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However, researchers found that lung function in patients who were assigned to the control group, ( receiving medical treatment only and no surgery), were much worse than at the start of the study. Therefore LVRS does buy some time for those with COPD. Garvey notes that this surgery is only targeted for patients with severe COPD with emphysema located primarily in the upper lobes of the lungs.

“The majority of patients with COPD are going to benefit from medications and beginning an exercise regimen that helps to improve their shortness of breath,” Garvey says.

Pulmonary rehabilitation programs provide exercise and education, and have been shown to help people coping with COPD lead fuller lives as well as reduce their number of hospital stays.

“Patients with COPD should always begin an exercise program under the supervision of a pulmonary rehab program,” Garvey says. “After being involved in a six-week program, patients will feel more confident performing the exercises on their own.”

Promoting awareness and self-care strategies

Although 13 million Americans suffer from COPD, nurses believe there are many more cases that haven’t been diagnosed because it’s common for patients to ignore their symptoms until their breathing capacity has become severely diminished.

COPD is typically diagnosed as part of pulmonary function testing. Another diagnostic tool which has been underutilized, according to nurses such as Garvey, is a device known as a spirometer, which allows doctors to assess lung function. It has proven helpful in diagnosing COPD, especially in the early stages of the disease before the symptoms are debilitating or even before they are recognized and acknowledged by the patient.

“There has been more of a move toward using the spirometer on patients with a long history of smoking,” Garvey says.

There are also steps that patients can take to prevent COPD.

“If people quit smoking, they can actually improve their lung function,” says Diane Harris, RN, BSN, a nurse at Boswell Memorial in Sun City, Ariz. “Many people don’t realize that COPD is largely preventable.”

Harris also helps her patients with COPD learn coping and relaxation skills to reduce the anxiety and fear that accompanies a patient’s shortness of breath.

“The fear makes their breathing worse, so it’s important for patients to learn how to relax,” she says. “We also help patients learn how to conserve their energy by doing things like eating six small meals a day, so that they can conserve energy while still maintaining good nutrition.”

Heather Maxey, RN, of First Choice Home Healthcare in Denver, Colo., empathizes with her patients who have COPD. Maxey has asthma and knows firsthand how scary it is to have breathing difficulties. Approximately 50% of the patients that Maxey cares for have COPD.

Memory Loss

A study being conducted by Paula Meek, RN, PhD, FAAN, a nursing professor at the University of New Mexico and Kathie Insel, RN, Ph.D., an assistant nursing professor at the University of Arizona, is examining whether build-up of carbon dioxide in the bloodstream can cause memory loss in those with COPD. Early indications show that some patients with COPD may have difficulties processing information.

Nurses know that lung and respiratory diseases hurt the body’s ability to bring oxygen to the brain, but Meek and Insel’s study is the first to examine carbon dioxide build-up in the blood. The results of their study could eventually lead to more effective drug treatments for people with COPD as well as a better understanding of how to care for patients whose memory loss stems from COPD.

The memory problems in patients with COPD are not like Alzheimer’s disease, but are related to processing information in a patient’s short-term memory. For example, remembering a seven-digit phone number wouldn’t be a severe problem, but processing that number-putting the digits in order from smallest to largest-might be increasingly difficult for people with COPD.

Maxey has witnessed confusion among many of her patients who have COPD. She often leaves them written reminders to take their medications or to wear oxygen. She also works with patients and their families to practice pulmonary breathing exercises and reviews each patient’s dietary and
sleeping habits.

“Care plans for patients with COPD are as unique as each individual,” Maxey says. “I check to see if patients are taking pain medications that can depress respiration, and I work with them to decrease their naps and increase their activity level.”

Despite having run a successful smoking cessation program, Maxey says helping patients dealing with COPD kick the tobacco habit is a formidable challenge.

Unfortunately, many patients who have COPD are diehard smokers.” she says. “If people stop smoking their lung function can increase. The number-one way to slow progression of the disease is to stop smoking, but for many patients quitting isn’t a possibility.”

Linda Childers is a freelance writer for NurseWeek.

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