COPD

[blushinglady]

My husband has been diaginosed with COPD and he was told he has only 22% of his lungs that are being used and there was no way that he will get anymore back. What does this mean for his survival rate, since he will not quit working in road construction. If anyone can help me to understand what I have coming please let me know.

[Davy9]

Generally speaking all animals have physical exercise reserves they use for hunting or their own defense. Humans have a lot of exercise capacity and the lungs are a key part of that process. As humans age they naturally lose lung function and when that happens they lose some of their exercise breathing reserves.

In lung disease the loss of actual lung tissue or functional lung tissue is greatly accelerated. This is especially evident in emphysema which is a type of COPD. The more lung tissue that is gone or is not working the less the patients exercise reserves become. People who suffer from these types of diseases get short of breath faster, with smaller amounts of exertion. Eventually they can be short of breath doing absolutely nothing but breathing.

Also, the lungs are integral to many of the bodies systems. The need for oxygen and the removal of carbon dioxide is vital for every organ to remain alive. As lung function diminishes other systems are impacted and they change as well. The heart changes, the blood itself can change and so on. So the worse the lung disease the more other systems become involved and are also compromised requiring medical treatment.

You are saying that your husband was told that he has only 22% of his "lungs" remaining and he won't get them back. I do not know exactly what was meant by the 22% number but if he had that little lung tissue left he would be quite severely compromised. I suspect he is not that bad and the number you recite reflects some other aspect of his lung function, or the doctor is overstating the situation. Whatever actual lung tissue is gone will not return. Depending on the type of COPD he may be able to improve his lung function by optimizing the care of his lungs. Also, his overall physical conditioning will help him deal with diminished lung function.

He needs to learn if his lungs respond to treatments. Does his pulmonary function improve after using brochodilator and anti-inflammatory medications? He needs to stop doing things that worsen lung function. Highest on that list is using tobacco. That would also include staying away from fumes and other airborne irritants. My understanding of 'road construction' is that it will expose him to asphalt fumes and a dusty working environment. If he insists on remaining on the job he should avoid those situations and wear lung filtration masks. You need to assess how well he oxygenates under workload and while he sleeps. Oxygen can be supplemented and keeping adequate oxygen levels will help the heart in particular.

There are many resources you can access about COPD. Sadly, because of tobacco, it is an all too common condition. The American Lung Association will have a lot of information. Pulmonologists ( a specialist lung doctor), Respiratory Therapists and Physical Therapists are medical disciplines well versed in diagnosing and managing COPD. There are many homecare devices and services available for the COPD patient.

[blushinglady]

Thank you Davy for your response. I do know that he goes through 2 to 3 emergency inhalers a month and he has finally quit smoking. Yet for him to go grocery shopping or to Wal Mart is a major challange. We have also had to give up intimate relations for it just can't seem to happen. Exertion is very hard on him. I also have found that he is more difficult to deal with mentally and he will not give up his work. I am frieghtend by his behavior now for he is so angry at the whole world. His doctor told us that he is only using the so called 22% of his lungs when he breaths. His sleeping oxygen abosortion with out oxygen was falling down to 69% and he was stopping breathing several times according to the testing. Yet, he insisted the doctor allow him to work and I think the specialist knew that if he stopped him he would totally give up. I really am scared and I pray on a constant basis, and I don't know where I can turn for answers. He says he only has a year at the most to live and I am not so sure I am ready to give him up that easily. Yet if he gives up what am I to do?

[Davy9]

I am sorry to hear how serious the situation really is. What I will share with you is not good news. Your husband will go through what so many other people have experienced thanks in large part to tobacco. He does have more than 22% of his lungs remaining but his COPD does sound quite advanced. Ideally he would complete what is called respiratory rehabilitation to maximize his health status. Respiratory Rehab is a program designed specifically for people with advanced lung disease. It is a multifaceted approach using many therapy disciplines. Talk with his doctor and see if there is such a program nearby and if he feels it appropriate for your husband.

He may get to his maximal health status through rehab but that will still be very limited compared to normal because of the severity of his COPD. He will not recuperate lost lung tissue and the disease will advance. His reserves are very limited and he needs to avoid people who have any illnesses such as the common cold or the flu. Flu shots are mandatory. HIs heart and its ability to meet its workload is probably also challenged. He is most likely on heart medications and on diuretic medications to help control his fluid balance. He needs to strictly adhere to all of his medications and he needs to understand the early signs of heart failure and lung infections.

I agree with your doctor. His status seems precarious and sounds pre-terminal. It will not be simple for him or you. You will also need some support. Talk with a Medical Social Worker about your feelings and concerns (they are on staff at hospitals). I will also suggest that you familiarize yourselves (as in 'both' of you) with hospice care. It is end of life medical care. It may not be needed now but you need to have some idea of when it will be beneficial. Hospice care addresses all issues related to dying including pain, anxiety and shortness of breath. It does not assist or accelerate death but keeps the events as well managed as possible.

His anger and emotional reactions are part and parcel with his disease and the final stages of living. Understanding that and learning how you should deal with it is part of what you need to learn from the social worker or hospice. You too might benefit from some supportive medications.

Let him work if he wants. Hopefully he will not be amidst the worst of that work. Ideally he would be administrative. He should use his oxygen and that could be dangerous around hot petrochemical materials. All oxygen use safety precautions must be adhered to for his sake and others.

I am sorry about your predicament and wish you the best possible given the circumstances.

[blushinglady]

Thank you Davy9...I do need to be realistic about this and I am on meds to help me due to my PTSD and anxiety attacks I am in counseling yet I haven't been able to get into my counselor since we recieved this news. I will be checking with the hospice program and praying for the strength to get through this. You have been more helpful then the specialist on answering my questions. I apperciate all you have said to help me to understand where this is going to go.
Charlotte