Pearl Fleming says that she was sick for many years before she was diagnosed with chronic obstructive pulmonary disease (COPD). “I got lots of chest infections, had shortness of breath and I struggled to get up the stairs,” says the 75-year-old. “I noticed these things but didn’t put a name on them.”
A smoker since her teenage years, it took the diagnosis of COPD in 2005 to finally force her to quit. “Giving up cigarettes was the best day’s work I ever did. In fact, I was so sick at the time, I had to stop, and I notice how my health has improved since then.”
COPD – a term that combines two chronic lung diseases, bronchitis and emphysema – is the most common respiratory disease in Ireland and the fourth leading cause of death here after heart disease, stroke and lung cancer.
Stopping smoking cigarettes (and e-cigarettes) is the most important thing you can do if you are diagnosed with COPD, as smoking is the cause of 90 per cent of cases.
And although COPD remains the most common reason for disease-specific emergency admission to hospital in Ireland, efforts are ongoing for earlier diagnosis and better management of the condition through shared care between GPs and integrated chronic disease management community hubs.
“Historically, GPs made a clinical diagnosis of COPD without using a spirometry breathing test, but now they can send their patients to the integrated care hubs for spirometry tests,” says Prof Stanley Miller, consultant respiratory physician who divides his time between the Mater hospital and St Clare’s Integrated Care Hub in Glasnevin, Dublin.
The spirometry test gives a more accurate diagnosis of COPD by checking whether the person has an obstruction when breathing out. Such a test also ensures patients with heart disease, asthma (often concurrent with COPD) or another breathing problem aren’t wrongly diagnosed with COPD. Once diagnosed, patients can then sign up for six- to eight-week courses in pulmonary rehabilitation.
“These twice-weekly classes include tailored exercises which help people reduce their shortness of breath and improve their quality of life,” says Prof Miller.
Integrated care hubs are staffed by specialist respiratory nurses and physiotherapists who also give patients advice on diet, keeping up to date with vaccines (Covid, influenza and pneumococcal vaccines are strongly recommended), smoking cessation programmes and the importance of staying active.
[ COPD: What is it, who gets it and what does the future hold?Opens in new window ]
“The idea is to have a better support structure in place to avoid crisis situations,” says Prof Miller, who is also chairman of the COPD Support Ireland.
“It’s about empowering patients to give them the tools to know what to do when they feel unwell so that they recognise a deterioration and contact their GP or their integrated care hub.”
Pearl Fleming, who is an active member of her local COPD Support Ireland group, feels like she is managing her condition as best she can. Although 75, she continues to work as a psychotherapist and interfaith minister.
“I mind myself,” she says. “I do daily exercises and I attend the COPD physical exercise classes once a week. I’ve a very healthy diet of fresh home-cooked food and I don’t drink or smoke.”
[ COPD: ‘I tell people not to smoke and to live one day at a time’Opens in new window ]
Fleming takes a daily puff of her preventative medicine via an inhaler and keeps her reliever inhaler in her pocket if she ever gets breathless when out and about. When she requires antibiotics for occasional escalations of her symptoms, she makes sure to build herself back up again afterwards.
“I do have to put pressure on myself to build my fitness back up again after a chest infection but I know that the better I look after myself, the better I’ll be.”
Prof Miller says that not smoking, keeping fit and at a stable weight (neither under- nor overweight) are keys to managing COPD. He says many patients with COPD can also have diabetes and/or heart and sleep-related problems.
Under the new chronic disease management programme, GPs are contracted to see patients with COPD and other chronic diseases twice a year if they are over 45 and have a medical or GP card. Some patients are also given rescue packs of antibiotics and steroids to take if they detect an exacerbation in their symptoms. “Although these rescue packs don’t take the place of seeing a healthcare professional,” warns Prof Miller.
Experts advise anyone over 35 with breathlessness, a persistent cough (particularly if they are a smoker) to attend their GP and ask for a referral to an integrated hub for a spirometry breathing test.
COPD Support Ireland (1800-832146) is offering free spirometry breathing tests at various centres throughout Ireland in advance of World COPD day on Wednesday, November 20th.
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