Avoiding Hospitalization for COPD

Helpful Highlights

• Sometimes hospitalization is necessary to resolve a COPD exacerbation.

• Exacerbations are not always preventable and often no one's fault.

• As the disease progresses, so do the frequency and severity of exacerbations.

More than a third of patients hospitalized for COPD exacerbation are readmitted to the hospital within 90 days.  A good discharge plan and ongoing compliance with prescribed medical treatment can help your loved one avoid readmission. Likewise, early recognition of exacerbation symptoms and prompt intervention are crucial to preventing the exacerbations that send them to the hospital.  

How are hospitalizations avoided?

Regularly discuss ongoing COPD maintenance and update the treatment plan with the provider.

Ask the provider what should be done when symptoms worsen - how to use rescue medications and implement additional interventions (such as increasing oxygen), when to call the provider, and when to call 9-1-1

Monitor your loved one and ensure they are adherent to their COPD treatment plan.

Ask the health care team questions if you do not understand the discharge instructions following a hospitalization, or want more specifics.

Be observant of subtle changes in your loved one's breathing, energy level, or activities of daily living

Encourage your loved one to be active - take short walks, tend flowerbeds or garden, or run a simple errand.  Staying active increases breathing capacity and reduces the risk of exacerbation.

Exercise

"A WALK a day keeps the doctor away!" Regular physical activity is an important key to managing COPD. Even a short walk daily can make a big difference in symptoms and quality of life.

Exercise lowers heart rate and blood pressure, making the body more efficient at using oxygen. This means the lungs don't have to work so hard. Cardiovascular exercise also helps strengthen chest muscles, which can also ease breathing.

How long or short is a "short walk"? Rather than put a number on it, walk until it is a little hard to breathe and follow these guidelines:

• Slowly increase walking distance.

• Try not to talk when walking.

• Discuss walking distance and location with the primary care provider or pulmonologist.

There are also several alternatives to walking (or additions to walking), such as riding a stationary bike or using a pedal exerciser. Many pedal exercisers can be placed on the floor for foot pedaling AND placed on a tabletop for arm pedaling.

Another alternative to walking is strength-building, which can be accomplished even while sitting.

• Stand up and sit down several times.

• Lift your legs straight out in front of you by extending the knees, holding them outstretched for a few seconds, then bend the knees and slowly lower them down. Repeat this movement several times. 

• Use wrist weights, small weights, or an exercise band to strengthen arms and shoulders. Ankle weights and bands can also be used to strengthen legs.

Talk to a primary care provider, pulmonologist, or physical therapist about appropriate cardiovascular and strengthening exercises for your loved one. Also, discuss conditioning programs such as pulmonary rehabilitation.

Healthy, COPD-compatible diet

• Have smaller meals and high-protein, high-calorie snacks throughout the day. This may seem counterintuitive, but working to breathe burns a lot of calories. High-calorie, high-protein foods also help a person feel fuller, longer.

• Choose food that's easy to chew, and allow for plenty of time to breathe between small bites.

• If a large meal is preferred, eat it earlier in the day (breakfast or lunch)

• Avoid things that cause bloating, like fizzy drinks and fried or greasy foods

• If prescribed oxygen, use it oxygen while eating

• Drink at least 8 oz of water after each meal

Clean air

• Stop smoking and stay away from smoke

• Clean up your air

  • The most common cause of COPD exacerbation is poor air quality, indoor and out 

  • Start by removing clutter, which attracts dust

  • Vacuum floors and curtains frequently, preferably with a HEPA filter vacuum

  • Get your air conditioner inspected for mold and mildew or other build-up

  • Consider using an air purifier or ionizer

  • Avoid fumes from cooking and cleaning products (especially aerosols), perfumes, and paint

  • Stay away from smoke

  • Avoid pet dander

Medications

• Take medicine as prescribed

  • Know how and when to take COPD medications

  • Don't be hesitant to use rescue medications, as prescribed

• Use oxygen when prescribed

• Encourage regular flu and pneumonia vaccinations

What more can you do for your loved one?

In addition to the above, you can do a lot to help your loved one reduce the risk of hospitalization by reducing the potential for exacerbations.

• Help your loved one to stay on the prescribed COPD treatment plan.

• Assist your loved one to avoid common triggers.

  • Smoking or being around others actively smoking

  • Indoor and outdoor air pollution - use an air ionizer, stay inside when outdoor air quality is low

  • Irritants such as aerosol sprays, as well as fumes from cooking or cleaning products

• Keep indoor temperatures cool

• Ensure everyone washes their hands frequently

• Control household dust

• Avoid anyone with active respiratory illness

• Ensure your loved one has all the medications they need and knows how to take them as prescribed

• Encourage early use of rescue medications (inhalers, nebulizers, anti-anxiety meds)

• Encourage your loved one to get regular flu and pneumonia vaccines

• Help your loved one to practice breathing exercises, relaxation, and body positioning techniques

• Observe for subtle changes in demeanor or physical well-being and ask your loved one questions about what they're experiencing

• Encourage your loved one to speak openly with you, their primary care provider, and the pulmonologist

• Coordinate and assist with follow-up appointments with providers and therapists