Comorbidies of COPD
"I’m falling apart I have COPD, it’s hard for me to breathe and as if that’s not bad enough, now they tell me my heart is acting up!"
Concurrent disorders, also referred to as co-morbidities, are common with COPD. And it can be discouraging. COPD, with other health issues piled on top, can be a lot to handle. But with a team approach these disorders can be managed effectively - so you can stay on your feet, out of the hospital - and living your life.
Let’s think of it in this way. Picture your health care - the care of your health - as a wheel. At the hub of the wheel are you and your primary care physician. This is usually either a family practice doctor or an internist. He or she takes care of your general health and wellness but should not be reluctant to refer you to a specialist when you need it.
The spokes of the wheel are your specialists. These might be your pulmonary doc, cardiologist, orthopedic surgeon, gastroenterologist, dentist, eye doctor, ear nose and throat doc, urologist, gynecologist, or other. When you are seeing a specialist, your primary care physician should receive reports from each visit.
But no matter how good the hub and the spokes are, a wheel can’t function without the outer circle, the tire that holds it all in place. This outer circle consists of a variety of other important health care professionals; all the good folks who take the doctor’s orders, put them together with your needs as an individual, and work out a plan for effective management of your health. These people are respiratory therapists, nurses, heart failure or other specialty nurses, dieticians, diabetes educators, physical therapists, sleep study technicians, dental hygienists, audiologists, social workers, or others.
So now we have the parts of the wheel - but there’s more. Now you know that your primary care physician must know what’s going on with your other health issues, but it’s especially important that he or she knows each and every medication, vitamin and / or supplement you’re taking. In fact, every doctor treating you should be aware of all the medications you’re taking. This is because some medications can react with others in a negative way, causing them to lose their effectiveness or causing unwanted side-effects. Some supplements, even if they’re "all natural" can also interact negatively with prescription, or over-the-counter (OTC) medications. Keeping a list of your current medications with you makes this possible - and easy.
Finally, if you require supplemental oxygen, it’s vitally important that you use your oxygen as directed not only to help you breathe easier, but to prevent putting added stress on your body. Keeping yourself at a low oxygen level can exacerbate concurrent disorders - or even cause them! The job of your lungs is to get oxygen into your bloodstream, which then delivers it to all parts of your body to be used as fuel. Your heart, your brain, your liver, your muscles - everything in your body - needs an adequate supply of oxygen to do it’s job. If there isn’t enough oxygen, your body’s organ systems can get into trouble and may even shut down. So, just because you’re not short of breathe (SOB), that doesn’t mean you have enough oxygen. Get your oxygen level tested and follow your doctor’s orders to keep not only your breathing, but all your body systems, on track.
Here are some of the most common co-morbidities with COPD -** Cor Pulmonale - Right-sided heart failure**
Almost any chronic lung disease or condition causing prolonged low blood oxygen levels can lead to cor pulmonale.
Heart failure - also called Congestive Heart Failure - CHF
When the heart becomes weak, it has less power to pump the blood from the left side. Blood returning to the heart backs up, causing congestion in the tissue resulting in swelling (edema) in the legs, ankles, or other parts of the body. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when lying down.
Osteoporosis is a condition in which bones become weak and brittle and you are at a greater risk for falls and fractures. Some people with COPD have other risk factors associated with osteoporosis including: smoking, low vitamin D levels, and use of systemic steroids (swallowed, not inhaled). Women with COPD and osteoporosis are at a greater risk for hip fractures.
Weakness - Risk of falling
Although this is not a specific disorder, general weakness brought on my inactivity brought on by shortness of breath often leads to lack of flexibility and balance and increases the risk of injuries due to falling.
Obstructive sleep apnea
Although the relationship is not fully understood, obstructive sleep apnea is common in people with COPD. Sleep apnea is characterized by abnormal pauses in breathing during sleep. Each pause can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour.
Diabetes is an abnormality in how your body uses blood glucose, or blood sugar. Some medications, particularly oral steroids (prednisone) may worsen high blood sugar, which results in symptoms such as blurry vision, frequent urination, thirst, and hunger.
GERD Gastro-esophageal reflux disease
Gastroesophageal reflux disease is a condition in which stomach contents back up from the stomach into the esophagus (the tube connecting mouth and stomach). This can irritate the esophagus, causing heartburn and other symptoms.
For some people with COPD, the act of simply breathing can require up to ten times more calories than normal. Because COPD’ers often lack the energy to prepare meals and eat them, far fewer calories are consumed, leading to extreme weight loss and even malnutrition.
Pulmonary hypertension is abnormally high blood pressure in the arteries of the lungs, causing the right side of the heart to work harder than normal.
Remember the wheel and all it’s parts. You, the patient with COPD are at the hub of that wheel. Get the help you need by working with experts to keep that wheel turning and manage concurrent disorders.
Jane M. Martin is a licensed respiratory therapist, teacher and the founder and director of http://www.Breathingbetterlivingwell.com and author of Breathe Better, Live in Wellness and Live Your Life With COPD, scheduled for release Spring, 2011.
Respiratory Therapist, COPD educator and author