People with COPD present with the following symptoms :
• breathlessness , which can typically be persistent , progressive over time , and worse on exertion
• a chronic / recurrent cough
• regular sputum production
• frequent lower respiratory tract infections
Collaborative working between services will improve life expectancy and respiratory health outcomes for people with substance misuse problems .
Some environments can contribute to the risk of developing COPD , such as air pollution or working with dust and toxins , while people with genetic lung diseases or asthma are also at increased risk .
SIMPLE DIAGNOSIS If left untreated COPD can progress from mild to severe , which can present with weight loss , breathlessness , loss of appetite and heart failure . Most GP surgeries can diagnose COPD with a simple test called spirometry , which looks at how the lungs are functioning and initiate and tailor treatment . The treating clinicians might also request a chest x-ray and blood tests , which will help determine if any co-existing conditions need to be considered . COPD management firstly aims to reduce the risk factor by promoting smoking cessation , looking at environmental causes and physical health issues . The basic treatment is with inhalers , and regular follow-ups with your GP practice to assess the progression and need for any changes in medication . At Blackpool with Darwen we have lung health check machines , where service users can check their lung age and be referred to stop smoking clinics .
COPD AND SUBSTANCE USE Research and meta-analyses of COPD in people who use substances are limited . A metaanalysis undertaken by Hulin et al in 2019 showed a predicted prevalence of 17.9 per cent of COPD in people who inhaled opiates , compared to the estimated general prevalence of between 2-3 per cent .
Conclusions drawn from research highlight the importance of considering the effects of environment and substance use on COPD . Primary health care , housing and substance misuse services should also explore improving living conditions and developing integrated respiratory health surveillance and promotion , while collaborative working between services will improve life expectancy and respiratory health outcomes for people with substance misuse problems ( Hulin , 2019 ).
HOLISTIC CARE As clinicians , we need to treat patients holistically and focus on all aspects of comorbidity . A range of skills is essential to promote holistic care , and Delphi recruits staff from a broad multidisciplinary background and encourages this approach to clinical management . A biopsychosocial approach that advocates opportunistic health promotion and intervention forms part of our ethos and drive to improve the quality of life of the people we work with .
COPD is a treatable ( not curable ) condition , and multi-agency psychosocial and health providers must promote access to resources to bridge the gap between health accessibility and service delivery to improve patients ’ quality of life .
Dr Abida Mohamed is clinical lead at Delphi Medical
THE RIGHT TECHNIQUE
As an NMP , Pamela Lang has a vital role in helping COPD patients to help themselves
In my previous role as a community nurse practitioner , I often provided treatment , care and education for respiratory patients experiencing COPD exacerbation . It was vital to advise when to commence their ‘ rescue ’ medication or how to use their prescribed inhalers correctly , as it contributed to self-management of a long-term condition . I could transfer and apply the skills and knowledge I had acquired in my previous job to substance misuse clients .
When clients are admitted to the detox unit , they often present with COPD , which is caused by long-term regular smoking and the smoking of heroin / crack cocaine . Education to aid self-management is paramount for our clients as they are only with us for a short period and must be allowed to understand the importance of taking their medication correctly . This , in turn , contributes to compliance and benefits longterm health outcomes .
James was a 38-year-old man who had smoked heroin for the past 12 years . His daily use was between two and three bags , and although a relatively young man , he had a recent diagnosis of COPD after a CT scan showed he had ‘ moderate to severe ’ upper lobe emphysema . James had been prescribed two inhalers by his GP but very rarely used them , as although he had been shown how , he had forgotten and just used them ad-hoc .
I explained to James that I would assess his technique and teach him when and why he should use his inhalers . He agreed to this . Firstly , I described the differences between the two inhalers . Salbutamol is a shortacting bronchodilator , and the ‘ pink ’ one ( Fostair ) is long-acting ,
Pamela demonstrates an aerochamber to recovery worker Chris .
and therefore must be taken twice a day , as the effects last around 12 hours .
I explained that the ‘ blue ’ one , also often referred to as a reliever , was the one that he should have on his person to use when needed , but also pointed out that overuse of the inhaler could result in feeling shaky and anxious , developing a headache and experiencing a fast heartbeat .
James ’ s technique was very poor , so he was not getting his metered dose when using it and having the impression that it did not work . I introduced an aero chamber and demonstrated how to use it effectively . He struggled at first but eventually began to feel the benefit of the medication and commented that he could feel the difference . Advice was also given on how to clean the aerochamber and to renew it every six to 12 months .
Pamela Lang is a non-medical prescriber ( NMP ) at Delphi Medical
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