The Elder Advocate

There are diseases and conditions of the lungs that cause difficulty breathing.

Many of you may have seen commercials for COPD, but what is it and how does it differ from other respiratory conditions such as asthma, emphysema, and chronic bronchitis.Chronic bronchitis leads to inflammation and mucus in the airways, while emphysema involves damage to the air sacs or alveoli in the lungs.

This article will focus on the differences between COPD and asthma.

COPD is the acronym for Chronic Obstructive Pulmonary Disease. It is a disease or breathing disorder that damages the tissues lining the airway and results in decreased airflow over time. People with COPD have trouble getting enough oxygen when inhale but they also have trouble not being able to get rid of the extra carbon dioxide, which is a bi-product of breathing, when they exhale. If the disease of the airway prevents the ability to expel the carbon dioxide from the lungs, the ability to breathe in sufficient oxygen is impaired, it is a vicious circle. This is known as CO2 retention. COPD is a progressive condition which worsens over time.

Asthma is usually considered a separate respiratory disease, but sometimes it’s mistaken for COPDbecause of the similarity of symptoms. These symptoms include chronic coughing, wheezing, and shortness of breath. Asthma is a temporary inability to breathe that can be resolved, it generally does not worsen over time. However, there have been instances of persons having severe asthma attacks with the inability to recover.

Because of the similarity in symptoms, asthma is often mistaken for COPD.

A pulmonologist, or lung doctor, would be the best person to determine if a person has COPD.

There are several ways to determine the difference between the asthma and COPD.

The First being the age when the person first develops the condition/symptoms. Asthma is often diagnosed in children, while smoking is the largest contributing factor to COPD and is usually detected in smoking or former smoking adults over the age of 40. Approximately 85-90 percent of the deaths attributed to COPD are the result of smoking. It is estimated that approximately 6% of the US population, (i.e., 24 million people) suffer from COPD. There are also other factors that may cause COPD, among them are: air pollution, certain chemicals and secondhand smoke. There is a genetic component; however, that usually accounts for only 2-3 percent of those persons diagnosed with the disease. Respiratory tract infections and influenza may trigger symptoms of COPD, thus it is recommended persons with COPD receive vaccines to avoid these infections. It is important to note that symptoms of COPD can also be apparent without any antecedent trigger and whether the person is active or at rest.

People with COPD may have a chronic cough which produces mucus and phlegm, not necessarily seen in persons with asthma or, if so, not to the same degree. In addition, they may experience shortness of breath during exertion, constriction of the chest (many may have seen a TV commercial which depicts a person feeling like an elephant is sitting on their chest), wheezing, respiratory infections, edema or swelling of the extremities, mental sluggishness and weight loss.  The weight loss that occurs in persons with COPD may be attributed to several factors. One factor is that damaged lungs require the person to exert more energy to breathe which results in burning more calories. Another factor may be the increased fatigue the person experiences as they continue to eat their meal. As a result, they may stop eating. There are several therapeutic approaches to address fatigue during meals so that the person can achieve a more pleasant eating experience.

The cause of asthma is still largely unknown. Genetics and environmental factors are generally suspected to be the root cause. Environmental factors are also known to trigger asthma, these include: pollen, dust, mold and smoke. Other factors may trigger what we call an asthma attack; that can be physical exercise and even cold air. In between asthma attacks, the individual in most cases returns to breathing normally.

Oftentimes, persons with asthma are encouraged to keep pets out of their homes and to avoid spending extended periods of time outdoors when pollen counts are high.

Though medications prescribed for COPD and asthma may be similar (i.e., bronchodilators and inhaled steroids) the treatments and therapy prescribed are different. The treatments for COPD may alleviate symptoms, but the damage caused to the airway by this degenerative disease is irreversible.

Neither asthma or COPD are curable, however, the future for each person with the condition may be different. Asthma is more easily controlled on a day to day basis. As stated, the person with asthma may breathe entirely normally in-between attacks.

COPD is a progressive disease that worsens over time. However, if following the doctors prescribed treatment plan, along with quitting smoking and reducing exposure to triggers, one may successfully retard the progression of the disease. To do this, the person with COPD may find themselves having to make changes to their lifestyle and habits so they can increase the quality of their life and potentially slow the progression of the disease. COPD represents the third leading cause of death in the United States.

The United States Food and Drug Administration (FDA) recently approved a new treatment for COPD; it has also been approved for individuals who suffer from chronic bronchitis. However, as with many other drugs, there are significant potential side effects that need to be considered.

There is something called COPD Exacerbation and Asthma Exacerbation. This is when symptoms heighten and the person is in need of immediate medical attention.

For the COPD patent, exacerbation may be detected by the following signs:

Edema (swelling) of the extremities (arms and legs), shortness of breath without any exertion, bluish lips or fingernails, lack of mental acuity, extremely rapid heartbeat and lack of efficacy with recommended treatments.

There are four stages to COPD: At risk; Mild; Moderate and Severe. There are non-invasive measures that can maintain the person’s ability to breathe for quite some time. However, unfortunately, as symptoms progress and the person’s condition worsens, breathing difficulties may require more invasive measures to allow the patient to breathe.

One of those measures is the surgical insertion of  a tracheostomy tube into the neck to create an airway directly from the trachea. In this way, the air directly flows into the lungs through the tube opening. In the event symptoms become more severe, a person may require mechanical ventilation (a breathing machine or ventilator ) which does the work of directly pumping air into the lungs.

In the event either of these latter situations occur, in all likelihood the person will be transferred from the hospital to a short-term rehabilitation unit for therapy. People can return home with a trach in place or if they are dependent on a ventilator to breathe. Despite a situation in which a person may need a tracheostomy tube or mechanical ventilation to breathe, it is possible that this may not be permanent. This can only be determined by an appropriate team of professionals who will assess and work with the patient towards returning to a respiratory state without artificial measures.

Skilled nursing facilities who accept ventilator dependent patients (those requiring mechanical ventilation) must be certified to accept those patients. However, many facilities accept patients with tracheostomy tubes and they are not qualified or best suited to provide proper care to those patients. There are a variety of reasons why this occurs. Thus, it is advisable to have information before this situation occurs in order to make the best possible decision to ensure the best care possible for the short-term rehabilitation stay. In some cases, the short-term rehabilitation stay for a person with a tracheostomy tube or ventilator becomes a long-term stay. A facility that offers proper care for the short-term stay in the case of a person with a tracheostomy tube or ventilator, will most likely be able to provide that same level of respiratory care on a long-term care unit.

Visit: for valuable information on choosing a facility for a person with a tracheostomy tube.

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