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Chronic Obstructive Pulmonary Disease: The Role of Occupational Therapy

Overview of COPD

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by a persistent obstruction of airflow in the lungs that makes breathing difficult. Common symptoms include coughing, wheezing, and shortness of breath. COPD is one of the leading causes of death and disability. The World Health Organization (WHO) estimates that COPD affects 329 million people worldwide and will overtake heart disease as the third leading cause of death by 2020 (WHO, 2022).

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by a persistent obstruction of airflow in the lungs that makes breathing difficult.

"COPD affects approximately 3 million Canadians, including 1.5 million Canadians who say they currently suffer from this disease and another 1.5 million undiagnosed Canadians. This makes COPD Canada’s fourth leading cause of death." - Canadian Lung Association (2007)

Understanding COPD

Chronic obstructive pulmonary disease (COPD) is a lung condition that worsens over time and impairs breathing. It is characterized by ongoing, protracted breathing issues, which are primarily brought on by prolonged exposure to lung irritants like tobacco smoke, air pollution, and dust and fumes at work. According to some estimates, smoking is the root cause of 90% of COPD cases, making it a common and preventable disease.

Emphysema and chronic bronchitis are the two primary diseases that makeup COPD. Chronic bronchitis is characterized by inflammation and narrowing of the airways, which can cause coughing and mucus production. On the other hand, emphysema is characterized by damage to the lungs' air sacs, which makes it challenging to exhale. Combined, these two conditions influence how COPD develops, and its symptoms worsen (Agarwal et al., 2022).

Early Diagnosis and Treatment

For the disease to be effectively treated and managed, early diagnosis of COPD is essential. With early detection, people can get the proper care and alter their lifestyles to slow the disease's progression. Early diagnosis and treatment can also lower the risk of hospitalization and complications while enhancing a person's quality of life. A thorough evaluation by medical professionals includes a physical exam and pulmonary function tests.

COPD is typically evaluated and diagnosed through several steps (Agarwal et al., 2022):

  1. Medical history and physical exam: Your healthcare provider will ask about your symptoms and medical history, including any history of exposure to lung irritants such as tobacco smoke or air pollution. They will also perform a physical exam, listening to your lungs with a stethoscope and checking for signs of wheezing or other breathing difficulties.

  2. Spirometry test: Spirometry is a simple, non-invasive test that measures how well your lungs function. During the test, you will be asked to blow into a device that measures the amount of air you can exhale and how quickly you can exhale it.

  3. Chest X-ray: A chest X-ray can help your healthcare provider rule out other conditions that may be causing your symptoms, such as pneumonia or lung cancer.

  4. Blood tests: Blood tests can help determine the oxygen level in your blood and check for other markers that may indicate COPD.

  5. CT scan: In some cases, a CT scan may be ordered to get a more detailed look at the structures within your lungs and to rule out other conditions that may be causing your symptoms.

Spirometry is a simple, non-invasive test that measures how well your lungs function. During the test, you will be asked to blow into a device that measures the amount of air you can exhale and how quickly you can exhale it.

"COPD poses a huge drain on health resources and carries a significant economic in Canada. It accounts for the highest rate of hospital admission and readmission among major chronic illnesses in the country." - Canadian Thoracic Society (2010)

How Patients With COPD Can Benefit from Occupational Therapy

Occupational therapy can be beneficial in the management and treatment of COPD.

COPD can significantly impact a person's ability to do daily activities at home, work, or other areas of life. According to a survey by the Government of Canada, breathing problems caused "a lot" of difficulty for people with COPD. Activities these people struggled to complete include bathing, dressing, getting around the house, doing chores, shopping and participating in leisure and social activities (Canada, 2011).

An occupational therapist can educate individuals with COPD on adaptable methods and techniques to increase their physical capability and independence. Occupational therapy can help people overcome various barriers to help them manage their symptoms and lower the risk of complications.

Improving Breathing: Pursed Lip and Diaphragmatic Techniques

Breathing difficulties are a common symptom of COPD, and managing the condition requires improving breathing techniques. Occupational therapists can instruct patients on breathing exercises such as pursed lip breathing, which is a breathing technique that involves inhaling slowly through the nose and then exhaling slowly and forcefully through pursed lips, similar to blowing out a candle. This technique often works because it:

  • Slows down breathing rate: By slowing down the breathing rate, pursed lip breathing helps to conserve energy and reduce shortness of breath.

  • Improves oxygenation: By exhaling more slowly, the technique increases the time it takes for the lungs to empty, which can help improve the oxygenation of the blood.

  • Alleviates symptoms of dyspnea: Pursed lip breathing can help to alleviate the sensation of shortness of breath by slowing down breathing and improving oxygenation.

  • Promotes relaxation: The slow and deliberate pace of pursed lip breathing can have a calming effect on the body, reducing anxiety and promoting relaxation.

Diaphragmatic breathing is a technique that focuses on using the diaphragm, a large muscle located at the base of the lungs, to control breathing. In diaphragmatic breathing, the individual focuses on breathing from the diaphragm instead of the chest. To do this, they take slow, deep breaths, filling their lungs with air and allowing the diaphragm to expand downward. Diaphragmatic breathing can be performed while sitting or lying down. It's often used in combination with other breathing techniques, such as pursed lip breathing, to improve breathing in individuals with COPD (Breathing Exercises for COPD | UM BWMG - Pulmonary Care, n.d.).

Energy Conservation Strategies

Energy conservation is a crucial strategy for managing COPD, as it helps to balance work, rest, and leisure activities in order to reduce strain on the body and minimize energy demands. By practicing energy conservation techniques, individuals with COPD can experience improved heart health, reduced fatigue, decreased stress-related pain, and an overall improvement in quality of life.

Energy conservation is a crucial strategy for managing COPD, as it helps to balance work, rest, and leisure activities in order to reduce strain on the body and minimize energy demands.

The following are the 4 Ps of energy conservation, which can help individuals with COPD get started:

  • Prioritize: It's important to determine what is most important for each day and prioritize tasks accordingly. Start with the most critical items to make sure they are completed.

  • Plan: By planning activities in advance, individuals with COPD can avoid unnecessary trips and conserve energy. Gather all necessary supplies before starting a task and alternate between heavy and light activities throughout the week. It's also a good idea to reach out to family and friends or pay for help with tasks that may be too demanding.

  • Pace: Maintaining a slow and steady pace, taking frequent breaks, and breathing slowly and steadily are all essential strategies for conserving energy in individuals with COPD. It's essential to listen to your body, be aware of your limits, and ask for help when necessary.

  • Position: Minimizing bending and reaching can help reduce fatigue and shortness of breath in individuals with COPD. Utilizing tools like a reacher or long-handled shoehorn can minimize bending and promote an upright posture while sitting or standing. Taking frequent sitting breaks can also help conserve energy and reduce energy use by 25%.

Assistive Devices and Home Modifications

Mobility aids, such as canes, walkers, or wheelchairs, can assist individuals with COPD in increasing their mobility and reducing the risk of falls. These devices provide additional support and stability, allowing individuals with COPD to move around with greater ease and comfort. This can help improve quality of life and independence and reduce the risk of injury from falls. It is important to work with a healthcare provider to determine the best mobility aid for an individual's needs and condition.

Modifications to a person's home can greatly benefit individuals with COPD by increasing their independence and reducing the risk of falls. In the bathroom, modifications such as grab bars, raised toilet seats, and shower chairs, provide added support and stability, making it easier for individuals with COPD to perform daily tasks. Grab bars can be used to assist in getting in and out of the shower or bathtub, while a raised toilet seat can make it easier to sit and stand. A shower chair can provide a safe and stable seating option during showering. These modifications can significantly improve the quality of life for individuals with COPD, helping them to maintain their independence and reduce the risk of injury from falls.

Through exercise and training, occupational therapy can assist COPD patients in increasing their physical ability and independence.

Improving Activity Tolerance with Exercise

Through exercise and training, occupational therapy can assist COPD patients in increasing their physical ability and independence. Building strength and endurance through exercise and physical activity can improve general health and reduce complications and hospitalization risks. Occupational therapists can create exercise regimens that are especially suited to the patient's requirements and capabilities and can assist patients in advancing and modifying their regimens as they improve.

Some general guidelines for exercising with COPD:

  • Start slowly: It's important to start with a gentle exercise routine and gradually increase the intensity and duration over time.

  • Focus on breathing: COPD can cause shortness of breath, so it's essential to focus on breathing techniques like the ones described above.

  • Incorporate both aerobic and strengthening exercises.

  • Avoid exacerbating activities: High-intensity aerobic exercises or exercises that require holding your breath can worsen COPD symptoms. It's important to avoid these activities and to listen to your body.

"21% (of people with COPD) reported that breathing problems affect their life "quite a bit or extremely" - Government of Canada, 2022

Closing Remarks

Patients with COPD may benefit significantly from occupational therapy's promotion of a healthy lifestyle. Occupational therapists can offer information and encouragement to support people in maintaining a healthy lifestyle, which includes stress management, regular exercise, and healthy eating. Additionally, they can offer people support and resources to help them stop smoking, which is the leading cause of COPD.

To summarize, here are some of the commonly used strategies occupational therapists use with people living with COPD (Snyder et al., 2021):

  • Improving daily activities such as dressing, grooming, and personal care

  • Teaching energy-saving techniques and safe body mechanics

  • Improving endurance and strength through exercise programs

  • Improving breathing techniques and cough management

  • Providing breathing assistive devices and equipment recommendations

  • Developing home modification plans to increase accessibility and safety

  • Providing education on pacing and reducing physical and mental stress

  • Improving the overall quality of life through leisure and recreational activities

  • Improving coordination and balance to prevent falls

  • Promoting overall health and wellness through lifestyle changes such as a healthy diet and stress management techniques.

It's important to note that an occupational therapist would develop an individualized treatment plan based on each person's specific needs and abilities.

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