Respiratory Therapist/Possible COPD
QUESTION: Hi sorry to bother you. My mother who is 48 and a smoker was recently hospitalized. She spent 3 days in the hospital for acute hypoxic respiratory failure, sepsis, and leukocytosis she was 88% room air when they brought her in. The Dr said he was treating for pneumonia. She spent a few days on IV's and oxygen. They did tests and scanned her lungs and heart for clots and blockage. They said everything was clear and good. They finally released her and prescribed her the following meds Azithromycin 250mg, Prednisone 10mg, Claritin 10mg, and Ventolin HFA 90 MCG. They also said she was prediabetic and scheduled her for a follow up appointment to test for possible COPD! Well she went to her follow up with her general practitioner and he wanted to wait to do the testing until she was off of the meds. They said her lungs and blood work looked ok and that she was at 99% room air. If her lungs look ok and she's on 99% room air why are they testing for possible COPD? Is this just a standard precautionary practice after being hospitalized for pneumonia? Is there a high likely hood that she has COPD or is it just a precaution to cover all the bases. I've been stressing like crazy because I've heard nothing but bad things about COPD. Thank you in advance for your time and assitance.
ANSWER: Unfortunately a smoker is about 80% sure he or she will get copd. Which is just another way saying emphysema. Most respiratory illnesses are when a person cannot breathe in . With copd they cant breathe out. Since she was bought in with heart failure, sepsis and pneumonia there is a reason why she went into heart failure, probably because the heart takes over the works of the lungs and visa versa. The only test to confirm copd which stands for chronic obstructive lung disease or emphysema is a pulmonary function test which is a simple painless test which she would blow into this machine various ways, slow ,fast etc.. they then would give her a broncholdilator like ventolin do the same breathing test , the machine will measure if the bronchodilator helped the numbers. If it did it is indicative of asthma copd depending on the which values improve. The one thing and the best thing she has going for her is she has to stop smoking immediately. She would be able to gain back some not all of her lung function depending on how bad the lungs are. However copd is not curable but is controllable . It all depends on how bad the lungs are. When a person stops smoking it takes up to 10 years before one sees the damage. However because of her age her organs are still young so she could very well get her lung function at least 80% functioning that is depending on just how bad the damage is now. Remember I said she must stop not cut down on smoking. The best way is cold turkey . One can use the nicotine patch or Chantix. If she does stop cold turkey believe it or not over the counter altoid mints many say control the nicotine. I am not a smoker tis just from what I have heard ex smokers say helped them quit. People with copd have a tendency to get pneumonia many 2-3 times a year so its best she stay away from anyone with colds. Pneumonia takes at least 3 months to totally leave ones body. She should have repeat chest xray to make sure the water in the lungs which is what pneumonia is has dissipated. Pneumonia can really weaken a person so don't let that scare you. Right now its best to take the Pulmonary function test pft, and in her case I would repeat it every 1-2 years if its normal. However I must say with what she was admitted for it is in all likely hood copd with respiratory failure. This may be in a way a wake up call for her to quit now to possibly get her life back. Continuing to smoke would definitely shorten her life. No one knows , but this has to be her wake up call to quit, if she wants to enjoy the rest of her life.feel free to email again. good luck and hang in there. Her age is really the best thing on her side because her body and organs respond better to treatments. As she gets older the copd will get worse. It all depends just how bad it is now. If there is no sign which I hope for her sake, she must stop the smoking to save her life. She has a chance to get the lung function back as much as her body will allow it too if its not too bad already. Karel.PS if you go to the Canadian lung association they have great info on copd. and tips such as do all appointments in the am as ones lungs tend to tire thru the day. stay indoors onhumid days. Also she must take the inhaler correctly the ventolin if not its useless.
1. she blows out all her air
2. place inhaler in mouth
3. take a deep breath in and at same time press the inhaler
4. do not take the inhaler out of your mouth instead immediately after she presses the inhaler she should count to ten.
5. then take the inhaler out and blow out her air.
this is so by inhaling very big then pressing the inhaler you are really getting the med down into the lungs, by then holding to a count to ten, the medication works through the gums being saturated so counting to ten holds in the meds and soaks the gums.. By blowing out the air she coats the lungs an airway. by blowing out the excess.
If she is prescribed inhalers, its is better to use those for emergency only and take nebulizer treatments, which is a small pipe like to put the medication in but only in liquid form. one thing one must remember is to change the filter when it gets black as this is where the bacteria that the nebulizer takes out of the lung. so read the machines manufactueer to see where the filter is. Don't buy extra filters, they can be replaced with a cotton ball.I say to change it every week this way you know the machine is sterile. You might also for now purchase a cold air humidifier, the best one and cheapest is the vicks cool air humidifier, you simply fill the tub with cold water. You are to throw a tablespoon of regular salt in the water, plug it in at night in the room close the door and run it . you can set it on top of a towel. It sounds like a tugboat but what it does is cleans the air and helps tremendously anyone with even just pneumonia. You can purchase it online or at cvs but the vicks runs about $40. make sure you buy filters on top those have to be replaced every 3 months or when it turns black. good luck, Karel
---------- FOLLOW-UP ----------
QUESTION: Ok so when she had her follow up they said her lungs were clear and her breathing was at 99% room air. So wouldn't that mean the likely hood of her having copd is slim to none? Also she didn't have heart failure. It was hypoxic respiratory failure. The dr at the er said he was treating her for pneumonia but he wanted to test for possible copd. With her breathing at 99% room air and having clear lungs. It doesn't seem likely that she has it. She has also never never shown signs of having breathing issuses. She walks for at least an hour myltiple times a week and does dancing. Am I correct in my thinking? That she is ok
Pneumonia and since it was caught due to hypoxia is a sign that she most probably is getting the copd. She still needs and should have the test. When doctors just say her lungs are clear, maybe now the test cant tell you if she has any low values that are a precursor to getting it. If she does not have copd now or lets say gets pneumonia a couple of times a year this is also a sign. A person doesn't gradually get copd. It shows when the damage is already done. In her case hypoxia with respiratory failure, is a sign. Since she now is breathing on 99% room air, that is great. But if she does not stop smoking she will definitely get copd. She is lucky like I said her age is on her side, but guaranteed ten years from now, she will get full blown copd and that is not reversible but controllable. She still should get the test the pft(pulmonary function test just to see. If she is however still taking an inhaler she is getting some respiratory problem. One does not continue with an inhaler after pneumonia. Like I said, her meds she was given ,the pneumonia caused by heart failure. Heart failure does not go away, then again, if this was by an er doctor the diagnosis should just be plain pneumonia. But due her being a cigarette smoker, chances of her getting copd if she doesn't have it now will get it. She needs to stop smoking or she wont bounce back so well as she ages. The meds may have reversed her lungs problems for now. But continuing to smoke will only make them exacerbate again, and next time it may not make her bounce back. Im not trying to scare you. She should read my answer perhaps then she will realize that to continue smoking will definitely make this happen again. If they leave her on the inhaler it is a suspicion that they are suspecting her starting to get copd. So she is lucky she got a second chance. But continueing to smoke will only make her symptoms happen again and again. Also keep in mind these er doctors many times are not the brightest. Which she should see a pulmonary doctor and get the test done, and repeat it in 2 years to see if the values have lessoned. If that happens that is the other copd indicator. feel free to email again Karel. If she had had heart failure, she would have been on a ventilator ,and not bounce back as quickly. Heart failure is not curable. So its a chance she had just pneumonia, however pneumonia due to hypoxia means low oxygen, and since she was a smoker, low o2 and smoking are signs of one getting copd. getting not got. good luck Karel PS I do hope she has quit smoking.