Pulmonary
- Critical Care Associates
of East Texas
Jeffrey M.
Shea, M.D., F.C.C.P.
Venkatesh Donty, M.D.
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Jeffrey M.
Shea, M.D., F.C.C.P. |
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Introduction Prevention tries to keep one from harm, no matter how sick you are; there is always some further complication that can be prevented. Preventive care is accomplished through health education, selective medical interventions, proper nutrition, and specific physical exercises, abstaining from breathing harmful fumes, and improving one’s respiratory living environment. It is the patients who are responsible for their own health, and it is their choices that ultimately determine the health outcome. Preventive medicine’s role is to educate, motivate, and then assist the patient in achieving the level of health that he or she chooses. The purpose of health education is to help people understand how their body and lungs function. Primary Therapeutic Modalities The therapeutic modalities are divided into four groups. In the proper amounts, the body uses these essential elements for energy and growth as well as healing. The first of the modalities are physical. These are self-selected, self-dosed, and consume at will. These are the following elements:
Air- this is the more important on the list, which can quickly affect a person’s health, if it is in insufficient supply or is contaminated. Many patients must be taught more efficient ways of breathing. Respiratory mechanics are often less than efficient, use of accessory muscles of breathing are common, poor use of the diaphragm is frequent, minimal breathing endurance often exists, and poor posture often further limits respiratory activities. Assessing, and then supplying appropriate levels of supplemental oxygen. Breathing retraining with attention to muscle mechanics and posture. Using bronchodilator and steroid inhalers to facilitate improved airflow and decrease inflammation of the airways will help decrease the oxygen cost of breathing. Avoidance of dust, of airway irritants, and of extreme or abrupt temperature or humidity changes, and most of all cessation of smoking. Water- About two-thirds of a person’s weight is water. Water is necessary to bring nutrients to the tissues as well as washing waste products away. Adequate fluid intake is vital for lung function. The airways are at 100% relative humidity at body temperature, and proper flow of phlegm and enhancement of expectoration requires adequate water intake. The patient can almost always tell if enough water is being taken in by observing how clear their urine is. Your urine should be clear in appearance at least one or more times in a day. Nutrition- this is a concern of the body meeting its energy requirements. Patients, who have chronic lung disease, the work of breathing increases the metabolic rate. Emphysema patients are more likely to be underweight and challenging in maintaining proper caloric intake and some severe COPD patients continue to lose weight even after increasing calories. Carbohydrates and fats are of special interest. If a patient takes in excessive carbohydrates it can result in increased carbon dioxide production and result in ventilatory problems. Carbohydrates are an important fuel source and can improve oxygenation, endurance performance, lower blood cholesterol, and decrease risk for heart disease and stroke. Fats contain the greatest number of calories for the volume consumed and is an excellent source of extra calories for patients who are underweight. Fats also result in a lower carbon dioxide production with metabolism, when compared with carbohydrates. Protein, like carbohydrate and fat, requires planning to help the patient obtain the appropriate quantity and quality. Not having enough protein can result in increased infections and edema (fluid retention), thereby causing too much stress on the kidneys and increase ventilatory drive. Patients with limited respiratory reserve cannot tolerate an increased ventilatory drive for any prolonged period. The process of eating can also drop oxygen saturation. Supplemental oxygen during meal times may be necessary from some. There are benefits from the consumption of foods high in antioxidants, such as beta-carotene, vitamins C and E. Vitamin C might help decrease lung emphysema development. There is suggestion that people who consume greater quantities of vegetables and fruits had a decrease in various cancers including some cancers of the lung. Exercise- patients with disorders, who engage in regular exercise, experience increased endurance and higher levels of functioning. Aerobic exercises, such as walking or use of a bicycle ergometer, are the major exercises prescribed for patients with COPD. Specific exercising for respiratory muscles can improve maximal sustained ventilation, increase maximal inspiratory and expiratory pressures, and increase peak flow rates. Regular upper body exercises for COPD patient’s help to decrease breathlessness and fatigue. A progressive exercise program that involves both upper and lower body exercises is of great benefit and can decrease hospitalizations and improve quality of living. Some patients may find they need supplemental oxygen with increased exercise and others may actually improve their oxygen saturation with light-to-moderate activity. The need for oxygen should not be a limiting factor to prevent one from exercising. Exercise is also a natural mood elevator and counteracts depression. Rest- Try to get a good nights rest and allow yourself some time throughout the day for some quiet time. Do whatever helps you to relax, whether it is a nice walk, reading a book or a hobby. Sunlight- sunlight contributes to vitamin D conversion in the skin, and lifts the spirits. Excess sunlight should be avoided because of damaging effects to the skin and increased risk of melanoma.
A patient’s mental health is extremely important and influences the overall health. A positive mental attitude and a good sense of humor help to fight against disease and help a person to better deal with their disability. When a patient keeps their minds productive and active they were observed to have fewer complaints. Motivation is defined as a driving force or a desire that is often triggered by an event that gets a person’s attention. For some the strongest motivation factor arises from the possibility of improved function and others occur from the discovery of an abnormal test result. Motivation leads to efforts to change behavior to improve one’s health or avoid an uncomfortable situation. Ultimately the person must choose to make a change. The change to alter behavior requires effort. Social interaction provides for love, companionship, and other social interactions. To care and be cared for is therapeutic and, in the right balance, enhances health. Spirituality provides a philosophy of life and system of beliefs that can help sustain one in daily life. The concept of meditation and being at peace with oneself and others is beneficial to overall health. Preventive Care Treatment Plan Patients who have chronic lung disease need to have consistent evaluations and follow-up care. When the patients needs are attended to their survival improves. The following risk factors should always be monitored. Are immunizations current? Does the patient still smoke? How is the nonsmoking status going? Are medications being taken properly? Is weight stable? Are pulmonary mechanics and oxygenation status stable? Have there been any major changes in jobs, relationships, or geographic moves? Patients should be educated on recognizing early signs of respiratory infections so that early treatment can be started. When a patient has compromised pulmonary function it leads to greater susceptibility to infections, respiratory tract infections must be treated aggressively. People with little or no lung reserve remaining cannot tolerate any additional work of breathing, such as would be by an acute infection. Periodic pulmonary function testing provides important data on lung capabilities over time and indicates whether the overall treatment plan is working. For asthmatics, a peak flowmeter is a useful device that the patient can use at home to monitor their condition. Preventive Management Stop Smoking- this is the leading cause of COPD. If you suffer from COPD or ASTHMA, you must stop smoking to prevent further lung damage. You cannot undo the damage done by smoking, but you can prevent further damage. Smoking increases the chances of infection, cough and sputum production. The nicotine and tar contained in cigarettes damage to lungs cleaning mechanism. What happens then is the dirt breathed in from the air settles down in the lungs, and can lead to infection. The nicotine and tar are also irritants to the airways and causes excess mucus production and thickening of the walls. Flu Vaccination- people with lung disease are more likely to get the flu and will be sicker and the infection will last longer if that person did not get the flu shot. Vaccinations are done in October and November yearly. Exposure To Environmental Hazards- irritants that can worsen symptoms of asthma and COPD include:
Avoid environmental irritants because they can lead to further narrowing of your bronchial tubes. Indoors- avoid breathing in the fumes from perfume, paints, and cleaning agents. When cooking, turn on your kitchen fan, which should be vented outdoors. Avoid smoke from fireplaces or woodstoves. Outdoors- if cold air and strong winds bother you, stay indoors or cover your nose and mouth with a scarf when outdoors. Environmental pollution can also worsen COPD and asthma symptoms. Air pollutants can irritate the bronchial tubes, causing coughing, wheezing and shortness of breath. Reduce Weight- when you are overweight, you have to do more breathing for the same amount of work. If you lose weight, then you will have more breathing reserve for walking, stair climbing, etc. Treat Infection Early- if you think you have an infection, call your doctor right away. Even a mild infection should be treated immediately. Be aware of the warning signs:
Use Respiratory Devices Properly- Metered Dose Inhalers (MDIs)
If you have trouble coordinating the routine of spraying and inhaling, your doctor may recommend a holding chamber. Care of an inhaler: keep the inhaler clean. Once a week, remove the medication canister from the plastic casing and wash the casing in warm, soapy water. When the casing is dry, replace the medication canister in the casing and place the cap on the mouthpiece. Ensure the hole is clear. Check the expiration date. Check to see how much medication is in the inhaler (see attached sheet). Holding chamber (aerochamber)
Care of an Aerochamber: clean the aerochamber about once a week. Run warm water through the large opening in the rubber ring. Shake off excess water and leave to dry overnight. When the flap valve hardens or starts to curl, the aerochamber cannot work properly and must be replaced. Nebulizer/Compressor Machines
Care of Nebulizer and Equipment: wash nebulizer container, mouthpiece and mask with hot, soapy water. Rinse well and allow to air dry before re-use. Oxygen Therapy: learning how to use oxygen therapy equipment properly and safely is very important. When uncertain about how to use your equipment, be sure to ask to get instructions. Summary When a patient pays careful attention to all aspects of the physical, mental, social, spiritual, and treatment, along with a thorough knowledge of their respiratory disease, they make it possible for improved health and well being. We now have a web site on the Internet. Anyone with Internet access can log on to www.pcca.net for more patient issues and education.
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