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COPD
The Non-pharmacological management of COPD Written by Ms. Joan Johnston, National Co-ordinator COPD Support Ireland Email: nationalcoordinator@copd.ie | Professor J.J.Gilmartin, Chair COPD Support Ireland. Email: chair@copd.ie
Chronic Obstructive Pulmonary Disease (COPD) has a prevalence of approximately 380,000 patients in Ireland. With the iterations of the GOLD (Global Initiative for Obstructive Lung Disease 2020) the pharmacological management of COPD by severity class has been well established. Additionally, there is now significant evidence-based literature on non-pharmacological interventions showing improvements in dyspnoea, quality of life and even life expectancy. COPD Support Ireland (COPDSI ) is a national patient oriented charity with over 30 patient support groups around the country. Joan Johnston, COPD Support Ireland
Nationally we have an advocacy role with links to the National Respiratory Programme, the ICGP, HSE and most recently on the Vulnerable people subgroup of NPHET. As per public health guidance we stood down our support groups and exercise programmes in March 2020, however we have been actively working with our members and health care professionals across Ireland to deliver alternative supports during COVID. COPDSI in conjunction with the National Clinical Programme have updated the “COPD & Me” information booklet, outlining many of the non-pharmacological options for patients with COPD. In this article we will review some of these interventions and the potential benefits in the management of COPD even during COVID-19: • Pulmonary Rehabilitation • Physical Activity • Peer Support • Breathlessness management • Anxiety management • Breathing Pattern Disorders Where do non-pharmacological interventions fit in? Declining activity levels in this patient demographic often happen long before diagnosis, the symptoms either go unnoticed or are easily explained away by progressing age, smoking history, weight gain etc. Initiation of Non-pharmacological management of COPD is just as important from diagnosis as the
pharmacological management. Enabling patients to manage their symptoms when well, provides a broad ranging ‘toolbox’ to draw upon during times of exacerbation or disease progression. Pulmonary rehabilitation This is the gold standard for improving quality of life, decreasing dyspnoea, and increasing life expectancy in COPD patients. These programmes are a one stop shop for the individually tailored, holistic management of COPD and commencing early after a COPD hospitalisation in now becoming the norm. They include a supervised exercise programme two to three times a week for 6-8 weeks with clear guidance on progressing exercise tolerance and understanding safe levels of exertional dyspnoea. The Borg scale of breathlessness is used with optimum exercise intensity resulting in moderate dyspnoea equivalent to a 3-4 on the Borg scale. In lay terms they should be able to “talk but not sing” during physical activity. Key to any pulmonary rehabilitation (PR) programme is to effect a lifestyle change that lasts beyond the 6–8-week programme, it is only with ongoing activity and self-management that the enduring benefit of PR can be found at 12-24 months post intervention. PR also provides education sessions covering topics such as pathophysiology of COPD, Inhaler technique, airway clearance, breathlessness management, anxiety, dietary advice, and
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smoking cessation delivered by the multidisciplinary team, and the interactive nature of these sessions can help cement those lifestyle changes. Unfortunately, PR programmes, while improving in number and capacity, can still have service gaps and waiting lists dependant on geography. COPDSI has used its group network to deliver key elements of PR where these gaps exist and recruits new members, for ongoing PR and peer support. During COVID-19 we have been rolling out the use of virtual solutions such as Zoom to deliver ongoing exercise, education, peer support and a singing for lung health programme for people living with COPD. Physical Activity & Peer Support 20-30 minutes of moderate intensity exercise 3-4 times per week maintains both physical and mental wellbeing in the general population and this is more important when living with COPD. People are conditioned to “listen” to their bodies and if something does not feel right, then avoid it so it’s unsurprising that a person with COPD limits their activity levels. This leads to a vicious cycle of breathlessness with reduced activity causing deconditioning and subsequent increased respiratory rate and oxygen demand during any future physical activity. Education on the benefits of physical activity specific to COPD using the basic premise of “use it or lose it” can resonate in this population. This is especially important during the current COVID-19 pandemic with advice for people at high risk to stay home. As an organisation we have maintained contact with our 33 support group exercise classes around the country and they have all strongly attributed their physical and mental well being to that exercise. The loss of this support is the single biggest challenge they currently face, in response to this we launched a “Living Well with COPD during COVID” information pack which includes an updated COPD & Me book detailing the self-management of COPD including simple exercises to be
done at home and our Top Tips to Protect your Physical and Mental Health during COVID. Breathlessness, Anxiety and Breathing Pattern Disorders The symptoms of these often coincide, overlap, or mimic each other and attempting to address one without considering the others can result in incomplete or futile interventions. Anxiety and depression are common comorbidities in COPD and can be associated with higher morbidity and mortality, increased disability, and increased healthcare service use. Where dyspnoea appears to be poorly controlled despite optimal bronchodilation and activity levels, anxiety is often the first consideration. While there are pharmacological interventions available to us, there are also proven non-pharmacological interventions. Cognitive behavioural therapy (CBT) has been shown to alleviate symptoms of anxiety in COPD through exploration of the link between a
