COPD, WINTERS AND CHEST PHYSICAL THERAPY

BY MEHREEN MUSTAFA

As the first signs of winter are palpable, and we are bracing ourselves for the transition , a huge chunk of the population has started to feel the dread of the frigid,chilly,dry air and the incumbent pulmonary distress.

Chronic obstructive pulmonary disease (COPD)] is a common and treatable disease characterised by progressive airflow limitation and tissue destruction. It is associated with structural lung changes due to chronic inflammation from prolonged exposure to noxious particles or gases, most commonly cigarette smoke.
COPD is a complex interaction between asthma, chronic bronchitis, and emphysema.

Chronic inflammation causes airway narrowing and decreased lung recoil. The disease often presents with cough symptoms, dyspnea(breathlessness), and increased sputum production which in turn increases chances of lung infections. Symptoms can range from being asymptomatic to respiratory failure.
Prevalence
COPD is primarily present in smokers and those over 40. Prevalence increases with age and is currently the third most common cause of morbidity and mortality worldwide. In 2015, the prevalence of COPD was 174 million, and there were approximately 3.2 million deaths due to COPD worldwide. However, the prevalence is likely to be underestimated due to the under diagnosis of COPD.
Exacerbating factors

Cigarette smoking is the most common cause of COPD worldwide.
Other causes may include second-hand smoke, environmental and occupational exposures,alpha-1 antitrypsin deficiency (AATD) ageing and gene-environment interactions (GxE).
Exposure to cold and dry weather conditions.

People who suffer from COPD acknowledge that harsh winds and frigidair can result in wheezing and breathlessness which can be frightening and sometimes dangerous.Cold irritates and causes dryness of the mouth and air passages which in turn intensify symptoms temporarily. Winter also means enclosed spaces,less ventilation and more spread of infections.
Precautions

• Avoid going outdoors in early mornings and late evenings.
• According to the AMERICAN LUNG ASSOCIATION, covering the nose and mouth areas while venturing out is a must.
• Stay away from active and passive cigarette smoke.
• Avoid strenuous activity outdoors in the cold.
• Stay commited to your medical regime.
• Team up with your physical therapist for designing a physical therapy regime that is practicable and maximizes your capacity and ease of Activities of Daily Living.

PHYSICAL THERAPY INTERVENTION
Exercise prescription is a key component of pulmonary rehabilitation programmes, part of the non-pharmacological approach to managing COPD. There is a high level of evidence for the benefits of pulmonary rehabilitation for people with COPD. Strength and endurance exercises are endorsed for people with COPD.
Deep breathing exercises are beneficial in teaching breathing control, improving lung expansion and hence Spo2 and inducing general relaxation .
Incentive spirometers are simple yet effective tools that help .

Even during an acute episode of dyspnoea,breathing control in the form of techniques such as pursed lip breathing and timed inspiration _expiration,reduces airway collapse during expiration thereby reducing severity of the attack. These also instil some sense of control in the breathless patient whose anxiety is already making his attack worse.
Many patients use accessory muscles of respiration to improve their breathing which include the Sternocleidomastoid,scaleni, pectoral and abdominal muscles. The patient needs to be taught the correct use of these muscles during an attack and use of the Primary breathing muscles when not experiencing symptoms.

The next issue to be addressed is loosening and removal of secretions from the chest.

A simple routine can be followed, that of steam inhalation or nebulization followed by techniques such as percussion, clapping, vibration over lung areas( that loosen the secretions), which are then easily coughed out. A variety of devices are available in the market now which can be easily used at home for example Acapella Devices, vibrators, and postural drainage tables.
Teaching general relaxation techniques and correction of posture also need to be addressed for a more wholesome treatment approach.

A study suggests that patients affected with COPD and pulmonary hypertension experience a lower exercise capacity reducing the general Quality of life.
Gradually improving the exercise capacity by progressive aerobic training under expert guidance is immensely helpful.
If you or someone you know is suffering from any form of COPD it is very advisable to get expert help and work in a multidisciplinary way to improve their quality of life.

Dr Mehreen Mustafa Physiotherapist and HOD PMRD-Khyber Medical Institute Srinagar Kashmir