.

General

Chronic bronchitis is a disease characterized by the following symptoms: a cough with sputum for at least three months a year for two consecutive years in combination with abnormalities according to spirometry (respiratory function tests).

Thus, the main complaint in chronic bronchitis is a cough with phlegm.

Together with pulmonary emphysema, chronic bronchitis refers to the so-called chronic obstructive diseases (diseases) of the lungs, abbreviated as COPD (or COPD). Emphysema of the lungs is characterized by their “overstretching”, an increase in air spaces.

The main complaint with pulmonary emphysema is shortness of breath (feeling short of breath).

Chronic bronchitis and pulmonary emphysema rarely occur in their pure form: in most patients, both diseases are combined to one degree or another.Depending on the prevailing symptoms, two types of COPD are distinguished: bronchitis and emphysematous.

The main cause of COPD is smoking. Some smokers have COPD episodes of asthma. This form of the disease must be differentiated from bronchial asthma , in which asthma attacks also occur, but between attacks, unlike COPD, airway patency is fully restored. This form of COPD is called Chronic Asthmatic Bronchitis .

In developed countries, COPD is the fourth most common cause of death. The prevalence of COPD increases with age. Among the patients, men predominate, which is natural, because earlier smoking was mainly a male habit. As women become more familiar with it, their proportion among patients with COPD increases.

The main risk factor for COPD is smoking. The likelihood of illness increases in proportion to the length of time of smoking and the number of cigarettes smoked. Cigar or pipe smokers are also at increased risk, but to a much lesser extent than cigarette smokers.Individual susceptibility to the effects of tobacco smoke seems to play a decisive role in the development of COPD, since COPD develops in only 15% of smokers.

Patients with alpha1-antitrypsin deficiency are extremely prone to pulmonary emphysema, although they account for less than 2% of cases of this disease. The cause of chronic bronchitis can be occupational hazards, primarily contact with inorganic dust (cement, coal), grain dust and sulfuric acid vapors. In nonsmokers, COPD can be promoted by general air pollution, indoor air pollution and recurrent respiratory infections in childhood, but the role of these factors is unclear.

Diagnostics

Mostly people over 50 years old, who smoke or have smoked earlier (smoking experience – more than 20 pack-years) are sick. COPD can be suspected by taking a history, but spirometry (a study of the function of external respiration) is necessary to confirm the diagnosis. The main symptom is progressive shortness of breath.Usually it is accompanied by coughing up phlegm and asthma attacks. A cough, as a rule, either precedes shortness of breath, or appears at the same time. The phlegm is pale gray in color and is discharged in the morning, but can also be coughing up during the day.

Long-term cough with phlegm and mild shortness of breath are characteristic of the bronchitic type of COPD. In the case of the emphysematous type of COPD, on the contrary, there is a rare cough with scanty sputum and severe shortness of breath. A change in the nature of sputum from mucous (pale gray) to purulent indicates the addition of an infection – acute bacterial bronchitis.Wheezing and choking attacks are the result of bronchospasm or narrowing of the airways due to inflammation. COPD in close relatives means that alpha1-antitrypsin deficiency may be the cause of the disease, especially if the first symptoms appear before age 50. Hemoptysis is usually caused by an acute bacterial infection (bronchitis or pneumonia), but lung cancer must be ruled out. If the disease began with progressive shortness of breath against the background of bronchial asthma, especially in a non-smoker, chronic asthmatic bronchitis is likely.

In the bronchitic type of COPD, there are usually no complaints at rest. Over time, hypoxemia (a decrease in the level of oxygen in the blood) inevitably develops, which leads to changes in the heart (cor pulmonale) and heart failure (which is manifested, in particular, by edema).

With COPD, especially severe COPD, there may be complaints that are not directly related to the damage to the respiratory system: fatigue, weight loss, decreased appetite. Sleep disturbances and mental disorders are also possible: depression, impaired concentration and memory.

Laboratory and instrumental research

The only reliable criterion for COPD is violations detected by spirometry (a study of the function of external respiration). Any changes in spirometric parameters, both for the better and for the worse, however, do not say anything until they are confirmed by repeated studies. In bronchial asthma, in contrast to COPD, obstructive disorders are reversible.

The functional reserve of the lungs is assessed using stress tests with the study of the function of external respiration and gas exchange.In addition, exercise tests make it possible to establish what causes poor exercise tolerance: impaired gas exchange or ventilation, or cardiovascular pathology. In patients with COPD, cardiovascular disease is often the limiting factor.

If obstructive disorders are detected, spirometry is usually supplemented with a definition of sensitivity to bronchodilators: for this, the patient is given several breaths through the inhaler and the study is repeated. However, the reaction to a single use of bronchodilators does not always reflect their effectiveness, and low sensitivity to bronchodilators in spirometry does not mean that their prolonged use will not improve the patient’s condition.Therefore, regardless of the reaction detected with spirometry, you should not refuse trial treatment with bronchodilators.

A chest x-ray can help diagnose pulmonary emphysema. Its most important symptom is over-inflation of the lungs. Bullae can be found in the upper lobes and a focal increase in the transparency of the pulmonary fields. Radiography only approximately characterizes the severity of pulmonary emphysema and is most informative in severe forms of the disease. Computed tomography (CT) is much more sensitive in detecting changes such as small bullae.However, neither X-ray nor CT can replace the key diagnostic method – spirometry.

At the initial examination, sputum microscopy, a general blood test with the definition of a leukocyte formula, electrocardiography (ECG) and often echocardiography (ultrasound examination of the heart) are also advisable. In addition, if alpha1-antitrypsin deficiency is suspected, its serum level is determined, and if chronic asthmatic bronchitis is suspected, skin tests with allergens are performed and the serum IgE level is determined.

Treatment

Smoking cessation

The majority of patients with COPD (85%) smoke or have smoked before. Quitting smoking not only slows down the rate of decline in external respiration (it becomes the same as that of a non-smoker), but also has a beneficial effect on the state of the cardiovascular system and reduces the risk of lung cancer. With the inclusion of nicotine preparations (chewing gum with nicotine, a patch with nicotine, an aerosol with nicotine for intranasal administration, an inhaler with nicotine) in complex programs to combat smoking, the frequency of persistent abstinence from smoking has reached 50%.With the help of chewing gum, the level of nicotine in plasma and tissues is maintained at about the same level as when you smoke a pack of cigarettes a day. Cancellation of treatment can be both gradual and abrupt. Among the disadvantages, it should be noted the bitter taste of chewing gum, which can lead to non-compliance with the doctor’s prescriptions, and insufficient intake of nicotine into the body with low chewing efficiency.

Many factors contribute to smoking: habit, influence of others, dependence. Therefore, in order to achieve good long-term results, in addition to nicotine preparations, these aspects should be taken into account in the smoking control program.The help and participation of the doctor is important.

Prevention of exacerbations

Exacerbations of COPD, especially chronic asthmatic bronchitis, are often caused by air pollutants in the workplace or at home. By identifying and eliminating them, you can reduce the frequency and severity of exacerbations. An exacerbation of COPD can cause severe smog.

Physiotherapy

Removing phlegm from the airways can significantly improve the patient’s well-being, especially with bronchitis-type COPD. There are many ways to clear phlegm from the airways and prevent phlegm buildup. Cough in patients with COPD, as a rule, does not remove phlegm and is only exhausting. Such patients can be advised a simple and effective method of coughing up sputum, which, unfortunately, is often neglected. Its essence is as follows: after a couple of slow deep breaths, you must hold your breath for 5-10 s to increase the intrathoracic pressure and then, on exhalation, cough up with an open glottis.

Postural drainage, vibration and percussion massage facilitate the removal of phlegm from the lower lungs by gravity and vibrating chest movements by percussion or vibrator. At the end of the procedure, the patient should clear his throat well, as described above.

All the methods described in one way or another facilitate the removal of phlegm, but the only cough with an open glottis can still move the phlegm into the trachea and large bronchi, from where it can be removed by coughing or by aspiration.

Rehabilitation

COPD significantly impairs quality of life. Comprehensive rehabilitation programs include patient education, exercise and fitness, proper nutrition, psychotherapy and social adaptation to address anxiety and other emotional disorders caused by COPD.

Drug treatment

Drug treatment for pulmonary emphysema and chronic bronchitis is aimed at relieving symptoms and improving lung function.Preference is given to inhaled drugs in the form of metered aerosols, since when the drug is administered directly into the respiratory tract, the risk of systemic side effects is less. For the administration of inhalation drugs, buffer nozzle (spacer) is required. It acts as a reservoir for the aerosol and eliminates the need to synchronize the inhalation and pressing of the inhaler-dispenser. The buffer nozzle allows the drug to be introduced deeper into the respiratory tract and prevents it from settling in the oropharynx.

The main groups of drugs used in COPD are M-anticholinergics (ipratropium bromide). Ipratropium bromide has a stronger effect on the bronchi than beta-adrenostimulants or theophylline, as well as a longer lasting effect. All this puts him at the forefront of the treatment of COPD. If ipratropium bromide is not effective enough in the usual dose (2 breaths 4 times a day), the dose can be safely increased to 3-6 breaths 4 times a day.

Beta-adrenostimulants improve airway patency, make it easier to pass mucus and relieve shortness of breath.To enhance the bronchodilating effect, you can increase the dose from 2 breaths 4 times a day to 2-6 breaths 4-6 times a day, without fear of complications. However, under the influence of reports of the death of patients with bronchial asthma due to an overdose of beta-adrenostimulants, experts do not welcome an increase in the dose.

The role of oral glucocorticoids in the treatment of COPD remains uncertain, in part due to the lack of evidence and severe side effects. Glucocorticoids for oral administration are indicated for outpatients with insufficient effectiveness of beta-adrenostimulants, ipratropium bromide and, possibly, theophylline. With prolonged use, oral glucocorticoids have severe side effects. Among them are adrenal insufficiency, osteoporosis, arterial hypertension, cataracts, myopathy, diabetes mellitus.

Although there is insufficient justification for the use of inhaled glucocorticoids in COPD, these drugs are frequently used. They contain smaller doses than oral preparations, are almost not absorbed and therefore cause only mild complications.

The benefits of mucolytic and expectorant drugs for chronic bronchitis are still in question. Mucolytics such as iodinated glycerin and acetylcysteine ​​are thought to reduce the viscosity of sputum. Expectorant drugs thin the phlegm and promote its excretion.

Infections provoke exacerbations of COPD, therefore antibacterial drugs are often prescribed – both for prophylactic and therapeutic purposes. During infectious exacerbations (they are indicated by increased shortness of breath and cough and the appearance of purulent sputum), lung function worsens (it is possible that it is irreversible). With frequent exacerbations (4 or more per year), monthly prophylactic antibiotic therapy for a week with a change of drugs can reduce their number.

Prevention of influenza and pneumococcal pneumonia

Because lung infection is common in patients with COPD and threatens to deteriorate lung function and respiratory failure, annual influenza vaccination is recommended for people who are not allergic to egg white. Its efficiency reaches 60-80%. Amantadine is given to unvaccinated patients at high risk of influenza A and early on.Patients over 50 years of age, in addition, are recommended a single immunization with pneumococcal vaccine. Revaccination is now carried out after five or more years, if at the time of vaccination the patient’s age did not exceed 65 years.

Long-term oxygen therapy

The benefits of continuous oxygen inhalation ( long-term oxygen therapy ) in COPD have been scientifically proven. Oxygen therapy significantly reduces the incidence of complications and deaths in severe COPD, as well as improves mental function and exercise tolerance.

90,000 COPD – chronic obstructive pulmonary disease

2019.12.17

Chronic obstructive pulmonary disease is a progressive and fatal disease

Chronic obstructive pulmonary disease (COPD) is a disease characterized by progressive incomplete airway obstruction (narrowing of air flow in the lungs, resulting in insufficient oxygenation of all tissues and organs) associated with an abnormal inflammatory response of the lungs to inhaled harmful particles or gases.in particular, smoking tobacco. The most important risk factor for COPD is long-term smoking. The onset of the disease is also influenced by environmental pollution and work in a polluted (dusty or smoky) environment, a history of frequent respiratory infections and, in very rare cases, a deficiency of a certain protein (alpha-1-antitrypsin).

Data from various studies show that morbidity and mortality from COPD is increasing every year. In Europe, the incidence of this disease ranges from 5% to 10%, especially among the elderly. COPD is currently the fourth highest mortality rate, but according to WHO projections for 2030. it will become the third leading cause of death in the world (cardiovascular diseases will remain in first place, and oncology – in second). COPD is a progressive disease, which means that if left untreated, it will get worse and the changes will be irreversible. COPD often exacerbates the course of comorbidities and surgeries, and is often associated with depression, heart disease, skeletal muscle atrophy, decreased endurance, wasting, chronic heart disease, secondary polycythemia (an increase in the number of blood cells), and lung cancer.

Symptoms specific to COPD

• Shortness of breath and shortness of breath. This occurs initially during increased physical activity, such as rushing to the bus or climbing stairs, and then, during simple daily activities (cleaning the house, getting dressed), and finally sitting or lying in bed;
• Cough of various kinds, cough, especially in the morning. A smoker usually associates cough with smoking, gets used to coughing in the morning, so he often does not notice that the cough has changed, has become constant and phlegm has appeared;
• Sputum regeneration.The sputum tends to be mucous and elongated, with exacerbation of the disease and the involvement of a purulent infection;
• Increased fatigue, general weakness;
• General respiratory infections;
• Weight loss, etc.

Diagnosis and treatment of COPD

Chronic obstructive pulmonary disease is diagnosed by a pulmonologist (pulmonologist) who assesses the patient’s complaints, has a medical history, clinical examination and spirometry.Lung volume and airflow rate during expiration are measured using spirometry. Patients with COPD have a reduced expiratory flow rate, which results in not all air being expelled from the lungs, and eventually emphysema (in other words, a “bulge”) develops, and the chest resembles a barrel.

After the diagnosis of COPD is made, treatment is carried out. Unfortunately, there is still no cure for chronic obstructive pulmonary disease, but following a doctor’s recommendations can slow its progression and improve quality of life, reduce the risk of death, and prevent flare-ups.

The earlier a disease is diagnosed, the easier it is to progress and the easier the treatment is. When diagnosing mild COPD, it is enough to follow the doctor’s recommendations and use fast-acting bronchodilators for shortness of breath. However, for the treatment of chronic obstructive pulmonary disease, inhaled bronchodilators are selected by the pulmonologist individually for each patient. In addition to the correct use of inhaled medicines (inhalers), the advice of another doctor should be followed.

Doctor’s recommendations for patients

• Don’t smoke because smoking continues to impair lung function and medications are less effective.
• Food is healthy and balanced: Eat 3-4 times a day, eat plenty of fresh foods, fruits and vegetables, and limit alcohol consumption.
• Maintain physical activity and improve physical fitness: 20 to 30 minutes of aerobic exercise at least 2-3 times a week – especially Nordic walking, climbing stairs.For those who do not like active sports, walking in nature with a pet, playing with children or grandchildren can be a pleasant physical activity. A fast-acting bronchodilator can be inhaled before exercise.
• Overweight is recommended for those who are overweight, as weight loss will significantly increase physical performance and reduce shortness of breath.
• Avoid colds, always wear appropriate clothing for the season and keep the temperature below 19 degrees
• Prevention of viral respiratory infections from sick loved ones, since any respiratory infection can make breathing difficult and further damage lung tissue, and viral and bacterial respiratory infections are the most common cause of exacerbation of COPD.
• If your home has a runny or cold nose, it is recommended that you use disposable masks and wash your hands frequently.
• Influenza and pneumonia can be protected by vaccinations, which are free of charge to patients with the disease and must be administered annually as soon as the fall season begins.
• The correct use of drugs (inhalers) is very important for respiratory diseases, otherwise they will not enter the lower respiratory tract and will be ineffective. After inhalation treatment, your pulmonologist will teach you how to use them correctly and give you detailed instructions on how to use your inhaler.If you do not feel any improvement or feel that your medicines are not working, read the directions carefully or ask your pharmacist for advice.

When to call a pulmonologist?

A visit to a pulmonologist for chronic obstructive pulmonary disease is recommended at least once a year, for patients with severe COPD – 3 times a year. During the visit, pulmonary function and changes during treatment are assessed and the inhaler technique is explained.An appointment with a pulmonologist is also recommended if the prescribed treatment does not improve. During the consultation, the doctor will select the most appropriate medication and inhaler.

If you are over 40, complain of shortness of breath with mild to moderate exertion, shortness of breath accompanied by morning cough, phlegm, “shortness of breath”, changes in breathing patterns, shortness of breath, increased breathing and pulse, especially if you smoke Visit your pulmonologist for a check spirometry to see if you have obstructive pulmonary disease.

Collaboration between patient and doctor is essential for the success of COPD treatment

Following the doctor’s recommendations and regular use of the drug can help stop the progression of the disease, maintain the ability to work longer, and continue a full-fledged social life. However, the patient’s own attitude and efforts are very important here. Failure to comply with the regimen and treatment will worsen the condition and cause irreversible changes. In more severe stages of COPD, physical activity is significantly reduced, and even seemingly light activities such as dressing or washing are questioned.Such patients may receive continuous oxygen therapy as determined by the pulmonologist who performed pulse oximetry and arterial blood gas monitoring.

90,000 Prophylactic antibiotic treatment for people with COPD

Seven RCTs involving 3170 patients were included in this systematic review. All studies were published between 2001 and 2011. Five studies were with continuous antibiotic use and two studies were with intermittent antibiotic prophylaxis (called “pulse” use in this review).The antibiotics studied were azithromycin, erythromycin, clarithromycin, and moxifloxacin. Azithromycin, erythromycin, and clarithromycin are macrolides, while moxifloxacin is a fourth generation synthetic fluoroquinolone antibacterial agent. Study durations ranged from three months to 36 months, and all studies used intent-to-treat analysis. Most of the results were of moderate quality. The risk of bias in the included studies was generally low, and we did not downgrade the quality of the evidence due to bias.

People with an average age of 66 years and at least moderate severity of COPD participated in the trial. Three studies included participants with frequent exacerbations, and two studies included patients who required systemic steroids or antibiotics, or both, and participants who were in the terminal stages of their illness and needed oxygen.

The primary outcomes in this review were the number of exacerbations and quality of life.

With continued prophylactic use of antibiotics, the number of patients experiencing exacerbations was reduced (odds ratio (OR) 0.55; 95% confidence interval (CI) 0.39 to 0.77, 3 studies, 1262 participants, high quality).This represents a decrease from 69% of participants in the control group versus 54% in the treatment group (95% CI 46% to 63%) and the number of patients to be treated to prevent a single exacerbation (PNNL) was therefore 8 (95% CI 5 to 18). The incidence of exacerbations was also reduced with continued prophylactic antibiotic use (frequency ratio 0.73; 95% CI 0.58 to 0.91).

Use of pulse antibiotic treatment showed a non-significant decrease in the number of people with exacerbations (OR 0.87, 95% CI 0.69 to 1.09, 1 study, 1149 participants, moderate quality), and the interaction test showed this result to be significant differed from the effect on exacerbations of continuous antibiotic use.

There was a statistically significant improvement in quality of life with both continuous and pulse antibiotic treatment, but this [improvement] was less than the four units improvement considered clinically significant (MD -1.78; 95% CI -2, 95 to -0.61, 2 studies, 1,962 participants, moderate quality).

Neither pulse nor continuous antibiotic use was shown to have a significant effect on secondary outcomes such as hospital admission rates, changes in lung function, serious adverse events, or all-cause mortality (moderate quality of evidence).

The adverse events that were reported varied across trials based on the use of different antibiotics. Azithromycin was associated with significant hearing loss in the treatment group. In the pulse moxifloxacin study, significantly more adverse events were reported in the treatment group due to a significant increase in gastrointestinal adverse events (p <0.001). Some of the adverse events that led to drug withdrawal, such as prolonged QTc interval or tinnitus, did not occur more frequently in the treatment group than in the placebo group.But they are essential for clinical practice.

The development of antibiotic resistance in society as a whole is of great concern. One study found that patients newly colonized with bacteria had higher rates of antibiotic resistance. Patients colonized with moxifloxacin-sensitive pseudomonas (Pseudomonas) at the beginning of therapy quickly became resistant to treatment with quinolones.

Official website of the municipal formation “City District Nogliki”

Diseases caused by smoking.

More than 60% of men and every 10th woman smoke in Russia.

Many people who smoke do not even think that most of the diseases they develop due to smoking.

How often you hear the following at a doctor’s appointment:

– shortness of breath tortured …

– weakness in the legs, chilly …

– pain, burning in the chest …

– the wound on the leg does not heal in any way …

Etc., etc. And what is the bewilderment of the patient (especially men) that health problems are provoked and aggravated by smoking.

A smoker can read about many diseases on cigarette packs, but as a rule they are not considered or read.

Poisons in tobacco smoke

In the lungs of a smoker who smokes 1 pack of cigarettes a day, approximately ¼ of the tar contained in tobacco smoke is deposited. More than 300 poisons have been found in these resins.

A person who smokes 2 packs a day shortens his life by about 8 years. Even those who smoke only 2 to 9 cigarettes a day shorten their lives by about 4 years.

Substances in tobacco smoke are listed below: arsenic, barium, benzoic acid, carbon, cesium, chromium, copper, ethanol, ethylene acetate, formaldehyde, formic acid, glycerides, hydroxypyruvic acid, isovaleric acid, lactic acid, lithium, methanol, nickel , phenol, benzopyrene, xanthines, silicone.

So, what diseases are caused by smoking?

Chronic bronchitis

Smoking is known to cause chronic bronchitis.The reason for this is the deposition of tobacco tar on the bronchial mucosa of the smoker, which irritates the respiratory tract and leads to an inflammatory process.

The body removes the resulting mucus by coughing. Persistent cough (smoker’s cough) and difficulty in breathing are in direct proportion to the number of cigarettes smoked.

Emphysema of lungs

One of the last stages of chronic bronchitis is emphysema.

The irritation caused by cigarette smoke can be so severe that the walls of microscopic air-filled pulmonary vesicles (alveoli) lose their elasticity and rupture, creating large air pockets in the lungs.At the same time, the efficiency of the respiratory process is sharply reduced. A person suffering from emphysema dies a slow death due to a lack of oxygen in the body.

Unfortunately, there is no cure for pulmonary emphysema. A smoker must stop smoking before this disease develops.

Lung cancer

Today, this disease is the leading cause of death among cancer patients. Lung cancer rarely gives early symptoms, having time to spread throughout the body (most often to the liver and brain) before it is detected on an X-ray.It has been proven that the main cause of lung cancer is tobacco tar.

Heart attacks (infarction)

Tobacco smoke absorbed by the body reduces the ability of the blood to bind oxygen and increases blood clotting. These changes, combined with the hardening of the artery walls, also caused by smoking, can lead to an attack of angina pectoris. These seizures are one of the most common causes of death. At the age of 50, among smokers, heart attacks are observed 3 times more often than among nonsmokers.

Phlebitis

Phlebitis is an inflammation of the wall of a venous vessel with the formation of blood clots inside it. This disease is manifested by swelling, induration, pain and redness at the site of inflammation. The veins of the lower extremities are most often affected, but the process can develop in the veins of the arms and abdominal cavity. Smoking increases blood clotting and increases the risk of phlebitis, which can later lead to heart attack or stroke.

Stroke

The cause of a stroke is a narrowing or blockage of the blood vessels in the brain.A stroke can lead to paralysis with impaired speech and consciousness.

Smoking contributes to the hardening and narrowing of the walls of the arteries, disruption of the supply of blood to the brain. Smokers are 2 times more likely to experience the tragedy of disability.

Diseases of the teeth

Dental caries is observed in smokers about 2 times more often than in nonsmokers. Under the influence of tobacco tar, dental plaque (calculus) forms on the smoker’s teeth, which is a favorable environment for the growth of bacteria, which contribute to the destruction of enamel and the formation of cavities in the teeth.Moreover, because of frequent inflammatory diseases of the gums, smokers are 2 times more likely to lose their teeth.

Peptic ulcer

Peptic ulcer resulting from gastric ulcer and duodenal ulcer is an open defect in the mucous membrane of these organs and is accompanied by abdominal pain, heartburn, nausea, vomiting and, often, weight loss. Special studies have shown that gastric ulcer and duodenal ulcer occurs in smokers 2-3 times more often than in non-smokers, and develops mainly in people who abuse tobacco for a long time.

This is due to the fact that under the influence of nicotine and other harmful substances contained in tobacco smoke and swallowed with saliva during smoking, the secretion of gastric acid hydrochloric acid in the stomach is stimulated (or suppressed).

In addition, smoking leads to narrowing of blood vessels, disrupts the blood supply to the stomach and duodenum, thereby creating favorable conditions for ulceration of the mucous membrane. This disease can be fatal due to bleeding caused by ulcer perforation or intestinal obstruction.

Pathologies observed in newborns

Poisonous substances contained in tobacco smoke, entering the mother’s body, penetrate the developing child’s body through the bloodstream. Studies show that the weight of children born to mothers who smoke is, on average, 200 g less than the norm (this is due to the low oxygen and nutrient levels in the mother’s blood caused by the toxic effects of tobacco smoke). Pregnant women are strongly advised to avoid alcohol and cigarette consumption, as the developing fetus is very sensitive to any toxic effects.A mother who smokes has a 10 times higher risk of spontaneous abortion than a non-smoker. Newborns whose mothers smoke have a 50% higher risk of developing sudden death syndrome than those born of non-smoking mothers. One of the consequences of the mother’s smoking can be a developmental delay in the child.

Oral cavity cancer

Toxic substances of tobacco smoke have a direct effect on the oral mucosa. When examining a smoker’s mouth, you can see dense, whitish patches of skin located on the inner surface of the cheeks, on the tongue and under it.

Such changes are called “leukoplakia”. This is a precancerous condition, quite often it leads to the development of cancer itself.

Cancer of the lip and tongue is being caused with increasing frequency in people who use chewing tobacco or snuff.

Cancer of the larynx

The larynx is located in the anterior region of the neck and connects the nasopharynx and trachea. The larynx is formed from cartilage connected by ligaments and is lined with mucous membranes inside.

Persistent hoarseness of the voice, not accompanied by pain, at the age of 40 is a warning about possible cancer of the larynx.This disease occurs in men mainly after 40 years.

The most common cause of laryngeal cancer is smoking. Alcoholism also contributes to the onset of this disease.

Bladder cancer

The leading symptoms of bladder cancer are pain when urinating, blood in the urine and frequent infections of the urinary system.

The frequent occurrence of bladder cancer in smokers is due to the fact that tobacco tar, ingested with tobacco smoke, is excreted in the urine.Thus, these carcinogenic (cancer-causing) substances constantly affect the cells lining the inner wall of the bladder.

Smoking is not a habit, but an imperative need that commands a person.

More than half of smokers would like to quit this addiction. And yet not one of those who quit smoking has regretted their decision.

Smoking or health – you choose!

Slogan of the World Health Organization.

90,000 November 18 – World COPD Day

17.11.2020

World Day Against Chronic Obstructive Pulmonary Disease – COPD, is celebrated annually at the initiative of the World Health Organization on November 17. COPD is not one specific disease, but an umbrella term that has recently been used to refer to chronic conditions that cause airflow restriction in the lungs. The most famous diagnoses of “chronic bronchitis” and “emphysema” are no longer used, they are now included in the diagnosis of COPD.

The purpose of these Days is to draw public attention to interrelated problems: pulmonary pathology and smoking, which is the main factor in the occurrence and development of chronic obstructive pulmonary diseases.COPD is a preventable but incurable disease. Treatment can slow the progression of the disease, but in general it progresses slowly over time. Because of this, the disease is most commonly diagnosed in people aged 40 and over.

According to WHO estimates, more than 200 million people suffer from COPD of varying severity, more than 3 million people die from this disease every year. Disease, if untreated, very often leads to physical disability and disability at a relatively young age.

Among the diseases that take the most human lives, COPD is still in fourth place, behind only cardiovascular, cancer and HIV. Nearly 90% of deaths occur in low-income countries, where effective strategies for the prevention and control of the disease are not always or readily available.

Deaths from chronic obstructive pulmonary disease are projected to rise over the next 20 years, making it the world’s third leading cause of death unless urgent action is taken to address the underlying risk factors.

COPD is not just a smoker’s cough, but an underdiagnosed, life-threatening lung disease. Its first symptoms may be shortness of breath during exercise and a feeling of respiratory discomfort, which a person does not always pay attention to. Therefore, most patients go to the doctor already at the stage of severe changes in the airways, when it is very difficult or even impossible to influence the course of the disease.

The lack of awareness of the population – not only about the symptoms and consequences of COPD, but also about the very fact of the existence of such a pathology – leads to the fact that patients, even at late stages, do not suspect they have this disease.