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The pulmonary rehab team at Seton Medical Center in Daly City, Calif.: Richard Constantino, MS; Michael Doyle, MA (back); Julia Rigler, RRT; Chris Garvey, FNP (seated)

A 68-year-old woman was having difficulty climbing the stairs to her doctor’s office. She was less than halfway up the stairs when she paused to catch her breath. Without a brief rest she knew from experience that she would soon feel as though she were suffocating.

More than 13 million Americans suffer from chronic obstructive pulmonary disease (COPD), a condition characterized by chronic cough, excess mucus production and shortness of breath. For these people, everyday physical tasks often seem like overwhelming obstacles.

For nurses such as Virginia Carrieri-Kohlman, RN, DNSc, FAAN, of the University of California, San Francisco, School of Nursing, working patients who have COPD presents a constant challenge. While there is no cure for the condition, nurses like Carrieri-Kohlman agree that new medications seem to improve the quality of life for patients with COPD. In addition, a number of clinical studies are currently taking place that promise to yield new insights and treatment options.

Chronic bronchitis and emphysema are among the most common conditions considered part of the COPD family. According to the American Lung Association (ALA), COPD is the fourth leading cause of death in the United States after cardiovascular disease, certain cancers and stroke. The number of deaths due to COPD has nearly doubled in the past two decades, and the most dramatic increase has occurred in women. By the year 2020, the ALA estimates that COPD will be the third leading cause of death worldwide. Many mistakenly believe that COPD is a disease that only affects the elderly, but in reality many patients exhibit symptoms of the disease in their 40s .

Smokers in denial

Although smoking is the leading cause of COPD, many smokers appear to be unconcerned about the long-term effects of smoking, according to a national study by the ALA conducted in 2004.

The study showed that nearly two-thirds (64%) of smokers aren’t concerned about developing COPD, even though more than half of them (55%) experience at least one of the symptoms of COPD on a regular basis. Although factors including genes and pollution can play a part in the disease, about 85% of all cases can be attributed to smoking.

Carrieri-Kohlman has worked with pulmonary patients for the past 35 years, and is currently conducting a study on how yoga can help reduce symptoms for patients with COPD.

“Management of dyspnea (shortness of breath) is a major concern for patients who have COPD,” she says. “Many patients believe exercise will make their condition worse, but we’ve seen that simple exercises help patients improve their endurance and reduce their anxiety levels, which in turn helps them breathe more easily.”

Simple yoga moves can even aid those with advanced COPD.

“We have 70-year-old patients on oxygen who are able to get down on the floor and do some of the simple poses and breathing exercises,” Carrieri-Kohlman says. “Many patient who have COPD think they are incapable of exercise but learn that if they push themselves, their limits increase and their breathing becomes easier.”

Over the years, her work with pulmonary patients has taught her that some of the best strategies in caring for patients with COPD are treatments that allow patients to feel they are more in control of their symptoms.

“When a patient who has COPD is hospitalized, nurses should ask what strategies have been successful in managing dyspnea in the past and capitalize on those strategies,” Carrieri-Kohlman says. “This often means ensuring the patient is in a comfortable position for breathing, having a fan at the bedside to help with shortness of breath, and employing methods of distraction such as music or guided imagery.”

Carrieri-Kohlman notes that in the past 10 years, there have been significant milestones in the field of COPD. Pulmonary rehabilitation programs have been shown to help patients while also teaching them methods of self-care. Inhaled steroids are being used to reduce inflammation in a patient’s lungs.

Chris Garvey, MSN, FNP, MPA, manager of pulmonary and cardiac rehabilitation at Seton Medical Center in Daly City, Calif, and a nurse volunteer with the ALA, attributes the increase in COPD cases to several different factors.

“I think we’re seeing the impact of high cigarette use in the 1950s and 1960s,” Garvey says. “Many of the people who have smoked a pack a day or more for the past 25 years are now suffering from chronic lung problems.”

New medication shows promise

Garvey is encouraged by the new medications available for patients with COPD, and she cites Spiriva, (tiotropium bromide). It’s the first once-daily inhaled bronchodilator and is one of the more exciting recent developments introduced in the COPD field.

“Early evidence of Spiriva usage has been very encouraging,” Garvey says. “Not only does it appear to help patients with shortness of breath, but it also appears to help reduce hospitalization for patients with COPD.”

Lung volume reduction surgery (LVRS), is another treatment that involves removal of parts of the lung badly affected by COPD.

By removing these damaged air sacs or alveoli, air trapping is reduced and the function of the rest of the lung is improved.

A five-year national, randomized trial of LVRS, known as the National Emphysema Treatment Trial or NETT was completed in 2003. The findings showed that breathing significantly improved, but by the two year mark lung function had returned to the pre-surgical condition.