According to the National Heart, Lung, and Blood Institute, there are 16 million Americans living with chronic obstructive pulmonary disease (COPD), and potentially millions more who are undiagnosed. COPD is a disease of the lungs that, over time, makes it difficult to breathe due to reduced airflow in and out of the lungs.
This decreased ability to breathe properly can affect all aspects of daily life, like the ability to walk or get dressed. The symptoms of COPD in many cases come on gradually, so it is important as a caregiver to know and understand the signs so that you may better help the person in your care.
Pro Tip: To learn more about how to care for your aging loved ones, check out my guide: What Is a Caregiver?
Learn the Signs and Symptoms of COPD
Only your loved one’s primary care physician can diagnose COPD, but it helps to recognize the symptoms of this condition so that you can expedite necessary care. COPD is often difficult to recognize because the symptoms may start out mild and compound slowly over the years.
The most common signs of COPD include:
Prolonged, chronic coughing
Shortness of breath
Increased mucus production with coughing
Most commonly, COPD affects people over 40 who are smokers or those who have had prolonged exposure to lung irritants (smoke, chemical fumes, dust). There is also a genetic condition called Alpha-1 antitrypsin (AAT) deficiency that can affect the lungs and lead to COPD; however, this condition is rare.
Caring for a person with COPD can have its challenges. Below I have listed some of the obstacles I have seen most often in my work with people affected by COPD:
Inability to engage fully in self-care
Difficulty walking and moving around the home
Difficulty managing oxygen tubing while moving around
The mental and emotional toll caused by the decreased ability to breathe
With a little education, you can learn how to overcome some of these barriers and help your loved one to live comfortably and happily in the home.
How COPD Progresses Over Time
The progression of COPD varies from person to person. While some can expect a relatively slow and gradual increase of symptoms, other folks are not so lucky. In some cases, the progression of COPD can quickly lead to bouts of severe breathlessness, acute exacerbations (a sudden worsening of existing symptoms), respiratory failure, and even death.
Your loved one’s health care practitioner can use different methods of testing, like spirometry (which assesses lung capacity) to determine how much the disease has progressed. Accordingly, COPD can be categorized as mild, moderate, severe, or very severe.
Type of COPD
Breathlessness with basic physical activity, such as housework or using the stairs
Some coughing, with phlegm production
Increased difficulty breathing with normal tasks, like getting dressed and walking around the house
Noticeably more coughing, with excess mucus production
Extreme fatigue, feelings of weakness, wheezing, and frequent breathlessness
Increased bouts of coughing, with thick mucus
Constant, prolonged fatigue
Inability to breathe sufficiently without supplemental oxygen
Difficulty breathing during any activity
Increased coughing, with copious mucus production
Having worked in skilled nursing homes over the years, I’ve dealt with people at each stage. When COPD progresses to a severe state and beyond, care becomes markedly more difficult. These folks will most likely be on continuous supplemental oxygen, have extremely low energy, be dealing with coughing fits, excessive sputum production, and require a much higher level of care for even the basic aspects of daily life. It is imperative to help your loved one make healthier life decisions to avoid advancing to the later stages of COPD.
Creating Your COPD Care Plan: Encouraging Healthy Habits
Living a healthy lifestyle can improve the quality of life with COPD and prevent worsening symptoms. Below I have outlined some guidelines to assist you in helping your loved one in making the best choices for living a balanced and healthy life with COPD.
Importance of Quitting Smoking
If your loved one is a smoker, it is of utmost importance that they quit smoking as soon as possible due to increased damage to the lungs, which will quicken the progression to the advanced stages of COPD. Quitting smoking is not an easy endeavor, so speak to your loved one’s health care professional about smoking cessation options, such as nicotine replacement therapy, counseling, and/or medications.
Regular exercise for people with COPD has been proven to improve functional stamina and mental health. It also reduces shortness of breath by building muscle and increasing pulmonary capacity. However, convincing your loved one to exercise while they’re feeling fatigued can be challenging.
As an occupational therapist, my number-one goal with physical activity for my patients with COPD is always purposeful action. This means I find something they need to do within the home, like light housework or outside projects, or I ask them what they enjoy doing. If they like lifting light weights and going for walks, then do these activities! Other people are not inclined to exercise in that way, so you’ll want to offer alternative ways to get them up and moving. Perhaps they enjoy shopping, gardening, or bowling.
The key is to find a way to encourage daily, consistent physical activity to improve overall health. Always check with your loved one’s primary care physician before starting a regular exercise schedule, and monitor oxygen levels and fatigue to avoid overdoing it.
Prepare Healthy Foods
Folks with COPD put more strain on their pulmonary muscles and thus use more energy breathing than other people do. They are also more prone to upper respiratory infections.
Eating a healthy diet full of complex carbohydrates, protein, and fiber can help keep a person strong and able to fight off infections. It’s also important to make sure your loved one gets plenty of water to stay hydrated throughout the day and to help keep mucus thin and easy to expel.
Did You Know: If grocery shopping and preparing foods are hassles, you might want to consider a meal delivery service. To learn more, read our guide to the best meal delivery services for seniors.
The key to modifying the home to care for someone with COPD is to improve ease of living and prevent worsening of symptoms. If you live in a multi-story home, it may be beneficial to move your loved one to the lower level if possible so they do not have to navigate stairs, which can be dangerous for someone with low energy.
Removing clutter and clearing pathways to allow for straightforward passage through rooms, as well as placing all frequently used items (kitchen appliances, cookware, clothing items) for easy access, can greatly reduce fatigue and shortness of breath. Removing carpet, making sure to dust and vacuum daily, and purchasing an air purifier to reduce air irritants can also be very helpful to keep air quality at its best.
Adapting the environment and the way we do things in order to conserve energy will improve the quality of life by ensuring your loved one has the energy to do the things they want to do throughout the day. In occupational therapy, I teach the five P’s of energy conservation: prioritize, plan, positioning, pace, and pursed-lip breathing.
Prioritize: Prioritize your daily routine and activities. Do more difficult tasks early in the day or only on “good” days, and break down tasks into stages according to importance.
Plan: Plan out your activities in advance, gather all needed items for a task, and keep them together in one place. To avoid unnecessary trips, use a rollator or wheeled cart to haul items (such as baskets of laundry).
Positioning: Use a shower chair for bathing or install a walk-in tub. Position yourself so that you can sit during extended tasks (such as folding laundry or cooking). When standing for tasks, use good, upright posture to avoid remaining in a bent-over or energy-sapping position, which can inhibit airflow.
Pace: Allot enough time to finish a task to avoid rushing. Slow and steady wins the race! Listen to your body and take breaks as needed so that you do not become overly fatigued.
Pursed-lip breathing (PLB): This is a technique we use in therapy to improve the quality and quantity of airflow into the lungs, especially when a patient is visibly short of breath. PLB helps to empty the lungs fully, eliminating carbon dioxide to allow for a full inhalation of fresh oxygen each breath, which will further oxygenate the blood. It is also relaxing, which can help reduce anxiety if your loved one is having some difficulty breathing.
Heat can really exacerbate COPD, so the use of air conditioning and fans can assist in alleviating symptoms. When we feel hot, we tend to also feel breathless, which in turn can cause us to begin taking fast, shallow breaths in an attempt to cool down. This goes double for someone with COPD. Shallow breathing reduces oxygen in the lungs and will lead to shortness of breath. To avoid this, keep your loved one inside on hot days, and if you must go out, a small handheld fan is a good way to keep them cool and calm.
Discuss Care with Your Loved One
If you suspect your loved one has COPD, or you think they are at risk for developing COPD, the first step is to schedule an appointment with their health care provider. Help your loved one take note of symptoms. Write down the activities that cause shortness of breath, the number and severity of coughing fits, fatigue levels, and times of day symptoms occur. Ask your loved one to rate the symptoms on a scale of 1 to 10 in order to give their doctor a detailed report of daily issues so that the doctor may best assist you in developing a plan.
Discuss lifestyle changes and the importance of taking care of themselves to prevent increasing symptoms. Talk to your loved one about your concerns, and together you can come up with a plan of care that will fit you both.
End of Life and COPD
Unfortunately, COPD is not curable and does not follow the same path for everyone. Very severe COPD is often referred to as end-stage COPD because at this point interventions and medications are no longer working and there is not much more that can be done.
Signs of end-stage COPD include:
Constant fatigue and breathlessness
Chest pain due to frequent lung infections and damage
Painful and constant coughing fits
Difficulty sleeping or remaining in a supine position
Increased hospital visits
If you suspect your loved one may be entering end-stage COPD, it is time to speak to their primary care physician about palliative care. Palliative options like hospice can provide comfort levels, medications, and respite to improve the quality of life for both you and your loved one in this difficult time.
Caring for a person with COPD at any stage can be exhausting, so it is important that you are taking care of yourself too. To avoid caregiver burnout, you need to set aside time to do things for yourself. Ask family or friends, or hire a private caregiver, to sit with your loved one for a few hours a few times a week so that you can unplug from your duties and reconnect with the things that bring you joy.
During this time off, I often instruct my families to follow one rule: absolutely no thinking of your loved one during your time off. This is your time, and if you are not able to mentally separate, it will not be time well spent. Eat a healthy and balanced diet, get outside for fresh air, and make sure you are getting enough exercise to keep your mind and body strong.
To get started, discuss the plan of care with your loved one’s health care provider and determine what stage of COPD they are dealing with. Establish a simple daily routine for self-care, modify the home to improve accessibility, and emphasize to your loved one the importance of energy conservation with daily tasks. Talk to your loved one about prioritizing their health, eating nutritious foods, and getting plenty of physical activity with a home exercise program or through purposeful activities.
Caring for a person with COPD can have its challenges, but as long as you have a plan and communicate with your loved one, it is absolutely something you should feel confident doing. With some research and tweaks to the home and their routine, you can help someone adapt to living with this condition and regain some control and joy in their lives.
Help them live a healthy lifestyle by encouraging a balanced diet and consistent exercise. Use energy conservation and planning to reduce exacerbating symptoms. Be sure to keep lines of communication open with their primary care physician if you have questions or concerns.
A COPD bundle is a comprehensive list of actions to be taken by medical staff prior to discharge to improve the overall outcomes of people suffering with COPD. This list will have the clinician ask the patient to demonstrate use of inhalers, ensure understanding of medications and supplemental oxygen use, provide smoking-cessation options and referrals, and schedule a 72-hour follow-up visit before the person has left the hospital, to increase the patient and caregiver’s success moving forward.
You should pay attention to increased coughing or wheezing, increased shortness of breath, increased fatigue, difficulty performing daily tasks due to low energy, increased mucus production or changes in consistency, changes in sleep, and inability to get comfortable in bed.
Staying hydrated can help keep mucus thin and easier to expel. Drinking an adequate amount of water daily can also increase overall health by regulating body temperature and helping blood flow to transport important nutrients throughout the body.
A former member of the Navy, Jenny Atwell has spent six years as an occupational therapy assistant, working in rehab hospitals, skilled nursing facilities, and, most recently, as a home health care specialist. Her primary focus is on geriatric care in a variety of settings.