Does copd cause pain: Pain Management With COPD | Everyday Health
Pain Management With COPD | Everyday Health
Chronic obstructive lung disease, or COPD, is a progressive lung disease that, over time, can make it difficult to breathe. Although COPD itself doesn’t directly cause pain, symptoms like persistent cough and chest tightness can cause pain.
COPD-related pain is usually located in the shoulders, neck, lower back, and chest. And the combination of pain, anxiety, difficulty sleeping, and trouble breathing can take a toll on your quality of life.
According to a review of studies published in 2014 in the journal BMJ Open, anywhere from 32 to 60 percent of people with COPD reported experiencing COPD-related pain. So if you have COPD, you may benefit from pain management strategies.
Reasons for COPD and Pain
There are direct and indirect reasons you may be experiencing pain with COPD. “COPD causes pain because the lungs become blown up like balloons. This causes pressure on the chest wall, the spine, and the diaphragm,” explains Harish Seethamraju, MD, medical director of the lung transplant program at the Methodist J. C. Walter Jr. Transplant Center in Houston. “This pain is real and severe, and it can be aggravated just by walking.”
Another common cause of pain in COPD is osteoporosis, a condition that involves bone loss. Osteoporosis may affect around 35 percent of people with COPD. This link may be due to COPD inflammation, use of steroid medication in COPD management, a history of smoking, poor nutrition, or inactivity.
People with osteoporosis are at an increased risk of bone fractures, which can also exacerbate COPD pain. Extreme bouts of coughing from COPD may cause muscle strains in your chest muscles or even lead to a broken rib, especially if you have osteoporosis. And if an osteoporosis fracture occurs in the spine, it can be difficult to fully expand the lungs and the rib cage, and even result in further loss of lung function in those with COPD.
What’s more, “the stress of struggling to breathe can cause anxiety,” Dr. Seethamraju says. “This can cause a person’s pain threshold to decrease and pain sensitivity to increase. ”
How to Manage COPD Pain
The right strategy for COPD pain management can vary depending on the cause of your pain and how advanced your COPD is. “Osteoporosis with COPD needs to be recognized and treated appropriately,” says Seethamraju. Some common options for COPD pain relief include:
- Paying attention to your breathing. Focus on inhaling slowly and exhaling slowly, sitting up straight, and breathing from the diaphragm. Slowing your breathing down can help you feel more in control and relax your mind and body. Try breathing techniques like pursed lip breathing and diaphragmatic breathing.
- Eating a healthy diet. Fatty, fried, and processed foods can contribute to gas and bloating, which can trigger chest pain and tightness. Eating too much salt can cause you to retain water, making it more difficult to breathe. Instead, aim to eat a balanced diet that includes plenty of grains, fruits, vegetables, dairy, and lean meat, fish, and poultry. And try to eat small, frequent meals to avoid excess bloating.
- Pulmonary rehabilitation. “This is the best treatment for chest pain due to expanded lungs,” Seethamraju says. “Pulmonary rehab strengthens the muscles of the chest wall and reduces pain.” This approach includes physical therapy, emotional support, and breathing retraining. It can decrease anxiety as well as improve strength and endurance.
- Pain medication. If your pain is mild, your doctor may suggest trying over-the-counter pain medication like acetaminophen or ibuprofen. If your pain is more severe, your doctor may prescribe opioid medications, which are often used to treat chronic pain. “They must be used with caution, but they can relieve pain as well as reduce the struggle to breathe in advanced COPD,” Seethamraju says. In large doses, these medications can dangerously decrease breathing, but used at the lowest effective dose, opioids can be part of COPD pain management without significant risk of addiction.
- Antidepressants. “For people with COPD who are also suffering from pain aggravated by emotional stress, an antidepressant medication may be helpful,” Seethamraju says. Antidepressants may also help reduce anxiety and physical discomfort for people with COPD. Talk therapy and supportive care may also help.
While the relationship between COPD and pain is being increasingly recognized, more research still needs to be done on how to manage.
If you have COPD and experience any change in your discomfort or pain levels, be sure to talk with your doctor. And if you are struggling emotionally with pain, ask for help. Work closely with your doctor to determine the cause of your pain and identify the best lifestyle modifications and treatment options for you.
Additional reporting by Kerry Weiss
Reporting of pain by people with chronic obstructive pulmonary disease (COPD): comparative results from the HUNT3 population-based survey | BMC Public Health
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Chronic Obstructive Pulmonary Disease (COPD): Symptoms, Treatment & More
What is COPD (chronic obstructive pulmonary disease)?
COPD is an umbrella term for a range of progressive lung diseases. Chronic bronchitis and emphysema both can result in COPD. A COPD diagnosis means you may have one of these lung-damaging diseases or symptoms of both. COPD can progress gradually, making it increasingly difficult to breathe over time.
Chronic bronchitis irritates your bronchial tubes, which carry air to and from your lungs. In response, the tubes swell and mucus (phlegm or “snot”) builds up along the lining. The buildup narrows the tube’s opening, making it hard to get air in and out of the lungs.
Small, hair-like structures on the inside of the bronchial tubes (called cilia) normally move mucus out of the airways. But the irritation from chronic bronchitis and/or smoking damages them. The damaged cilia can’t help clear mucus.
Emphysema is the breakdown of the walls of the tiny air sacs (alveoli) at the end of the bronchial tubes, in the “bottom” of the lung. The lung is like an upside down tree. The trunk is the windpipe or “trachea,” the branches are the “bronchi,” and the leaves are the air sacs or “alveoli . ” The air sacs play a crucial role in transferring oxygen into your blood and carbon dioxide out. The damage caused by emphysema destroys the walls of the air sacs, making it hard to get a full breath.
How common is COPD?
COPD affects nearly 16 million Americans, or about 6% of the U.S. population.
Who gets COPD?
The primary cause of COPD is smoking. But not all smokers develop the disease. You may be at higher risk if you:
- Are a woman.
- Are over the age of 65.
- Have been exposed to air pollution.
- Have worked with chemicals, dust or fumes.
- Have alpha-1 antitrypsin deficiency (AAT), a genetic risk factor to develop COPD.
- Had many respiratory infections during childhood.
Symptoms and Causes
What causes COPD?
Smoking tobacco causes up to 90% of COPD cases. Other causes include:
- Alpha-1 antitrypsin (AAT) deficiency, a genetic disorder.
- Secondhand smoke.
- Air pollution.
- Workplace dust and fumes.
Tobacco smoke irritates airways, triggering inflammation (irritation and swelling) that narrows the airways. Smoke also damages cilia so they can’t do their job of removing mucus and trapped particles from the airways.
AAT (alpha-1 antitrypsin deficiency) is an uncommon, inherited disorder that can lead to emphysema. Alpha-1 antitrypsin is an enzyme that helps protect lungs from the damaging effects of inflammation. When you have AAT, you don’t produce enough of the enzyme, called alpha-1 antitrypsin. Your lungs are more likely to become damaged from exposure to irritating substances like smoke and dust.
What are signs of chronic obstructive pulmonary disease (COPD)?
- Cough with mucus that persists for long periods of time.
- Difficulty taking a deep breath.
- Shortness of breath with mild exercise (like walking or using the stairs).
- Shortness of breath performing regular daily activities.
If I am having chronic obstructive pulmonary disease symptoms, how do I determine when I need to call my doctor?
If you are having any of the symptoms described below, don’t wait for your next appointment to call your doctor. Report these symptoms promptly, even if you don’t feel sick. DO NOT wait for symptoms to become so severe that you need to seek emergency care. If your symptoms are discovered early, your doctor might change your treatment or medications to relieve your symptoms. (Never change or stop taking your medications without first talking to your doctor).
Note: Remember that warning signs or symptoms might be the same or different from one flare-up to another.
Talk to your doctor on the phone within 24 hours if you have these changes in your health:
- Shortness of breath that has become worse or occurs more often. Examples:
- Unable to walk as far as usual
- Need more pillows or have to sit up to sleep because of breathing difficulty
- More tired because you’re working harder to breathe
- Need breathing treatments or inhalers more often than usual
- Wake up short of breath more than once a night
- Sputum (mucus) changes including:
- Changes in color
- Presence of blood
- Changes in thickness or amount (more than you usually have or more than you are able to cough out)
- More coughing or wheezing
- Swelling in your ankles, feet, or legs that is new or has become worse and doesn’t go away after a night’s sleep with your feet up
- Unexplained weight loss or gain of 2 pounds in a day or 5 pounds in a week
- Frequent morning headaches or dizziness
- Fever, especially with cold or flu symptoms
- Restlessness, confusion, forgetfulness, slurring of speech, or irritability
- Unexplained, extreme fatigue or weakness that lasts for more than a day
Diagnosis and Tests
How is chronic obstructive pulmonary disease (COPD) diagnosed?
To assess your lungs and overall health, your healthcare provider will take your medical history, perform a physical exam and order some tests, like breathing tests.
To diagnose COPD, your provider will ask questions like:
- Do you smoke?
- Have you had long-term exposure to dust or air pollutants?
- Do other members of your family have COPD?
- Do you get short of breath with exercise? When resting?
- Have you been coughing or wheezing for a long time?
- Do you cough up phlegm?
To help with the diagnosis, your provider will do a physical exam that includes:
- Listening to your lungs and heart.
- Checking your blood pressure and pulse.
- Examining your nose and throat.
- Checking your feet and ankles for swelling.
Providers use a simple test called spirometry to see how well your lungs work. For this test, you blow air into a tube attached to a machine. This lung function test measures how much air you can breathe out and how fast you can do it.
Your provider may also want to run a few other tests, such as:
- Pulse oximetry to measure the oxygen in your blood.
- Arterial blood gases (ABGs) to check your oxygen and carbon dioxide levels.
- Electrocardiogram (ECG or EKG) to check heart function and rule out heart disease as a cause of shortness of breath.
- Chest X-ray or chest CT scan to look for lung changes that are caused by COPD.
- Exercise testing to determine if the oxygen level in your blood drops when you exercise.
What are the stages of COPD?
COPD can gradually get worse. How fast it progresses from mild to severe varies from person to person.
Mild COPD (stage 1 or early stage)
The first sign of COPD is often feeling out of breath with light exercise, like walking up stairs. Because it’s easy to blame this symptom on being out of shape or getting older, many people don’t realize they have COPD. Another sign is a phlegmy cough (a cough with mucus) that’s often particularly troublesome in the morning.
Moderate to severe COPD (stages 2 and 3)
In general, shortness of breath is more evident with more advanced COPD. You may develop shortness of breath even during everyday activities. Also, exacerbations of COPD – times when you experience increased phlegm, discoloration of phlegm, and more shortness of breath – are generally more common in higher stages of COPD. You also become prone to lung infections like bronchitis and pneumonia.
Very severe COPD (stage 4)
When COPD becomes severe, almost everything you do can cause shortness of breath. This limits your mobility. You may need supplemental oxygen from a portable tank.
Management and Treatment
How is chronic obstructive pulmonary disease (COPD) managed?
COPD treatment focuses on relieving symptoms, such as coughing and breathing problems, and avoiding respiratory infections. Your provider may recommend:
- Bronchodilators: These medicines relax airways. Delivered through a mist you inhale, bronchodilators help you breathe easier.
- Anti-inflammatory medications: Doctors commonly prescribe steroids to lower inflammation in the lungs. You inhale steroids in a mist form (nebulizer or inhaler) or take them by swallowing a pill.
- Supplemental oxygen: If you have low blood oxygen (hypoxemia), you may need a portable oxygen tank to improve your oxygen levels.
- Antibiotics: COPD makes you prone to lung infections, which can further damage your weakened lungs. Your doctor may prescribe antibiotics to stop a bacterial infection.
- Vaccinations: Respiratory infections are more dangerous when you have COPD. It’s especially important to get shots to prevent flu and pneumonia.
- Rehabilitation: Rehabilitation programs focus on teaching effective breathing strategies to lessen shortness of breath and on conditioning. When maintained, fitness can increase the amount you can do with the lungs you have.
- Anticholinergics relax the muscle bands that tighten around the airways. This action opens the airways, letting more air in and out of the lungs to improve breathing. Anticholinergics also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can therefore be coughed out more easily. Anticholinergics work differently and more slowly than fast-acting bronchodilators.
- Leukotriene modifiers might be used. Leukotrienes are chemicals that occur naturally in our bodies and cause tightening of airway muscles, and production of mucus and fluid. These newer drugs work by blocking the chemicals and decreasing these reactions. These medications help improve airflow and reduce symptoms in some people.
- Expectorants thin mucus in the airways so it can be coughed out more easily. Take these medications with about 8 ounces of water.
- Antihistamines relieve stuffy heads, watery eyes, and sneezing. Although effective at relieving these symptoms, antihistamines can dry the air passages, making breathing difficult, as well as causing difficulty when coughing up excess mucus. Take these medications with food to reduce upset stomach.
- Antivirals might be prescribed to treat or prevent illnesses caused by viruses, most frequently to treat or prevent influenza (“the flu”). Influenza is particularly dangerous for people who have COPD.
For severe COPD, your provider may suggest you consider a clinical trial (tests of new treatments) or lung surgery, if you’re a candidate.
How can I avoid COPD?
The best thing you can do to avoid developing COPD is to not smoke. If you’d like to quit, smoking cessation programs can help you. Also, avoid any environment that has poor air quality — air that has particles like dust, smoke, gases and fumes.
Why should people with COPD (chronic obstructive pulmonary disease) watch for signs of infection?
People with COPD have difficulty clearing their lungs of bacteria, dusts and other pollutants in the air. This makes them at risk for lung infections that may cause further damage to the lungs.
Therefore, it is important to watch for signs of infection and follow these tips to help prevent infections. You will probably not be able to avoid infections entirely, but these tips will help you prevent infections as much as possible.
What are warning signs of an infection, especially if I have COPD (chronic obstructive pulmonary disease)?
Warning signs of infection
While most infections can be successfully treated, you must be able to recognize an infection’s immediate symptoms for proper and effective care.
- Increased shortness of breath, difficulty breathing or wheezing
- Coughing up increased amounts of mucus
- Yellow- or green-colored mucus (may or may not be present)
- Fever (temperature over 101°F) or chills (may or may not be present)
- Increased fatigue or weakness
- Sore throat, scratchy throat or pain when swallowing
- Unusual sinus drainage, nasal congestion, headaches or tenderness along upper cheekbones
If you have any of these symptoms, contact your physician right away, even if you do not feel sick.
What can I do to prevent infections, especially if I have COPD (chronic obstructive pulmonary disease)?
Frequently wash your hands with soap and warm water, especially before preparing food, eating, taking medications or breathing treatments; and after coughing or sneezing, using the bathroom, touching soiled linens or clothes, and after you’ve been around someone with a cold or the flu as well as after you’ve been at a social gathering. It is also good to carry waterless hand sanitizers with you to use when necessary.
If visitors have cold or flu symptoms, ask them not to visit until they are feeling well.
- Keep your house clean and free from excess dust. Keep your bathrooms and sinks free from mold or mildew.
- Do not work in or visit any form of construction site. Dust can be harmful. If you absolutely must go near this type of area, wear a mask provided by your doctor.
- Avoid air pollution, including tobacco smoke, wood or oil smoke, car exhaust fumes and industrial pollution which can cause inhaled irritants to enter your lungs. Also avoid pollen.
- Make sure your cooking vent is working properly so cooking fumes can be drawn out of the house.
- If possible, try to stay away from large crowds in the fall and winter when the flu season is at its peak.
- Keep breathing equipment clean.
- Do not let others use your medical equipment, including: oxygen cannula, metered dose inhaler (MDI), MDI spacer, nebulizer tubing and mouthpiece.
- Try to eat a balanced diet. Good nutrition is important to help the body resist infection. Eat foods from all the food groups.
- Drink plenty of fluids—at least 6 to 8 eight-ounce glasses per day (unless your doctor gives you other guidelines). Water, juices and sports drinks are best.
Other general health guidelines
- Do not rub your eyes, as this can transmit germs to your nasal passages via the tear ducts.
- Quitting smoking and avoiding second-hand smoke (the smoke from a burning cigarette or cigar and the smoke exhaled by a smoker) are important steps you can take to protect your lungs from infection.
- Follow your doctor’s medication guidelines.
- Get enough sleep and rest.
- Manage your stress.
- Talk to your doctor or healthcare provider about getting a flu shot every year and get the pneumonia vaccine if you have not had one.
- Be careful to avoid infection when traveling. In areas where the water might be unsafe, drink bottled water or other beverages (order beverages without ice). Swim only in chlorinated pools.
Outlook / Prognosis
What is the outlook?
COPD progresses at a different rate for every person. Once it progresses, the lung damage from COPD can’t be reversed but, by following a healthy lifestyle and getting treatment as early as possible, you can manage symptoms and feel much better.
How can I manage COPD at home?
You can take several steps to make breathing easier and slow the progression of the disease:
- Quit smoking.
- Avoid air polluted by chemicals, smoke, dust or fumes.
- Take prescribed medications as directed by your provider.
- Ask your doctor about a pulmonary rehabilitation program, which teaches you how to be active with less shortness of breath.
- Maintain a healthy weight.
- Get an annual flu shot.
The good news about COPD is that the symptoms can be managed. You’ll breathe easier if you take the necessary steps to support your lung capacity and fight lung irritation. By getting treatment early, you’ll have the best shot at continuing to do the things you love.
When should I call my doctor if I have COPD (chronic obstructive pulmonary disease) and I might have an infection?
Call your doctor if you experience any of the warning signs of an infection. Also call your doctor if you have any symptoms that cause concern.
The lungs of people with COPD are sensitive to certain irritating substances in the air, such as: cigarette smoke, exhaust fumes, strong perfumes, cleaning products, paint/varnish, dust, pollen, pet dander and air pollution. Extreme cold or hot weather conditions can also irritate your lungs.
You can avoid some of these irritants by:
- Asking those around you not to smoke.
- Sitting in non-smoking sections of public places.
- Requesting smoke-free hotel rooms and rental cars.
- Avoiding underground parking garages.
- Avoiding high traffic or industrialized areas.
- Not using perfumes, scented lotions or other highly scented products that may irritate your lungs.
- Using non-aerosol cleaning or painting products in well-ventilated areas and wearing a mask or handkerchief over your mouth when cleaning (dusting, vacuuming, sweeping) or working in the yard.
- Reducing exposure to dust by regularly changing filters on heaters and air conditioners and using a dehumidifier.
- Keeping pets out of the house, especially if you wheeze.
- Using an exhaust fan when cooking to remove smoke and odors.
- Staying indoors when the outside air quality is poor and pollen counts are high.
- Following weather reports and avoiding extreme weather. During cold weather, cover your face when going outdoors. During extreme humidity, try to stay in air conditioned areas.
11 Ways to Reduce Chest and Rib Pain Caused by COPD
If you are like most people with COPD, you’ve probably experienced at least some degree of pain in your chest and ribs. This kind of pain can come in a variety of forms, including muscle aches, rib soreness, chest tightness, and general feelings of discomfort.
Unfortunately, these types of aches pains often don’t get the attention they deserve, since discussions about COPD tend to focus on respiratory symptoms. However, research suggests that chest pain is exceedingly common, affecting more than half of people with COPD.
That’s why we’ve created this guide all about chest pain, rib pain, and COPD. It contains all the basics you need to know about COPD-related chest pain, including why it happens, where it comes from, and what you can do to relieve it.
In the following sections, we’ll explain the various types of chest pain that COPD can cause, and how to differentiate COPD-related chest pain from from other, more serious causes. Then, we’ll show you how to manage and minimize that pain by walking you through nearly a dozen of helpful strategies that you can put to use right away.
What is COPD Chest Pain?
A large percentage of people with COPD experience some type of chest pain, whether it’s frequent, chronic, or only just occasional. It can sometimes be difficult to pinpoint the exact source or reason for this chest pain because there are so many potential COPD-related causes.
Some of the most common types of COPD-related chest pain include:
- A general feeling of pressure, squeezing, or tightness in the chest
- Feeling of weight or pressure on the chest
- Chest muscle tightness and soreness
- Pain and soreness in and around the rib cage
- Aching and stiffness in the chest
- Soreness in the chest and/or ribs when breathing
- Feeling of fullness or discomfort in the chest when eating
- Tightness or heaviness in the chest when lying down
Some chest pains are triggered by COPD symptoms like shortness of breath or coughing, while others are related to physical changes (such as lung hyperinflation) caused by the disease. Some types of COPD chest pain tend to get worse in certain situations, such as when you eat, lie down, or experience a COPD exacerbation.
Most sources of COPD-related chest pain are harmless, but some types of chest pain are caused by health problems other than COPD. Certain types of chest pain can even signal a medical emergency like a heart attack.
In the next sections, we’ll take a closer look at some of the major causes of COPD-related chest pain, and how to recognize other types of chest pain that might have a more serious cause. Then, in the following sections, we’ll introduce you a to variety of practical strategies you can start using today to minimize your COPD chest pain.
What Causes COPD Chest Pain?
Normally when healthy people breathe, the diaphragm does most of the work required to move air in and out of the lungs. When your breathing is strained by COPD, however, you tend to rely more on the muscles in your chest to breathe.
Because of this, living with COPD tends to wear out your chest muscles, making them feel tired and sore. This soreness can be triggered by coughing fits, bouts of breathlessness, or even normal daily symptoms.
This type of chest soreness tends to get worse along with increasing shortness breath. This can happen during COPD symptom flare-ups and exacerbations, and during activities—like exercise—that are particularly demanding on your lungs.
This type of pain can range anywhere from mild to severe. For some people with COPD chest pain is simply a nuisance; for others, it is a significant source of pain that makes it even more difficult to breathe.
Lung hyperinflation describes lungs that are enlarged and take up more space in your chest than they should. It is a common COPD complication that tends to get worse as the disease progresses, and it’s a major cause of chest and rib pain in people with the COPD.
Lung hyperinflation has a couple of major causes: The first cause is lung tissue damage, which happens gradually over time in lungs affected by COPD. This damage causes normally-stretchy lungs to lose the flexibility and elasticity that allows them to expand and collapse as you breathe.
Eventually, the lungs lose so much of this elasticity that they can’t “bounce back” completely from their fully inflated state. This causes your lungs to remain slightly inflated even after you exhale, and it’s known as static hyperinflation.
The second major cause of lung hyperinflation is trapped air in the lungs. This happens when airway constriction (often combined with weak and shallow breathing) makes it difficult to empty all the air out of your lungs, causing some of the air you breathe to stay trapped inside.
This leftover air takes up space and leaves less room for fresh, oxygenated air to come into your lungs; this makes your lungs less efficient and worsens shortness of breath. The trapped air also prevents your lungs from collapsing all the way, forcing them to stay partially inflated even after you exhale.
As a result, hyperinflated lungs are bigger, stiffer, and take up more space in your chest compared to healthy lungs. This causes them to press against your chest cavity, putting extra pressure on your ribs, the surrounding muscles, and the ligaments that support all the muscles and bones in your chest.
Because of this, hyperinflated lungs tend to cause a lot of pain and discomfort. This pain can range from sore ribs or aching muscles to a general uncomfortable feeling of pressure or fullness in the chest.
Unfortunately, hyperinflation tends to get worse over time, as the stiffened, expanded lung tissue becomes even more prone to trapping air. Fortunately, it is possible to reduce the symptoms of hyperinflation, even though the actual damage of lung enlargement often can’t be reversed without surgery.
With proper treatment and management techniques, you can reduce chest pain caused by hyperinflation and potentially even slow down how quickly the condition gets worse. Treatments include brochodilators, breathing exercises, and other strategies which we will discuss more in the sections below.
Strain on Connective Tissues
The same COPD symptoms that wear out your chest muscles (e.g. coughing and shortness of breath) can also put stress on the ligaments and connective tissues in your chest. These tissues are responsible for connecting and holding everything in your chest in place, including your bones, muscles, lungs, and other organs.
In people with COPD, these connective tissues tend to get stretched and strained by frequent coughing and labored breathing. These tissues are also affected by hyperinflated lungs, which press on your ribs and chest wall, straining all the structures that connect and support them.
This stress on connective tissues can cause a great deal of soreness and pain in the chest and ribs, especially when paired with other symptoms like coughing. COPD can also cause permanent changes to the structure of your chest that could contribute to this pain.
|Lung tissue changes caused by COPD. Image from Dcoetzee.|
Over time, inflammation caused by the disease can weaken and stiffen the connective tissues surrounding your lungs, making them less elastic and more prone to causing pain. While this phenomenon is not yet fully understood, researchers believe it could be a major contributor to chest pain in people with COPD.
If you suffer from a psychological illness like anxiety or depression, it can actually make any chest pain you experience significantly worse. However, that doesn’t mean the pain isn’t real or that it’s “all in your head.”
The brain and body are intimately connected, and psychological illnesses can have biological effects that cause real, physical pain, or that amplify pains you already have. This phenomenon is widely recognized by researchers and mental health experts, which is why psychological therapy is a common treatment for chronic pain.
Unfortunately, a very large percentage of people with COPD suffer from depression or anxiety, especially among those with more severe disease. Research shows that these mental disorders can not only worsen COPD-related pains—such as chest pain—but also worsens quality of life and increases patients’ risks for disability, hospitalization, and death.
GERD, which stands for gastroesophageal reflux disease, is condition that causes stomach acid to leak into your esophagus (a phenomenon known as acid reflux). For reasons that are not yet fully understood, GERD is extremely common in people with COPD.
Some researchers believe that the high risk of GERD may be caused by hyper-inflated lungs putting pressure on the abdomen and chest. Others believe that certain COPD medications may contribute to the risk by weakening the barrier that usually stops acid from leaking out of the stomach.
Unfortunately, GERD often causes symptoms that overlap with COPD symptoms, including coughing, shortness of breath, and chest pain. What’s worse, GERD can cause stomach acid to leak into your lungs, which can exacerbate existing COPD symptoms and even trigger COPD flare-ups.
Because of this, GERD can be a significant contributing factor in COPD-related chest pain and discomfort. If you think you might have GERD, it’s important to talk to your doctor so you can get treatment right away.
Some of the most common symptoms of GERD include heartburn, coughing, lung irritation, throat irritation, and disrupted sleep. Another sign of GERD is burning chest pain that tends to gets worse after eating and after you lie down.
When Chest Pain is an Emergency
Many types of chest pain are generally harmless, including most types of rib and chest muscle soreness caused by COPD. In some cases, however, chest pain can be a sign of a life-threatening emergency like a heart attack, heart failure, or another serious cardiac event.
Unfortunately, the symptoms of major cardiac events vary significantly from person to person and can sometimes be very mild, which makes them difficult to detect. They can also be disguised by other health conditions, like COPD, which has symptoms that mimic and overlap with the same symptoms caused by heart problems.
That’s why it’s important to be familiar with your COPD symptoms and what kinds of pains and sensations are typical for you. The better you know your disease, the better you will able to detect if something is abnormal or wrong.
You should also know how to recognize the symptoms of a heart attack so you can better differentiate it from other symptoms that are caused by COPD.
Here are the major signs and symptoms of a major cardiac event:
- Chest pain that doesn’t go away with rest
- Chest pain that is different or more severe than chest pain you’ve had in the past
- Pain that spreads from the chest to the left arm, back, or jaw
- Sudden feeling of pressure, tightness, crushing, or squeezing in your chest
- Sudden shortness of breath, especially if it doesn’t go away with rest
- Sudden drop in blood pressure
- Extremely slow or rapid heartbeat
- Extremely rapid breathing
- Dizziness or lightheadedness
- Nausea or vomiting
- Weakness or losing the ability to stand or walk
- A sense of impending doom
- Confusion or disorientation
- A family history of heart disease
If you experience these symptoms and have any doubt about whether they are caused by a heart problem or COPD, you should seek medical attention immediately.
There are also some signs you can look for that indicate your chest pain is not related to your heart. However, it’s important to realize that having one or more of these signs does not rule out a heart attack completely.
Here are some signs that your chest pain might not be caused by a cardiac event:
- You can pinpoint the specific location of the pain.
- The pain gets worse when you take in a deep breath, and subsides when you hold your breath for a few seconds.
- The pain gets worse when you move in a specific way or press in a specific spot on your chest, neck, or shoulder.
- The pain gets better with medication, such as antacids.
- The pain doesn’t last very long and goes away quickly.
- The pain feels identical to pain you’ve felt before, at a time when you knew for a fact that it was not caused by a heart problem (e.g. chest pain that you had diagnosed as being caused by COPD).
How to Reduce Chest & Rib Pain Caused by COPD
Now that you have a better understanding of how COPD causes chest pain, let’s look at what you can do about it. In the following sections, we’ll introduce you to a plethora of effective tips and techniques you can use to reduce various types of chest and rib pain related to COPD.
Adjust Your Posture
There’s a reason that good posture is considered to be so important in activities that rely on your breath, such as singing, public speaking, and playing wind instruments. The reason is that your posture can have a significant effect on your lung capacity and your overall ability to breathe.
When you sit or stand in a slouched posture, it scrunches up your chest and restricts how much your lungs can expand. This increases the effort it takes to breathe and puts extra pressure on your chest and ribs, which can cause them to become sore.
Good, straight posture, on the other hand, opens up your chest cavity and gives your lungs, diaphragm, and chest muscles much more room to move when you breathe. This relieves some of the strain on your ribs and breathing muscles, reducing chest soreness and other posture-related pain (e.g. back pain, neck pain, and shoulder pain).
The most important aspect of good posture is holding your back up straight, which means avoiding bent positions like hunching and slouching. You should also keep your chin up and your shoulders back while keeping your shoulder muscles relaxed.
You should also practice proper sleeping posture, which can reduce chest pressure and make it easier to breathe when you sleep. Avoid sleeping sitting up, as some people with COPD do, and try to find a comfortable position on your side or back instead.
You should also make sure your back is properly supported both when you sit and when you lie down. Any chairs you sit in often should have lower back support and your mattress should be firm enough to keep your back straight while you sleep.
For more information and advice about posture and COPD, visit our guide on the topic here. You can also check out this guide to learn more about good sleep posture and how to get the best quality of sleep possible with COPD.
Practice Breathing Techniques
As we mentioned earlier, shortness of breath on its own can cause certain types of chest pain, especially muscle soreness. This is partially caused by the natural instinct to take much quicker and shallower breaths when you are struggling to breathe.
This essentially forces your breathing muscles to work overtime, wearing them out more quickly and causing muscle pain. Your muscles also have to work harder to push air through constricted airways, which tend to get even narrower during bouts of shortness of breath.
Fortunately, there is a special breathing exercise you can use when you feel breathless that reduces strain on your chest muscles. This technique, known as pursed lips breathing, works by physically opening up your airways to make it easier to breathe.
The basics of pursed lips breathing are simple: you breathe in through your nose for about two seconds, and then you purse your lips before breathing out. If you’re pursing your lips correctly, they should make a small “o” when you exhale, as if you were whistling or blowing a kiss.
Finally, exhale for another four seconds or so, until there’s no more air to push out. Make sure you empty your lungs as completely as possible before you take your next breath.
Breathing out in this way creates extra pressure in your airways, which holds your airways open and prevents them from collapsing. This reduces shortness of breath and can also reduce lung hyperinflation by helping you empty all the air out of your lungs.
Pursed lips breathing also helps you learn how to control your breaths, which allows you to slow and steady your breathing rate. This technique is particularly useful for bringing rapid and shallow breathing patterns back under your control whenever you start to feel short of breath.
To learn more about pursed lips breathing and get step-by-step instructions for how to do it, check out our guide on breathing exercises for COPD.
Practice Controlled Coughing
Many people with COPD have lots of extra mucus clogging up their airways, which can cause a chronic cough and painful coughing fits. This kind of uncontrolled coughing can be extremely hard on your chest, causing violent spasms that strain your rib cage and wrack the walls of your chest.
This can lead to muscle soreness, aching, and sharp pain in the ribs that gets worse when you move your chest. It can also make it extremely painful to cough, take breaths in, or make certain motions, and may even interfere with your sleep.
However, you can reduce the pain of uncontrolled coughing by practicing controlled coughing, which is gentler and puts less strain on your chest. It also does a better job than uncontrolled coughing at loosening up mucus and moving it out of your lungs.
Here are the basics of how to do it:
- First, sit down in a comfortable chair, placing your feet flat on the ground.
- Relax your body, fold your arms across your lower abdomen, and lean forward slightly in your seat.
- Inhale slowly through your nose.
- Then, cough by following these steps in order:
- Press your arms against your abdomen
- Lean forward
- Open your mouth and make 2-3 short, sharp coughs
- Make sure you use your diaphragm, not your chest muscles, to force the cough out (your belly should move when you inhale and exhale, while your chest muscles should stay still)
- Immediately take another slow breath in through your nose.
- Take a moment to rest, then repeat.
|Make sure you breathe from your diaphragm, not your chest muscles. Image from Theresa Knott.|
If you practicing controlled coughing regularly, it can help you breathe easier by clearing out excess mucus that’s blocking up your airways. Less mucus also means you’ll have less need to cough and likely have fewer coughing fits.
For more information about controlled coughing and how to do it correctly, check out this guide from the Cleveland Clinic. You can also find more ways to reduce coughing and get rid of excess mucus in our guide on mucus clearance techniques.
Improve Your Fitness
Getting regular exercise is absolutely essential for staying healthy with COPD. It helps you stay mobile, independent, and can even improve your COPD symptoms and make it easier to breathe.
Exercise can also improve how efficiently your respiratory system works. It does this primarily by strengthening your heart, strengthening your breathing muscles, and reducing how much oxygen your body needs to do physical activities.
This improves your exercise endurance, allowing you to stay active for longer without feeling too short of breath. It also helps your breathing muscles work better, improving how long and hard they can work before they get tired out.
In this way, exercise can improve COPD-related chest pain by reducing how sore and fatigued your chest muscles get from breathing. It can also reduce strain on those muscles by reducing how often you become breathless and reducing the overall effort required to breathe.
But in order to get these benefits, you need to make a commitment to living an active life. That means exercising consistently—within your physical limits, of course—in spite of the extra difficulty that COPD symptoms can cause.
There are many ways to improve your fitness, even simple things like walking, aerobics, and other exercises you can do at home. Other great ways to get more exercise include joining a gym, playing a sport, or simply taking part in an active hobby like gardening.
If you find it difficult to exercise because of your COPD symptoms, there are many ways get help and learn to exercise with COPD. You could see a physical therapist, join a pulmonary rehabilitation class, or ask your doctor for advice and references to exercise programs that could help you.
Change Your Eating Habits
Mealtimes can be difficult for people with COPD, especially those who suffer from chest pain and lung hyperinflation. The most common complaint is a feeling of pressure and fullness in the chest that begins during or after eating.
This can can happen for several reasons, most of which have to do with your stomach expanding and taking up extra space in your chest. When combined with the pressure of hyperinflated lungs, a full stomach can exert a painful amount of pressure on your chest cavity and your lungs.
This pressure can be extremely uncomfortable, painful, and make it more difficult to breathe. It can cause so much discomfort, in fact, that some people with COPD dread mealtimes and struggle to eat enough food to meet their nutritional needs.
Another problem is that, when you eat, you’re more likely to swallow air, which makes lung hyperinflation worse. Then, if you add digestion issues like bloating and heartburn to the mix, you have a perfect recipe for chest pain and discomfort after you eat.
Fortunately, you can mitigate most of these problems simply by changing your diet and eating habits. Even small changes, like spacing out your meals, can reduce chest pain and make eating a much more comfortable experience.
Eat Smaller Portions
Eating smaller portions is often an effective way to to reduce chest discomfort and shortness of breath at meal times. That doesn’t necessarily mean you have to eat less overall; instead, you can split your usual 2-3 meals into several smaller meals that you can eat throughout the day.
Spacing out smaller portions will help you avoid overeating and ensure that you never put too much in your stomach at once, so you don’t have a full stomach putting pressure on your chest. Eating smaller amounts at a time can also reduce your risk for indigestion, which can cause uncomfortable heartburn and bloating.
Reduce Foods that Cause Bloat
When your chest already feels tight and full, the last thing you need is a bloated belly to make it worse. The best way to reduce bloating, however, is to eat a healthy diet and avoid foods that cause gas and bloating.
Fried, processed, and fatty foods are some of, the worst foods for bloat, and they are generally unhealthy for many other reasons as well. However, even healthy foods like raw vegetables and leafy greens can cause gas and indigestion, especially if you have a bowel sensitivity like irritable bowel syndrome.
Other foods, especially salty foods, can cause you to retain more water in your body than usual. This results in water bloating, which, like gas bloating, can be very uncomfortable and put extra pressure on your chest.
Everybody’s body is different, which is why you should pay attention to what you eat and how it makes you feel. If you experience gas or bloating often, take notes on when it happens and what foods you ate before.
In many cases, the only way to avoid bloating is to avoid the food altogether or to limit yourself to eating only small quantities at a time. In some cases, however, cooking gas-causing vegetables and fruits can make them more digestible and reduce the risk of gas.
Here is a list of common foods that are known to cause bloating:
- Carbonated drinks
- Fried and fatty foods
- Processed foods and snacks
- High-carb foods
- Parsnips and leeks
- Salad greens
- Brown rice
- Many fruits, including citrus fruits, apples, raisins, bananas, and prunes
- Certain vegetables, including: onions, cauliflower, radishes, cucumber, celery, cabbage, and brussels sprouts
Some people are particularly sensitive to foods that contain a certain type of carbohydrate that is difficult to digest. These are known as FODMAP foods, and you can find more information about them in this guide from the University of Virginia (PDF link), which contains an extensive list of low and high FODMAP foods.
To learn more about foods you should and should not eat if you have COPD, check out the following guides:
Eat and Drink More Slowly
If you eat food or drink liquids too quickly, it increases your risk of accidentally swallowing air. This air gets trapped in your digestive system, which can result in extra bloating and gas.
To avoid this, try to eat your food slowly and deliberately, chewing up all your food completely and resting a moment or two between bites. This is the first step to mindful eating, which is a great way to build healthier mealtime habits and pace yourself while you eat.
Eating more carefully and slowly will not only reduce swallowed air, but it can also reduce the risk of indigestion. It can also help you eat less overall, which can be helpful if you tend to overeat or if you are trying to lose weight.
Avoid Eating Before Bed
Many people with COPD notice that their chest pressure and discomfort gets worse when they lie down. That’s because lying on your back positions more of your chest weight on top of your lungs, which can amplify any chest tightness or stomach fullness you feel.
Because of this, you should stop eating at least a couple of hours before you go to bed at night. A light snack before bed might be fine, but anything more substantial could cause uncomfortable stomach fullness or bloating when you try to sleep.
As we mentioned earlier in this guide, having COPD increases your risk for GERD and can make GERD symptoms worse. That’s why, if you experience heartburn, chest pain, or acid reflux after eating, you should definitely talk to your doctor about the possibility of GERD.
Untreated GERD is extremely bad for your lungs, raising your risk for exacerbations, worsening shortness of breath, and triggering chest pain and discomfort. That’s why, if you do have GERD, it’s important to take steps to manage it, even though it may require major dietary changes.
The main treatment for GERD is avoiding foods that tend to make your stomach particularly acidic. Your doctor may also prescribe antacid medications to neutralize the excess acid your stomach makes.
Another thing you can do to improve your GERD is quit smoking, which is obviously good for your health in a variety of other ways, too. Smoking causes extra problems for people with GERD, however, because it both increases stomach acid and makes it more likely to leak.
Here are some more tips for reducing chest pain and other symptoms caused by GERD:
- Always eat while sitting upright, and avoid lying down for at least an hour after eating.
- Eat smaller portions and space them out throughout the day.
- Avoid wearing tight-fitting clothing that constricts your abdomen or chest.
- Raise the head of your bed to create a slight incline when you sleep (you can do this by placing wooden blocks or commercial bed risers under your bedposts).
- Quit smoking.
Here is a list of some of the major foods you should avoid to reduce GERD symptoms:
- Peppermint and spearmint.
- Caffeinated beverages
- Acidic beverages like coffee and tea
- Alcoholic beverages
- Fried, fatty foods, including french fries, fried chicken, etc.
- Other fatty foods, including dairy, fatty meats, fatty vegetables (e.g. avocado and olives), and peanut butter
- Fatty baked goods, including pizza, cookies, cake, donuts, and croissants
- Certain fruits, including lemons, limes, oranges, pineapple, and grapefruit
- Certain vegetables, including onions, garlic, hot peppers, tomatoes, and vegetable juices
Always Take Your Medications
If you have COPD, it’s vital to take all your prescribed medications correctly and consistently. These medications don’t only help you breathe, but they also help prevent COPD complications like chest pain and lung hyperinflation.
Bronchodilators essentially work by opening up your airways, making it easier for air to flow both in and out of your lungs. This reduces the amount of energy and muscle it takes to breathe, reducing chest soreness and muscle fatigue.
These medicines can also prevent and slow the progression of lung hyperinflation, which is a major cause of rib pain and general chest discomfort. By expanding constricted airways, bronchodilators make it easier to exhale completely without leaving stale air behind.
Long-acting bronchodilators work in your body all of the time, keeping your airways open and making it easier breathe every day. Short-acting bronchodilators bring quick relief when your symptoms act up, dilating your airways immediately and reducing the effort it takes to breathe.
Together, these medications can help reduce baseline chest soreness, rib pain, lung hyperinflation and reduce soreness caused by sudden bouts of shortness of breath. That’s why it’s so important to take your medications as directed every singe day, and to always keep your rescue inhaler by your side.
Get Psychological Support
As we discussed earlier in this guide, psychological illnesses can make chronic pains, including chest pain, much worse than they already are. They can also make it much more difficult to cope with the pain on your own.
If you are suffering from anxiety or depression, like many people with COPD are, it’s important to seek help. There’s no need to suffer on your own when there are a variety of medications and psychological treatments that can help.
You can always schedule an appointment with a psychologist, psychiatrist, or therapist on your own, or you could ask your doctor for advice. However, keep in mind that only a doctor or psychiatrist can write prescriptions for medication.
Even if you don’t have a psychological disorder, you might still want to seek psychological help if you experience significant COPD-related pain. Living with chronic pain often causes a lot of emotional stress, and it helps to have a trained mental health professional by your side.
A therapist can help you learn how to cope in healthy ways and even teach you mental strategies for reducing how much pain you feel. Some therapists even specialize in treating people with chronic diseases and chronic pain.
Even if you feel skeptical now, you might just be surprised at how much of a difference that working with a therapist makes. It can not only improve your mental health and your physical pain, but also help you learn new strategies for coping with COPD in many other aspects of daily life.
To learn more about mental health services for people with COPD, you can find more information in our post about COPD treatment teams. This guide includes a detailed section about working with psychologists, psychiatrists, and therapists, and explains the difference between these different titles, which are easy to confuse.
Ask Your Doctor About Pain Medication
You can treat many types of mild chest pain, especially rib and muscle soreness, with simple over-the-counter painkillers like ibuprofin and tylenol. While these mild medications may not relieve the pain altogether, they might be able to reduce the pain at least.
However, you should always talk to your doctor if it’s okay before you take any kind of over-the-counter medication. Only a doctor can tell you whether or not a certain medication is safe for you and make sure that it doesn’t interfere with your other medications and treatments.
If your pain is more severe, your doctor might also be able to prescribe you a stronger medication. However, most prescription pain relievers have the potential to cause serious side effects, so it’s important to weigh all your options before taking on that risk.
COPD can cause chest pain for a multitude of reasons, and there is often a variety of contributing factors instead of a definite cause. Because of this, there is no one-size-fits-all treatment for chest pain caused by COPD.
However, it is possible to treat and relieve chest pain, even if it’s not always simple. Just like other aspects of COPD treatment, a multi-faceted approach is often necessary to manage COPD-related chest pain.
The tips and techniques in this guide are a great place to start if you or someone you love suffers from chest pain and COPD. By combining the strategies that are most relevant to you, you should be able to find some measure of relief.
However, you should always work with your doctor to manage your COPD symptoms, including chest and rib pain. He can adjust your treatment, offer advice, and help you put together an effective strategy for reducing your pain.
Pain in people with chronic obstructive pulmonary disease (COPD)
https://doi.org/10.1016/j.rmed.2012.03.004Get rights and content
The prevalence and characteristics of pain are not known in COPD patients. The purposes of this study were to determine if pain is more common in COPD patients than in healthy people and if it was related to self-reported physical activity, health related quality of life (HRQoL) and comorbidities.
Participants returned a mailed survey package that contained: 1) McGill Pain Questionnaire (MPQ) and Brief Pain Inventory (BPI) to evaluate pain severity and how pain interferes with activities; 2) Tampa Scale for Kinesiophobia (TSK) to evaluate fear of movement related to pain; 3) Short Form-36 (SF-36), to measure HRQoL; 4) Community Health Activities Model Program for Seniors (CHAMPS) to evaluate physical activity; 5) a form to list medications and comorbidities.
Forty-seven COPD patients and 47 age- and gender-matched healthy people responded. People with COPD demonstrated more pain (MPQ and BPI, p = 0.000), a greater pain-related interference in their lives (BPI, p = 0.000), a higher pain-related fear of movement, and lower frequency and energy expenditure of physical activities (CHAMPS, p = 0.000) than healthy people (TSK, p < 0.001). Pain severity (MPQ and BPI) was indirectly correlated to the Physical Component Score of the SF-36. COPD patients identified pain in the neck and trunk 3.1 times more often than healthy people. The number of comorbidities was the most consistent independent correlate of pain in COPD patients.
COPD patients demonstrate more pain which interferes with activities more so than healthy people of similar age. Pain is also negatively associated with HRQoL in COPD.
Chronic obstructive pulmonary disease
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Copyright © 2012 Elsevier Ltd. All rights reserved.
Guide | Physical Therapy Guide to Chronic Obstructive Pulmonary Disease (COPD)
The American Physical Therapy Association believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of COPD. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Polkey MI, Spruit MA, Edwards LD, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med. 2013;187(4):382–386. Free Article. Article Summary on PubMed.
US Department of Health and Human Services, National Heart, Lung, and Blood Institute. COPD. Accessed October 19, 2021.
Chen H, Liang BM, Tang YJ, et al. Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities. Chin Med J (Engl). 2012;125(17):3053–3058. Article Summary on PubMed.
Spruit MA, Polkey MI, Celli B, et al. Predicting outcomes from 6-minute walk distance in chronic obstructive pulmonary disease. J Am Med Dir Assoc. 2012;13(3):291–297. Article Summary on PubMed.
Beauchamp MK, O’Hoski S, Goldstein RS, Brooks D. Effect of pulmonary rehabilitation on balance in persons with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010;91(9):1460–1465. Article Summary on PubMed.
Global Initiative for Chronic Obstructive Lung Disease. “Global strategy for diagnosis, management, and prevention of COPD.” Updated December 2009. Accessed March 2011.
Nield MA, Soo Hoo GW, Roper JM, Santiago S. Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev. 2007;27(4):237–244. Article Summary on PubMed.
Heppner PS, Morgan C, Kaplan RM, Ries AL. Regular walking and long-term maintenance of outcomes after pulmonary rehabilitation. J Cardiopulm Rehabil. 2006;26(1):44–53. Article Summary on PubMed.
Dechman G, Wilson CR. Evidence underlying breathing retraining in people with stable chronic obstructive pulmonary disease. Phys Ther. 2004;84(12):1189–1197. Free Article. Article Summary on PubMed.
Emery CF, Shermer RL, Hauck ER, Hsiao ET, MacIntyre NR. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol. 2003;22(6):598–604. Article Summary on PubMed.
Palliative and end-of-life care for patients with severe COPD
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. For many patients, maximal therapy for COPD produces only modest or incomplete relief of disabling symptoms and these symptoms result in a significantly reduced quality of life.
Despite the high morbidity and mortality associated with severe COPD, many patients receive inadequate palliative care. There are several reasons for this. First, patient–physician communication about palliative and end-of-life care is infrequent and often of poor quality. Secondly, the uncertainty in predicting prognosis for patients with COPD makes communication about end-of-life care more difficult. Consequently, patients and their families frequently do not understand that severe COPD is often a progressive and terminal illness.
The purpose of the present review is to summarise recent research regarding palliative and end-of-life care for patients with COPD. Recent studies provide insight and guidance into ways to improve communication about end-of-life care and thereby improve the quality of palliative and end-of-life care the patients receive. Two areas that may influence the quality of care are also highlighted: 1) the role of anxiety and depression, common problems for patients with COPD; and 2) the importance of advance care planning.
Improving communication represents an important opportunity for the improvement of the quality of palliative and end-of-life care received by these patients.
Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of mortality and the 12th leading cause of disability worldwide 1, 2. By the year 2020, COPD will be the third leading cause of mortality and the fifth leading cause of disability worldwide 3–5. For many patients, maximal therapy for COPD produces only modest relief of symptoms, leaving patients with significantly reduced health-related quality of life. Many patients with COPD receive inadequate palliative care. The purpose of the present review is to examine problems in the delivery of high-quality palliative care to patients with severe COPD and to identify ways in which to address these problems. Since other articles in the series have discussed treatment of dyspnoea and other symptoms and improving quality of life, the current review will focus on communication about palliative and end-of-life care.
THE DEFINITION OF PALLIATIVE AND END-OF-LIFE CARE
The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of disease or the need for other therapies 6. The World Health Organization adopted the following definition of palliative care: “Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social and spiritual needs and to facilitate patient autonomy, access to information and choice” 7. As such, palliative care expands traditional treatment goals to include: enhancing quality of life; helping with medical decision making and identifying the goals of care; addressing the needs of family and other informal caregivers; and providing opportunities for personal growth 6. In contrast, the term “end-of-life care” usually refers to care concerning the final stage of life and focuses on care of the dying person and their family. The time period for end-of-life care is arbitrary and should be considered variable depending on the patient’s trajectory of illness 8, 9. Using these definitions, palliative care includes end-of-life care, but is broader and also includes care focused on improving quality of life and minimising symptoms before the end-of-life period, as depicted in figure 1⇓. Although end-of-life care usually refers to care in the final months, weeks or days, there is growing evidence that communication with patients and families about their preferences for end-of-life care should occur early in the course of a chronic life-limiting illness, in order to facilitate high-quality palliative and end-of-life care. The present review will summarise some of this evidence, particularly as it pertains to patients with severe COPD.
Schematic diagram for use of the terms “palliative care” and “end-of-life care”.
POOR PALLIATIVE CARE IN COPD AND THE LINK TO POOR COMMUNICATION
The Study to Understand Prognosis and Preferences for Outcomes and Treatments (SUPPORT) enrolled seriously ill, hospitalised patients in one of five hospitals in the USA with one of nine life-limiting illnesses, including COPD 10. Compared with patients with lung cancer, patients with COPD were much more likely to die in the intensive care unit (ICU), on mechanical ventilation, and with dyspnoea 11. These differences occurred despite most patients with COPD preferring treatment focused on comfort rather than on prolonging life. In fact, SUPPORT found that patients with lung cancer and patients with COPD were equally likely to prefer not to be intubated and not to receive cardiopulmonary resuscitation (CPR), yet patients with COPD were much more likely to receive these therapies 11. A study in the UK also found that patients with COPD are much less likely to die at home and to receive palliative care services than patients with lung cancer 12. Additional studies have documented the poor quality of palliative care and significant burden of symptoms among patients with COPD 13. Healthcare for these patients is often initiated in response to acute exacerbations rather than being initiated proactively based on a previously developed plan for managing their disease 14. A recent study of patients with COPD or lung cancer in the US Veterans Affairs Health System also found that patients with COPD were much more likely to be admitted to an ICU, and have greater lengths of stay in the ICU during their terminal hospitalisation, than patients with lung cancer. In the same study, significant geographic variation in ICU utilisation was found for patients with COPD 15. Although variation in care may be influenced by many factors including availability, access and reimbursement issues, such geographic variation suggests a lack of consensus concerning the best approach to palliative and end-of-life care for patients with COPD. In summary, there are important opportunities for research and quality improvement if better palliative and end-of-life care is to be provided for patients with severe COPD.
CHALLENGES IN PROGNOSTICATION FOR INDIVIDUALS WITH COPD
In COPD, it may be difficult to identify those patients who are likely to die within 6 months. The prognostic models used in SUPPORT, which were based on the Acute Physiology and Chronic Health Evaluation II, documented this difficulty. These models showed that, at 5 days prior to death, patients with lung cancer were predicted to have <10% chance of surviving for 6 months, while patients with COPD were predicted to have >50% chance 11. Recent efforts to identify disease-specific prognostic models for patients with COPD do improve prognostic accuracy, but do not predict individual short-term survival as well as can be done for many patients with cancer 16–18.
Therefore, uncertainty concerning prognosis plays a more prominent role in discussions of prognosis and end-of-life care for patients with COPD than for patients with cancer. As physicians have difficulty discussing prognosis in the setting of uncertainty 19, it is not surprising that they also struggle with knowing when to raise issues about end-of-life care. Nevertheless, it remains the responsibility of physicians caring for patients with severe COPD to educate them about end-of-life care and to ensure that they receive care consistent with their informed preferences for care at the end of life.
Despite the uncertainty, a profile emerges of the types of patients at high risk of mortality or morbidity over the next 6 months. Physicians should be encouraged to identify patients with COPD for whom discussions about treatment preferences or end-of-life care are especially important 20. This profile could include an assessment of: forced expiratory volume in one second (FEV1) <30% predicted; oxygen dependence; one or more hospital admissions in the previous year for an acute exacerbation of COPD; left heart failure or other comorbidities; weight loss or cachexia; decreased functional status; increasing dependence on others; and age >70 yrs (table 1⇓). The presence of two or more of these prognostic indicators should be a reason for such discussions. Multiple criteria increase the relevance and urgency for the discussion, as they increase the risk for a life-threatening exacerbation and for receiving care at the end of life that is not consistent with their informed treatment preferences.
Characteristics that should trigger a discussion on preferences about end-of-life care
It is also important that clinicians understand patient preferences for end-of-life care and provide them with an opportunity to discuss these issues. Most patients with life-limiting illness prefer to discuss their preferences for end-of-life care relatively early in the course of their illness 21, as these discussions are less stressful when the patient is feeling relatively well. Although most patients with COPD will prefer a trial of mechanical ventilation for acute respiratory failure, raising these issues in advance of the requirement makes it easier to revisit these discussions when patients are unwell 21, 22.
CURRENT STATE OF COMMUNICATION ABOUT END-OF-LIFE CARE
Studies have shown that only a minority of patients with moderate-to-severe COPD have discussed treatment preferences and end-of-life care issues with their physicians 23–25 and most believe that their physicians do not know their preferences for end-of-life care 24, 25. The current author’s group recently found that only a third of patients with oxygen-dependent COPD had discussed end-of-life care with their physicians and <25% of physicians had discussed some important aspects of end-of-life care with their patients, including talking about how long the patient might live and what dying might be like for the patient and the family 23. The study also examined the items that patients with COPD rated as being performed most poorly, which included talking about prognosis. Therefore, improved communication regarding end-of-life care, prognosis and dying needs to be targeted.
A recent study by McNeely et al. 26 examined the perspectives of Canadian respirologists on communication about end-of-life care for patients with COPD. When respirologists discussed mechanical ventilation for end-stage COPD, the discussions occurred late in the disease trajectory, most commonly taking place in the ICU, with only 23% occurring in the clinic or office 26. It was found that 84% of physicians waited until dyspnoea was severe and 75% waited until the FEV1 was <30% pred. A survey of 214 general practitioners in the UK found that, although 82% felt that general practitioners should discuss the prognosis with patients with COPD, only 41% reported “often” or “always” discussing prognosis with these patients 27. Furthermore, two thirds of these physicians who reported infrequently discussing end-of-life care reported feeling inadequately prepared to have such discussions. These studies suggest that communication about end-of-life care is an important area for improvement in the care of patients with COPD.
DIRECTION FOR IMPROVING COMMUNICATION ABOUT PROGNOSIS AND ABOUT END-OF-LIFE CARE
There are a number of studies that provide some specific direction for physicians in their communication about end-of-life care for patients with severe COPD. One qualitative study compared patients with severe COPD to patients with metastatic cancer or advanced AIDS, noting that patients with COPD were more likely to express concern about the lack of education that they received about their disease 28. Patients with COPD wanted more information in the following five specific areas: diagnosis and disease process, treatment, prognosis, what dying might be like, and advance care planning (table 2⇓).
Components of end-of-life care that patients would like to discuss with their physician 28
A qualitative study of patients with severe COPD in the UK also showed that most, but not all patients wanted more information about their prognosis 29. In a survey of older patients with serious illnesses and limited life expectancy, just over half (56%) of participants with COPD wanted to know their life expectancy 30. Often, family members may want this information even when patients do not 31. Therefore, it is important to determine how much information about prognosis patients and family members want.
Expert recommendations suggest numeric expressions of risk (e.g. “eight out of 10 people will have side-effects from this drug”) generally lead to better comprehension than do qualitative expressions of risk (e.g. “this drug is very likely to cause side-effects”) 32. Moreover, since prognostic information applies to outcomes of groups of patients, experts recommend that prognostic information be phrased in terms of outcomes for populations rather than in terms of individual outcomes (e.g. “out of a group of 100 patients like your mother, I would expect about 10 to survive this”) 33. In addition, because some individuals do not wish to receive prognostic information, experts recommend the “ask-tell-ask” approach to discussing prognosis 34–36. For this approach, physicians first seek permission to discuss prognosis prior to doing so and afterwards ask patients and families their understanding of the prognosis to ensure comprehension. Table 3⇓ summarises some of these recommendations for discussing prognosis.
Tips for talking about end-of-life care, prognosis and advance care planning
Another area of communication that was rated as poorly performed by patients with severe COPD was asking about the patients’ spiritual or religious beliefs 23. Several studies suggest that the majority of patients want to discuss spiritual or religious issues with their physicians, although some patients do not have a strong preference and others have a preference to not have such discussions with physicians 37–39. Studies from Europe suggest that physicians’ religion may be an important determinant of the care patients receive 40, 41. Several reviews suggest approaches that physicians can take in determining whether patients want to discuss the patient’s religion and spirituality and having these discussions with patients 42, 43, although empirical data about which specific techniques improve patient experience are limited.
OVERCOMING THE BARRIERS TO COMMUNICATION ABOUT END-OF-LIFE CARE FOR PATIENTS WITH COPD
An important step towards improving communication about end-of-life care is to identify the barriers to this communication and implement strategies to overcome them. A recent study of patients with oxygen-dependent COPD examined the barriers to communication about end-of-life care and noted them to be many, diverse and patient-specific 22. Although 15 barriers were identified, only two were endorsed by >50% of patients, suggesting that an individualised process is required.
The two most commonly mentioned barriers were: “I’d rather concentrate on staying alive than talk about death” and “I’m not sure which physician will be taking care of me if I get very sick.” The former suggests the need for skill in talking about a difficult subject with patients who would rather not discuss it. Although many patients do not wish to discuss dying and death, these same patients often have strong opinions about CPR and mechanical ventilation 44. Among patients in SUPPORT who did not want to discuss CPR, 25% did not want to have CPR and among those who did not want to discuss mechanical ventilation, 80% did not want to have prolonged mechanical ventilation. Therefore, it may be important to have these discussions even with patients who are reluctant to do so. It may be helpful in these situations to acknowledge that discussions about dying can be difficult, but are nonetheless important for patients, families and physicians to undertake, and may provide an opportunity to decrease the burden of decision making on family members. It can also be useful to explicitly state that such a discussion will not diminish the physicians’ focus on finding therapies to improve survival or quality of life, as some patients worry that such a discussion might cause a physician to “give up” on them 45. Another useful tool for raising these discussions may be to frame them in the context of “hoping for the best, while preparing for the worst” 46.
The other most common barrier, “I’m not sure which physician will be taking care of me if I get very sick,” suggests that patients may fear abandonment by their physicians at the end of life and that discussions of continuity of care between physicians and patients may be an important component of discussions about dying and death. In a qualitative study of patients with severe COPD, metastatic cancer or advanced AIDS, concerns about continuity of care and abandonment emerged as important for patients with each of these diseases 21, 47.
The most common physician-endorsed barriers to communication about end-of-life care 22 include: “There is too little time during our appointments to discuss everything we should”; “I worry that discussing end-of-life care will take away his/her hope”; and “The patient is not ready to talk about the care s/he wants if s/he gets sick.” These barriers suggest that interventions also need to target physicians and address systems-level issues, such as ensuring adequate time for discussions about end-of-life care. Some patients prefer a direct approach to discussing prognosis, while others prefer a more indirect approach 31. There is no relationship between the number of barriers endorsed by patients and the number endorsed by their physicians 22. This lack of an association suggests that encouraging interventions may be more successful if they target both patients and physicians.
THE ROLE OF DEPRESSION AND HEALTH STATUS IN COMMUNICATION ABOUT END-OF-LIFE CARE
Although anxiety and depression are common in COPD, they are not well recognised or treated 48–52. In a recent study, only a third of patients with COPD and clinically significant depression or anxiety were being treated and only half of those with severe depression or anxiety were being treated 53. Antidepressants can significantly improve mood among patients with COPD and depression 54. Furthermore, in patients with COPD and depression, antidepressants can also decrease ratings of dyspnoea and other physical symptoms 54.
Anxiety and depression may modify patients’ treatment preferences concerning end-of-life care. Patients with COPD and a higher burden of depressive symptoms have a stronger preference against CPR 55. This association is similar to findings of two prior investigations, one from SUPPORT 10 and one by Blank et al. 56, which assessed preferences for CPR, but not specifically for patients with COPD. Patients with depression are more likely to change their treatment preferences after depression resolves 57. They also rate the quality of patient–physician communication about end-of-life care significantly lower than those without depression 23. It is unclear whether this finding reflects an effect of depression on patients’ ratings of the quality of communication or whether the quality of communication is negatively influenced by depression but, regardless of the reason, it is important for physicians to be aware of this relationship between depression and quality of communication about end-of-life care. Simply put, the presence of anxiety and depression may influence the patient’s ability to understand the impact of decisions that they make and therefore, if possible, these symptoms should be treated prior to end-of-life decision making.
Another noteworthy finding about treatment preferences was that health status, as measured by the Saint George’s Respiratory Questionnaire, was not associated with end-of-life treatment preferences in a population of patients with severe COPD 55. These data confirm and extend the results of two prior studies performed in elderly outpatients without severe comorbidities 58 and in seriously ill, hospitalised patients with several different primary diagnoses 59. Healthcare providers should not assume that poorer health status is necessarily associated with a higher likelihood of refusing life-sustaining treatment. Since physicians consistently underestimate patients’ quality of life compared with the patients’ own assessments 60, 61 and since there is evidence that physicians’ estimates of patients’ treatment preferences are influenced by the physicians’ estimates of patients’ quality of life 62, it is important that physicians caring for patients with severe COPD examine their own assumptions and directly obtain treatment preferences from patients. A recent survey from Europe showed that physicians and nurses placed more value on quality of life and less value on prolonging life than patients or family members 63. Clinicians should keep this difference in mind and avoid inappropriately imposing their values on patients and their families.
THE ROLE OF ADVANCE DIRECTIVES AND ADVANCE CARE PLANNING IN PATIENTS WITH SEVERE COPD
There has been considerable dissatisfaction with the lack of effects of advance directives on end-of-life care 64. A number of studies suggest that advance directives do not influence the treatments that patients receive 65–67 and do not change end-of-life decision making 68–70. It is clear that advance directives in the absence of good communication about end-of-life care do not improve the quality of end-of-life care. However, in the context of good communication between patients, families and physicians, advance directives may be an important component to end-of-life care. In addition, some studies suggest that the presence of advance directives are associated with decreased levels of stress and increased ratings of the quality of care among family members of dying patients 71, 72.
Advance directives may be especially useful among patients with COPD because of their likely trajectory of illness, with unpredictable exacerbations that may make patients suddenly critically ill 8. In addition, some patients with COPD have strong feelings about the situations in which they would want to forego CPR or, particularly relevant for COPD, mechanical ventilation for acute respiratory failure. Other authors have reported on the development of COPD-specific advance directives for this purpose, although there have not been studies showing that these advance directives improve the quality of end-of-life care 73, 74. Nonetheless, advance directives are a topic that should be discussed with all patients with moderate or severe COPD as part of advance care planning and other aspects of communication about end-of-life care. For patients who have experienced noninvasive or invasive ventilation in the past, physicians have the opportunity to use patients’ prior experiences as a reference point for discussing potential future episodes of acute respiratory failure and those circumstances under which they would not want these types of ventilation. Patients’ prior experiences with life support, or with relatives or friends who have required life support, can be important facilitators to patient–physician communication about treatment preferences and end-of-life care 22.
CARE OF THE PATIENT DYING FROM COPD AND THE ROLE OF THE HOSPICE
Some patients with COPD will die from lung cancer or cardiovascular disease 2, 75, whereas others die from progressive respiratory dysfunction, or a systemic complication of it 14. Physicians caring for patients dying with severe COPD may need to consider the value of treating their comorbidities in the setting of advanced and terminal COPD. For example, indications for treatment of hypertension may change as COPD advances. Physicians should consider physiological changes as patients become progressively closer to death and reassess the risks and benefits of the treatments for these comorbidities 76.
Improvements in care of the dying have been largely confined to patients in hospice care and specifically to patients with cancer 77. Patients dying of progressive COPD are less likely to be offered the opportunity to benefit from hospice services when compared with patients with cancer 12. The illness trajectory among patients with COPD is more likely to be a gradual slow decline interspersed with unpredictable acute exacerbations, which are often followed by an improvement back towards, but not quite reaching, their pre-exacerbation baseline 9. This trajectory does not fit the traditional hospice model well and may be part of the reason that patients with COPD are less likely to receive hospice and palliative care services. However, understanding this trajectory and discussing it with patients and their families may offer an opportunity to adapt hospice and palliative care services to meet the needs of these patients and their families 8. Accomplishing this goal represents one of the most important challenges to improving end-of-life care for patients with severe COPD.
Patients with COPD are at risk for respiratory failure and recent advances in the use of noninvasive ventilation raise questions about the use of this technology in the palliative care setting. The use of noninvasive ventilation for patients who choose to forego invasive mechanical ventilation is relatively common in Europe, with approximately one third of patients who receive end-of-life care in the hospital receiving noninvasive ventilation as the most aggressive form of ventilation before death 78. A recent Society of Critical Care Medicine Task Force provided a systematic approach to considering noninvasive ventilation in palliative care settings, and concluded that although noninvasive ventilation may be appropriate as a form of life support for patients who choose to forego invasive ventilation, current literature does not support the routine use of noninvasive ventilation for the sole purpose of palliation of symptoms 79. Furthermore, most hospice settings do not have familiarity with noninvasive ventilation and this lack of familiarity increases the risk for harm and decreases the chance of benefit from noninvasive ventilation.
In summary, palliative care is an important component in the treatment of patients with severe chronic obstructive pulmonary disease. There is strong evidence to suggest that patients with chronic obstructive pulmonary disease receive poor-quality palliative care compared with patients with cancer 11, 12, 14. One reason these patients may receive poor-quality palliative care is that patient–physician communication about end-of-life care is unlikely to occur, or only occurs late in the illness 23–25. The quality of this communication is likely to be poor and current models for training physicians in communication about end-of-life care are inadequate 23, 27, 80. Understanding the barriers to this communication may be an important step to improving it 22. Furthermore, recognising the importance of anxiety and depression will also be important when discussing palliative and end-of-life care 55. Advance directives and good advance care planning offer an opportunity for improving the quality of palliative care received by patients with severe chronic obstructive pulmonary disease. Finally, hospice and palliative care services represent an important opportunity for improving end-of-life care, but clinicians caring for patients with chronic obstructive pulmonary disease must find more effective ways to utilise these services.
Statement of interest
Previous articles in this series: No. 1: Viegi G, Pistelli F, Sherill DL, Maio S, Baldacci S, Carrozzi L. Definition, epidemiology and natural history of COPD. Eur Respir J 2007; 30: 993–1013. No. 2: Fabbri LM, Luppi F, Beghé B, Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J 2008; 31: 204–212. No. 3: Hill K, Geist R, Goldstein RS, Lacasse Y. Anxiety and depression in end-stage COPD. Eur Respir J 2008; 31: 667–677. No. 4: Albert P, Calverley PMA. Drugs (including oxygen) in severe COPD. Eur Respir J 2008; 31: 1114–1124. No. 5: Clini EM, Ambrosino N. Nonpharmacological treatment and relief of symptoms in COPD. Eur Respir J 2008; 32: 218–228.
- Received September 24, 2007.
- Accepted October 20, 2007.
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Lo B, Ruston D, Kates LW, et al. Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA 2002;287:749–754.
Hofmann JC, Wenger NS, Davis RB, et al. Patients’ preferences for communication with physicians about end-of-life decisions. Ann Intern Med 1997;127:1–12.
Wenrich MD, Curtis JR, Shannon SE, Carline JD, Ambrozy DM, Ramsey PG. Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Arch Intern Med 2001;161:868–874.
Back AL, Arnold RM, Quill TE. Hope for the best, and prepare for the worst. Ann Intern Med 2003;138:439–443.
Carline JD, Curtis JR, Wenrich MD, Shannon SE, Ambrozy DM, Ramsey PG. Physicians’ interactions with health care teams and systems in the care of dying patients: perspectives of dying patients, family members, and health care professionals. J Pain Symptom Manage 2003;25:19–28.
McSweeny A, Heaton R, Grant I, Cugell D, Solliday N, Timms T. Chronic obstructive pulmonary disease; socioemotional adjustment and life quality. Chest 1980;77:309–311.
Prigatano GP, Wright EC, Levin D. Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease. Arch Intern Med 1984;144:1613–1619.
Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD. Chest 1985;87:35–38.
Engstrom CP, Persson LO, Larsson S, Ryden A, Sullivan M. Functional status and well being in chronic obstructive pulmonary disease with regard to clinical parameters and smoking: a descriptive and comparative study. Thorax 1996;51:825–830.
van Ede L, Yzermans CJ, Brouwer HJ. Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax 1999;54:688–692.
Kunik ME, Roundy K, Veazey C, et al. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest 2005;127:1205–1211.
Borson S, McDonald GJ, Gayle T, Deffebach M, Lakshminarayan S, Van Tuinen C. Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics 1992;33:190–201.
Stapleton RD, Nielsen EL, Engelberg RA, Patrick DL, Curtis JR. Association of depression and life-sustaining treatment preferences in patients with COPD. Chest 2005;127:328–334.
Blank K, Robison J, Doherty E, Prigerson H, Duffy J, Schwartz HI. Life-sustaining treatment and assisted death choices in depressed older patients. J Am Geriatr Soc 2001;49:153–161.
Rosenfeld KE, Wenger NS, Phillips RS, et al. Factors associated with change in resuscitation preferences of seriously ill patients. Arch Intern Med 1996;156:1558–1564.
Uhlmann RF, Pearlman RA. Perceived quality of life and preferences for life-sustaining treatment in older adults. Arch Intern Med 1991;151:495–497.
Levenson JW, McCarthy EP, Lynn J, Davis RB, Phillips RS. The last six months of life for patients with congestive heart failure. J Am Geriatr Soc 2000;48: Suppl. 5 S101–S109.
Sprangers MA, Aaronson NK. The role of health care providers and significant others in evaluating the quality of life of patients with chronic disease: a review. J Clin Epidemiol 1992;45:743–760.
Wilson KA, Dowling AJ, Abdolell M, Tannock IF. Perception of quality of life by patients, partners and treating physicians. Qual Life Res 2000;9:1041–1052.
Schneiderman LJ, Kaplan RM, Pearlman RA, Teetzel H. Do physicians’ own preferences for life-sustaining treatment influence their perceptions of patients’ preferences. J Clin Ethics 1993;4:28–33.
Sprung CL, Carmel S, Sjokvist P, et al. Attitudes of European physicians, nurses, patients, and families regarding end-of-life decisions: the ETHICATT study. Intensive Care Med 2007;33:104–110.
Tonelli MR. Pulling the plug on living wills – a critical analysis of advance directives. Chest 1996;110:816–822.
Schneiderman LJ, Kronick R, Kaplan RM, Anderson JP, Langer RD. Effects of offering advance directives on medical treatment and costs. Ann Intern Med 1992;117:599–606.
Danis M, Mutran E, Garrett JM. A prospective study of the impact of patient preferences on life-sustaining treatment and hospital cost. Crit Care Med 1996;24:1811–1817.
Danis M, Southerland LI, Garrett JM, et al. A prospective study of advance directives for life-sustaining care. N Engl J Med 1991;324:882–888.
Teno JM, Lynn J, Connors AFJ, et al. The illusion of end-of-life savings with advance directives. J Am Geriatr Soc 1997;45:513–518.
Teno JM, Lynn J, Wegner N, et al. Advance directives for seriously ill hospitalized patients: effectiveness with the Patient Self-Determination Act and the SUPPORT Intervention. J Am Geriatr Soc 1997;45:500–507.
Teno JM, Licks S, Lynn J, et al. Do advance directives provide instructions that direct care?. J Am Geriatr Soc 1997;45:508–512.
Tilden VP, Tolle SW, Drach LL, Perrin NA. Out-of-hospital death: advance care planning, decedent symptoms, and caregiver burden. J Am Geriatr Soc 2004;52:532–539.
Norris K, Merriman MP, Curtis JR, Asp C, Tuholske L, Byock IR. Next of kin perspectives on the experience of end of life care in the community setting. J Palliat Med 2007;10:1101–1115.
Dales RE, O’Connor A, Hebert P, Sullivan K, McKim D, Llewellyn-Thomas H. Intubation and mechanical ventilation for COPD: development of an instrument to elicit patient preferences. Chest 1999;116:792–800.
Singer P. Advance directives in COPD. Monaldi Arch Chest Dis 1995;50:62–63.
Calverley PM, Anderson JA, Celli B, et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 2007;356:775–789.
Stevenson J, Abernethy AP, Miller C, Currow DC. Managing comorbidities in patients at the end of life. BMJ 2004;329:909–912.
Fordham S, Dowrick C. Is care of the dying improving? The contribution of specialist and non-specialist to palliative care. Fam Pract 1999;16:573–579.
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Block SD. Medical education in end-of-life care: the status of reform. J Palliat Med 2002;5:243–248.
90,000 Chronic Obstructive Pulmonary Disease (COPD) – History and Examination
History and Examination
Key Diagnostic Factors
Smoking is a major risk factor. Other key risk factors include advanced age and genetic predisposition.
This is usually the primary symptom of COPD.
This is often a morning cough that becomes permanent as the disease progresses.
Usually a productive cough, the properties of sputum change depending on exacerbations, or the addition of infection.
Difficulty breathing first appears during exercise, but as the disease progresses, it can be felt at rest.
Patients may find it difficult to speak in full sentences.
Other diagnostic factors
The anteroposterior chest size is increased.
This suggests hyperinflation and excessive air retention in the lungs due to incomplete exhalation.
Caused by hyperinflation and excessive air retention in the lungs due to incomplete exhalation.
Caused by a barrel chest, hyperinflation and increased air retention in the lungs.
Secondary, to loss of elasticity in the lungs, and damage to lung tissue.
Frequent occurrence during exacerbations. Nowadays, this word is commonly used to describe the musical pulmonary sound.
It is an indicator of airway inflammation and resistance.
Frequent occurrence during exacerbations. Sounds of varying duration, reflecting the presence of mucus, or phlegm, in the airways.
It is an indicator of airway inflammation and increased mucus secretion.
An increase in respiratory rate occurs to compensate for hypoxia and hypoventilation.
Additional respiratory muscles may be involved.
Loss of postural control with arms extended forward (commonly known as wiggle) caused by hypercapnia.
These changes reduce gas exchange in the lung parenchyma, worsens even more with exercise and involves the development of respiratory failure.
Occurs again due to an increase in intrathoracic pressure and cor pulmonale.
Makes it possible to suspect cor pulmonale and secondary pulmonary hypertension as a complication of chronic lung disease in the terminal stage.
Occurs as a result of intermittent sleep secondary to persistent nocturnal cough and persistent hypoxia and hypercapnia.
May occur as a result of hypercapnia-induced vasodilation.
Observed in the late stages of COPD, usually in combination with hypoxia, hypercapnia, and cor pulmonale.
Sign of COPD in the final stages.
Indicates secondary pulmonary hypertension as a complication of cor pulmonale.
A symptom of COPD in the terminal stage, complicated by cor pulmonale.
A symptom of COPD in the terminal stage, complicated by cor pulmonale.
COPD itself does not cause drumstick changes, but if exposure to tobacco in COPD patients leads to lung cancer and / or bronchiectasis, then COPD may develop drumstick changes.Barrel-like changes usually do not develop until there is significant impairment of lung function.
The most important risk factor. Causes 40 to 70% of COPD cases.  Raherison C, Girodet PO. Epidemiology of COPD. Eur Respir Rev. 2009 Dec; 18 (114): 213-21.
Leads to an inflammatory response and dysfunction of the ciliated epithelium and oxidative damage.
The effect of age can be associated with a long history of smoking, as well as with a physiological age-related decrease in FEV1.
The susceptibility of the respiratory tract to inhalation irritants depends on genetic factors. Alpha-1-antitrypsin deficiency is a genetic disorder that occurs most commonly in people of northern European descent and leads to panlobular emphysema of the lower lobes at a young age.
Despite the high smoking rate among Black Americans and other racial and ethnic groups, COPD is more common among Caucasian people.
Chronic exposure to dust, vehicle exhaust and sulfur dioxide increases the risk of COPD.
Frequent childhood infections can lead to scarring of the lungs, decreased elasticity, and an increased risk of COPD.
COPD is more common among men, but this may be due to the fact that the majority of smokers are male. Incidentally, it is believed that women are more susceptible than men to the effects of tobacco smoke.  Xu X, Weiss ST, Rijcken B, et al.Smoking, changes in smoking habits, and rate of decline in FEV1: new insight into gender differences. Eur Respir J. 1994 Jun; 7 (6): 1056-61.
 Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994 Nov 16; 272 (19): 1497-505.http://www.ncbi.nlm.nih.gov/pubmed/7966841?tool=bestpractice.com
 Silverman EK, Weiss ST, Drazen JM, et al. Gender-related differences in severe, early-onset chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000 Dec; 162 (6): 2152-8.
 Calverley PM, Anderson JA, Celli B. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.N Engl J Med. 2007 Feb 22; 356 (8): 775-89.
The risk of developing COPD is increased in people with low socioeconomic status.  Prescott E, Lange P, Vestbo J. Socioeconomic status, lung function and admission to hospital for COPD: results from the Copenhagen City Heart Study. Eur Respir J. 1999 May; 13 (5): 1109-14.
However, this may reflect the influence of tobacco smoke, pollutants and other factors.
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Lifestyle.Wellness program for COPD.
General Description What is COPD?
Chronic obstructive pulmonary disease (COPD) is a group of serious breathing disorders that includes chronic bronchitis, asthma and pulmonary emphysema, or may be a combination of two or more of these diseases. It is a progressive, irreversible, and debilitating lung disease that often begins with a morning cough of mucus and is associated with shortness of breath and difficulty breathing as the disease progresses.
• Feeling of tightness in the chest
• Cough with mucus
• Shortness of breath that gets worse even with mild physical activity
• Frequent respiratory infections
• Heavy breathing COPD is accompanied by shortness of breath not only when climbing stairs, but also when doing light exercise and even walking around the room. In severe cases, the patient has great difficulty in performing normal breathing.
In addition, COPD can cause coughing, wheezing and chest tightness, and breathing difficulties.Although there is no known effective treatment for COPD, changing the patient’s lifestyle and taking nutritional supplements can slow down and, in some cases, partially reverse the course of the disease.
A multi-pronged approach is likely the best way to deal with COPD. You can act haphazardly, taking a drug or supplement as needed, but in the long term, lifestyle and dietary changes, breathing techniques, relaxation techniques, along with moderate exercise and supplementation will lead to far more beneficial results.Lifestyle change
• Quit smoking! If you smoke or are in the midst of smokers, quit smoking and stay away from tobacco smoke.
• Avoid scented candles and personal care products (cosmetics, perfumes, soaps, deodorants, etc.) If you have dry-cleaned clothes, air them well before placing them in the closet, otherwise headaches or other allergic reactions.
• Do not drive during rush hour when the exhaust gas content of the environment increases sharply.
• Avoid all types of aerosols and sources of strong odors. They will irritate your bronchi and aggravate your condition. Nearly all cleaning products used in your home are similar irritants. Use natural, non-sprayable products instead. You can use baking soda or vinegar.
• If you live in an area with high air pollution, limit your time outdoors.
• Avoid people with colds , as people with COPD are much more susceptible to infection and can easily catch colds.Rhinoviruses, one of the main causes of the common cold, are known to exacerbate the complications of COPD and can lead to pneumonia, the leading cause of death for people with chronic obstructive pulmonary disease. You should be aware that if you start coughing with greenish, yellowish or brownish phlegm, it is a bacterial infection and you should see your doctor right away. Strengthening your immune system is the cornerstone of a wellness program.
• Eat small amounts of , several meals a day.Overloading the stomach puts pressure on the diaphragm, resulting in breathing discomfort.
• If you have mold in your home or workplace, eliminate it. Mold is one of the main initiators of COPD symptoms.
• If your home has ventilated equipment and air ducts, clean them at least once a year to remove dust. Consider installing a filter in them to clean the system of pollen, dust, mold, and other particles.
• Keep the indoor humidity at an optimal level of 30-55% .You can buy an instrument to monitor the humidity level, and if it is too high, use a dehumidifier, and if it is too low, use a humidifier.
• Buy a negative ion generator. The air will be purified by adding negative ions to it, which attract positively charged microparticles of dust, wool and other irritants. This device will be especially important when your house or apartment is tightly closed and not ventilated.
physician therapist Yusupov I.R.
OGBUZ “Graivoronskaya CRH”
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90,000 The doctor spoke about the side effects of dexamethasone – Society
MOSCOW, June 17. / TASS /.The anti-inflammatory drug dexamethasone, which has been shown to be effective against the complications of COVID-19, has side effects such as an increased tendency to thrombosis and the ability to cause stomach ulcers. Therefore, only specialists should appoint it. Honored Doctor of Russia Mikhail Kagan told TASS about this.
Dexamethasone is a steroid drug with anti-inflammatory and immunosuppressive effects. It is used to treat rheumatoid diseases, asthma, allergies, chronic obstructive pulmonary disease and many other diseases.According to the results of the RECOVERY clinical study, which involved more than 6 thousand patients with coronavirus infection, dexamethasone reduced the mortality rate of patients with COVID-19 who were on mechanical ventilation by one third.
The head of the World Health Organization (WHO) then called these results a “scientific breakthrough.” However, the study has not yet been independently reviewed and published in any scientific journal. The authors promise to do this in the near future.
Why dexamethasone should be taken with caution
“[Side effects] are the same as for other drugs in this group – increased tendency to thrombosis, increased blood pressure, increased blood glucose, the ability to cause stomach ulcers, etc. This is a serious drug for serious situations with serious side effects Therefore, only an experienced doctor will understand what’s what, – said Kagan.
The doctor explained that the drug, according to preliminary results of the study, does not affect the virus itself, it only reduces the excessive inflammation that occurs in the body after infection.
As a prophylaxis and in the first week after infection with coronavirus, Kagan did not recommend using this drug, since it suppresses the immune system. “It can only help the virus,” the doctor explained.
In general, as Kagan explained, dexamethasone has been known to mankind since the 1960s and has long been registered for the treatment of autoimmune diseases in all countries, including the USSR and Russia. Traditional therapy for many autoimmune diseases is based on corticosteroids, such as systemic lupus erythematosus, glomerulonephritis, bronchial asthma, Kawasaki syndrome, autoimmune thrombocytopenic purpura and others.
It is logical to use corticosteroids for coronavirus infection, the doctor noted, but there were no unequivocal recommendations, since there was no evidence of the effectiveness of this drug against COVID-19 before. In addition, doctors are aware of the risks of using such steroids. At the same time, in the seventh version of the temporary methodological recommendations of the Ministry of Health “Prevention, diagnosis and treatment of a new coronavirus infection” dated June 3, there was a recommendation that this drug can be used in a severe course of the disease, Kagan noted.
“It should be noted that in the UK the dose of dexamethasone was used significantly lower than that recommended by our Ministry of Health – 6 mg per day (in domestic recommendations – 20 mg per day. I think that the British managed to find the optimal dose that already provides a positive effect and minimizes side effects) actions “, – concluded the doctor.
How clinical trials were carried out
More than 6.4 thousand people participated in the RECOVERY study, which began in March 2020.patients with coronavirus infection. Of these, 2.1 thousand people were randomly selected, who were given 6 mg of dexamethasone per day for ten days. The rest of the participants underwent the usual treatment in such cases.
The results showed that this immunosuppressant reduced the number of deaths among patients with severe forms of COVID-19: by a third among patients on ventilation and by 20% among those who needed supplemental oxygen.
90,000 Chronic obstructive pulmonary disease –
This disease mainly affects smokers.Particularly unpleasant is that it is steadily progressing to treat COPD is very difficult. If you know young men and women who smoke, tell them that they are at risk of becoming disabled in 20-30 years in the midst of their lives. Doctors all over the world say – this disease is easier to prevent, but how? NO SMOKING! So the cause of COPD is known. In our country, smokers account for 40 to 60% of the population. The number of female smokers is growing. What happens in the lungs when tobacco smoke enters the respiratory tract? The combustion products of tobacco cause inflammation in all parts of the respiratory system: bronchi, lung tissue, blood vessels.It is accompanied by the production of a large amount of mucus in the bronchi, which causes a cough, leads to a narrowing of the airways, and destroys lung tissue. As a result, the lungs cease to provide the body with oxygen and the most serious and most painful symptom of the disease arises – ODDHEAD. Why don’t all smokers choke.
COPD develops from one third to half of smokers (the rest suffer from lung cancer, vasoconstriction of the lower extremities, ischemic heart disease). This leads to a hereditary predisposition.So the probability of getting sick is very high. A person who starts smoking, in fact, plays Russian roulette, only the “loss amount” will be known sooner or later – whoever is lucky. The insidiousness of the disease also lies in the fact that shortness of breath, forcing you to see a doctor, does not come immediately, but by the age of 45. But the disease begins to develop even when a person starts smoking and after a few years a cough with a small amount of sputum appears, and sometimes the smoker does not notice the symptoms at all.But the process of destruction of the lungs is already underway! Thus, a fifteen-year-old teenager who first took a cigarette in his mouth, and has no idea what he can expect at the age of 50. Unfortunately, COPD, once started, cannot go away. Moreover, the disease progresses, no treatment has been found for it that can radically change its course, such as in bronchial asthma. Shortness of breath is a symptom that makes a person seek medical help indicates the onset of irreversible changes. in the bronchi, lungs and pulmonary vessels.But slowing down the progression, reducing the manifestations of the disease, fighting respiratory failure, improving the quality of one’s life is quite a feasible task.
Here are the main treatments:
- Smoking cessation
- Use of bronchodilators
- Prevention of exacerbations – vaccination
- Physical training
Scientists have proven that smoking cessation at any stage of the disease slows down its progression.Moreover, quitting smoking is perhaps the most effective measure for reducing the rate of progression of the disease, but of all treatment procedures, this is the most difficult to perform.
Here are some tips that might help you cope with quitting smoking more easily:
- Realize that success depends on yourself. Do not rely on anyone or anything. The foundation of success is a strong belief that you should quit smoking.
- Ask someone you know who has quit smoking about their experience.Perhaps something will come in handy for you.
- Talk to your doctor about smoking cessation relief pills / gums, mouthpieces, or patches to help you quit smoking.
- Quit smoking immediately; it is more effective than gradually reducing the dose.
- Avoid the circumstances under which you are accustomed to smoking (communication with smokers, smoke breaks at work, drinking coffee, alcohol, etc.)
- Remove ashtrays from visible places, do not carry lighters, matches.
- Keep yourself and your hands occupied, especially when you are craving to smoke. If your cravings increase, chew gum, eat fruits or vegetables, and drink water.
- Do not let your loved ones, relatives, friends smoke in front of you.
- If you smoke again, do not despair.
Sometimes it takes several tries to quit smoking once and for all. Bronchodilators are the main drug treatment for COPD.They are used on demand or regularly as a preventive treatment. Bronchodilator drugs are often prescribed by inhalation for better penetration into the bronchi. Sometimes the doctor may prescribe them in tablets.
An exacerbation is a difficult episode in the life of a person with COPD. It is accompanied by increased shortness of breath, fever, discharge of purulent sputum. The main cause of exacerbation is a viral infection. Therefore, it is important to vaccinate against influenza, correctly and regularly use prescribed drugs.Inflammation in COPD affects the entire body. Loss of muscle mass and muscle strength is especially important. This reduces exercise tolerance and increases shortness of breath. The only proven way to combat physical weakness is exercise. It is better to exercise under the supervision of a specialist, but if you do not have this opportunity – do the training yourself. Start with a daily walk for 20 minutes. Do gymnastics with light dumbbells, gradually increase the load on the arms, as well as walking time and speed.Increase the intensity of the exercises gradually! Never bring yourself to severe shortness of breath. If you are tired, increased shortness of breath, pain in your legs or arms, be sure to take a rest or interrupt your workout today, take an oronchodilator. To reduce shortness of breath during exercise, it is sometimes helpful to use a bronchodilator inhaler before its beginning.
For a person with COPD, some general recommendations regarding daily life are very important:
- Avoid smoky, dusty rooms, ventilate your home regularly.When cooking, keep the window or window open or turn on the ventilation.
- Eat right. Eating is very important for someone with COPD.
- Eat more vegetables and fruits, as well as food rich in proteins, meat, fish, eggs, milk, beans, soy.
- Be sure to keep an eye on your weight – it is bad to be both overweight and underweight. See your doctor regularly. Discuss issues that bother you with him.
- Ask your doctor to write down the name of the drugs you are taking, how much and when to take them, and display them in a prominent place.
- Find out and receive training at your health center for a special school for people with COPD.
The material was prepared by S.A. Popova, a pulmonologist.
90,000 Respiratory diseases – diagnostics and treatment in Moscow, price
The article was checked by a general practitioner Mardanova O.A. is for general informational purposes only and does not replace specialist advice.
Consultation of a physician is required for recommendations on diagnosis and treatment.
It is believed that respiratory diseases are one of the most common pathologies with which patients consult a doctor. They significantly reduce the patient’s quality of life and are often difficult to self-treat. In addition, the environment, including the ecological situation, has a serious impact on the state of the respiratory system, and therefore, in recent years, the number of patients with these diseases has increased markedly.
Therapists of the Clinical Hospital on Yauza diagnose respiratory diseases and refer patients to doctors specializing in the treatment of respiratory organs.
Causes of diseases of the respiratory system
The most common causes of diseases of the respiratory system include the following:
- microorganisms (bacteria, viruses, fungi, less often parasites). The largest role among these pathogens belongs to bacteria that cause serious diseases such as bronchitis and pneumonia, as well as viruses, including influenza viruses
- various allergens, including household allergens, animal allergens, plant pollen, etc.d.
- environmental factors
- presence of diseases of other organs and systems
Major diseases of the respiratory system
Any part of the respiratory system can be attacked by viruses and bacteria.
The following main diseases are distinguished.
Laryngitis and pharyngitis – inflammation of the pharynx. The main symptom is “sore throat”, hoarseness, cough.
Tracheitis – inflammation of the trachea, the main symptom of which is a dry cough.It is exacerbated at night or early in the morning, and also aggravated by inhalation, laughter, physical exertion. The body temperature may rise slightly.
Bronchitis is an inflammatory disease of the bronchi, which can occur as an independent disease and as a secondary process in various diseases. With bronchitis, the patient suffers from a dry cough, which gradually turns into a wet cough. The body temperature may rise, the patient feels a general malaise.
Pneumonia is an infectious and inflammatory lung disease, in which the most striking symptom is a cough with sputum production.Also, with pneumonia, the patient complains of weakness, shortness of breath, fever.
Pleurisy – inflammation of the pleura – the membrane that covers the lungs. The main symptom is pain in the side, which is aggravated by coughing or inhaling.
Bronchial asthma is a disease that is of an allergic nature, but affects the state of the respiratory system, and in particular the bronchi. The lumen of the bronchi narrows, as a result of which the patient has shortness of breath on exhalation, as well as a cough.
X Ronic obstructive pulmonary disease (COPD) – this concept unites a group of diseases of the bronchopulmonary system, which lead to impaired bronchial patency. The main symptoms of the disease are cough with a small amount of sputum and shortness of breath.
Diagnostics and treatment of respiratory diseases in the Clinical Hospital on Yauza
Doctors of the therapy department of the Clinical Hospital on Yauza have all the facilities for high-quality diagnostics and treatment of diseases of the bronchopulmonary system.The most common methods used for complex diagnostics are blood tests, X-rays and endoscopy. All these opportunities are available at the Clinical Hospital on Yauza.
After a comprehensive examination, the therapist of the Clinical Hospital on Yauza directs patients to a specialist who prescribes the optimal treatment.
Cost of services
You can look at prices for services in the price list or check the phone number indicated on the website.
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90,000 Who is at risk of COPD and how Ulyanovsk residents can fight it
Hearing the word “COPD”, many will think that this is a new trade mark, a youth word, but not a disease.Meanwhile, this is a new name for a number of known bronchopulmonary problems. They are combined according to one, but very serious sign – a gradual narrowing of the bronchial lumen. And the abbreviation stands for “chronic obstructive pulmonary disease.”
Medical workers of the therapeutic service of the State Institution “Bazarnosyzganskaya RB” of the Ulyanovsk region tell about the symptoms, causes and prevention of this disease.
Chronic obstructive pulmonary disease is a chronic inflammatory disease of the respiratory system that occurs under the influence of various environmental factors, the main of which is tobacco smoking.COPD usually begins after age 40. However, an earlier occurrence is also possible in the case of a genetic defect and a long smoking history.
Symptoms of chronic obstructive pulmonary disease (COPD): cough with mucous sputum, more often in the morning, shortness of breath, interruptions in the work of the heart, aching pain in the heart, bluish tinge of the lips and fingertips; changes in fingers and nails, muscle weakness. The main causes of the development of the disease are smoking – the main factor in the development of the disease; harmful production factors – long-term exposure to dust, acid and alkali vapors, and other chemical particles contained in the air; harmful environmental factors; genetic defect – deficiency of the enzyme Alpha-1-antitrypsin (extremely rare).
In most cases, the diagnosis of COPD is straightforward. A general medical examination, a study of the function of external respiration, which is called spirometry, makes it possible to establish a diagnosis.
By far the most effective measure for influencing COPD is to quit smoking. Exercise and a balanced diet take a special place in the treatment of COPD. During breathing, a COPD patient burns 10 times more calories than a healthy person. Therefore, COPD patients need high-calorie foods to provide energy, prevent infections, and maintain respiratory muscle strength.
Due to the continuous development of medicine, the approaches to the treatment of COPD are constantly being improved. Currently, there are two main groups of drugs used to treat COPD: bronchodilators, which widen the airways, and corticosteroids, which reduce airway edema. With an exacerbation of the disease against the background of infection, antibiotics are added to these drugs.
Oxygen therapy has significantly reduced mortality from COPD. It is prescribed to patients whose body receives an insufficient amount of oxygen from the air.
Despite the fact that COPD is a serious disease, effective methods of its treatment have been developed. The first symptom of COPD is shortness of breath, so if it develops, you should see your doctor immediately. The sooner the diagnosis is made, the earlier treatment is started, and the sooner the patient quits smoking, the faster it will be possible to stop the progression of the disease.
As with all chronic diseases, the key to successful COPD treatment is a positive attitude.
90,000 ACC® About cough. What is a cough – dry, wet, phlegm and how to treat it. Mucolytics and expectorants – ambroxol, carbocisteine, bromhexine. Cough with acute respiratory infections (ARVI), bronchitis, pneumonia, sinusitis, laryngotracheitis, bronchiolitis, COPD, otitis media.
Cough is a protective reflex of the body that allows you to free the respiratory tract from mucus, dust and foreign bodies. Every day, a small amount of mucus is produced in the cells lining the airways.This mucus moisturizes the airways and absorbs small particles that are inhaled with the air to keep them from entering the lungs. The body needs a cough because it removes the accumulation of mucus and helps clear the airways.
At the same time, cough is the main symptom accompanying various infections of the respiratory system, such as ARVI (“cold”) and flu. In inflammatory diseases of the respiratory tract, a change in the viscosity of bronchial mucus is characteristic (viscous mucus is called sputum).
The following stages of the development of cough in diseases of the lower respiratory tract can be conditionally distinguished:
Unproductive or unproductive cough (feels “dry” and does not yet cough up phlegm).
An unproductive or unproductive cough, as a rule, occurs at the very beginning of acute respiratory infections. The separation of sputum does not yet occur, because it is very thick and viscous and difficult to cough up.
In order to help get rid of phlegm and cough in ARI, the use of mucolytics is recommended – for example, ACC ® . This will translate an unproductive cough into a productive one, and thereby help recovery 11 .
The course of many respiratory diseases involves the transition from an unproductive or unproductive cough to a productive cough with sputum discharge.
Important! An unproductive cough with a cold is not recommended to be treated with antitussives, this can only aggravate the disease, due to stagnation of phlegm in the bronchi.
Productive cough (feels like “wet” with expectoration).
Unlike a nonproductive cough, this cough is characterized by sputum production and usually occurs in the later stages of the disease. As a rule, it is painless, more frequent, sometimes with wheezing. A productive cough helps clear accumulated phlegm from the bronchi and lungs. 11 Mucolytic preparation ACC ® helps to thin and remove phlegm.
Unproductive cough (sputum is present, but not separated)
Unproductive cough (little sputum, poor discharge)
Productive cough (expectoration)
Continue to take ACC ®
It is important to remember that the productivity of a cough depends both on the phase of the inflammatory process and on the nature of the disease.In upper respiratory tract infections, phlegm may not form and the cough may remain dry.
This recommendation is not a substitute for professional advice.
The purpose of the treatment of sputum cough is primarily to dilute the sputum. To turn a “dry” unproductive cough into a “wet” productive cough, it is recommended to start taking mucolytics, which reduce the viscosity of mucus and facilitate its excretion from the respiratory tract.
The active substance of the drug ACC ® – acetylcysteine - dilutes viscous phlegm and increases the effectiveness of cough 12 , contributing to recovery. For colds accompanied by the formation of viscous sputum, it is recommended to start taking mucolytics at the very beginning of the onset of an unproductive cough, when the resulting sputum is difficult to cough up on its own 12 .