Introduction to the Case
Mary is a 70-year-old female with a history of COPD, hypertension, type 2 diabetes mellitus, and arthritis of the hand. She has been diagnosed with COPD for five years and is an ex-smoker of 60 pack-years. Her recent spirometry test shows a decline in lung function with a 30% FEV1, 50% predicted, indicating severe COPD. Despite optimal treatment, Mary experiences chronic breathlessness, which has prompted the GP to refer her to a community matron for further management.
Mary is considered at high risk of complications due to her medical history, and blood tests and an ECG have been taken to rule out heart failure and detect any cardiac issues. The options available for the management of Mary’s chronic shortness of breath include withdrawing some or all therapies, supervised treatment, and simplifying non-drug treatments. However, the most suitable options are nebulizer therapy, opioid therapy, and fan therapy.
Management Options
Chronic breathlessness is a common symptom in patients with COPD, and it can significantly affect their quality of life. Various management options are available to manage this symptom. Carette et al. (2019) conducted a study in a tertiary center, finding that optimal COPD treatment, including bronchodilators and steroids, can significantly improve patient breathlessness. However, despite optimal treatment, some patients may experience chronic breathlessness. Management options include nebulizer therapy, opioids, and non-pharmacological interventions like fan therapy.
Additionally, Minakata et al. (2015) investigated the effects of pharmacological treatment on airflow limitation in patients with COPD. The study found that pharmacologic treatment, including bronchodilators and steroids, can improve lung function and reduce patient breathlessness. This treatment also improved the quality of life in COPD patients. Hence, steroids and bronchodilators can reduce a patient’s breathlessness, and pharmacologic intervention can improve this process; however, some exceptions may occur during treatment.
Nebulized therapy is helpful in severe cases of COPD and can help to control breathlessness. Nebulizer therapy is a standard option for managing breathlessness in patients with severe COPD who do not respond to inhaler treatments (Marciniuk et al., 2011). Nebulizer therapy involves delivering medication in a mist form through a nebulizer machine that converts the medication into a fine mist that can be inhaled. Nebulizers are recommended in severe cases of COPD where inhalers are not effectively controlling breathlessness. Therefore, nebulized therapy is considered one of the most suitable treatment methods to decrease patients’ breathlessness.
Opioids can also be used in patients with severe breathlessness who are not adequately controlled by other therapies. A study by Bausewein et al. (2010) found that fan therapy can be an effective non-pharmacological intervention for managing breathlessness in patients with COPD. In addition, a study by Marciniuk et al. (2011) found that opioid therapy effectively managed breathlessness in patients with advanced COPD. Opioid therapy involves using opioid drugs such as morphine to manage breathlessness in severe cases of COPD. The use of opioids for breathlessness in COPD patients is controversial due to the potential for addiction and respiratory depression.
Fan therapy can effectively treat patients’ breathlessness and is easily used by patients. Luckett et al. (2017) conducted a study to evaluate the contributions of hand-held fan therapy to the self-management of chronic breathlessness. The study found that hand-held fan therapy effectively reduced breathlessness in patients with COPD and was easy to use and acceptable to patients.
Fan therapy is an effective way to relieve breathlessness (dyspnea) in individuals with COPD. Multiple studies, including research by Bausewein et al. (2010) and Galbraith et al. (2010), have shown that using a hand-held fan significantly reduces this chronic symptom in COPD patients.
Appropriate Treatment
For patients with severe COPD whose breathlessness doesn’t improve with standard inhalers, the best drug treatments are nebulizer therapy and opioids. Separately, fan therapy offers a highly effective and safe non-drug approach (Luckett et al., 2017). This non-pharmacological option is practical, inexpensive, has few side effects, and can be easily used in conjunction with other treatments.
Moreover, nebulizer therapy is effective for managing breathlessness in severe cases (Marciniuk et al., 2011). However, it requires the use of a nebulizer machine and medication, which may not be practical for some patients. Opioid therapy is effective but has potential risks, including addiction and respiratory depression (Bausewein et al., 2010). Hence, each therapy has its benefits, but fan-therapy and nebulized therapy are the most effective in overcoming COPD.
In Mary’s case, due to her severe COPD and chronic breathlessness, nebulizer therapy and opioids can be considered as management options. However, fan therapy is the preferred management option for Mary’s chronic breathlessness. Fan therapy is a safe and feasible option for managing Mary’s breathlessness, given her history of allergy to steroids, which rules out triple therapy. Mary’s poor inhaler technique due to arthritis in her hand makes using a nebulizer machine challenging.
Fan therapy is a non-invasive, non-pharmacological intervention that Mary can use independently to alleviate her breathlessness. The fan can be easily carried and used in different settings, allowing Mary to maintain her quality of life. However, Mary is allergic to steroids, which rules out the option of triple therapy. It is essential to consider the risks and benefits of nebulizer therapy and opioids for Mary, given her past medical history and allergies. Non-pharmacological interventions, such as fan therapy, can also be considered a safe and effective option for Mary.
Treatment Implementation
A shared decision-making approach can be used to implement the preferred management option, involving Mary and her healthcare team. The healthcare team can educate Mary about the available options and discuss the potential risks and benefits of each option. They can also discuss the potential side effects of each option and the monitoring required for each treatment option.
The healthcare team can work with Mary to identify her preferences and goals for managing her breathlessness and develop a management plan that is feasible and acceptable to her. Lastly, Mary’s inhaler technique should be reviewed and addressed, possibly with the use of a spacer or a different inhaler device, to ensure optimal medication delivery.
Conclusion
In conclusion, managing chronic breathlessness in patients with COPD requires a comprehensive approach that considers both pharmacological and non-pharmacological interventions. Nebulizer therapy and opioids are effective pharmacological options for managing breathlessness in severe COPD patients. In contrast, fan therapy is a safe and effective non-pharmacological intervention. A shared decision-making approach that involves the patient and their healthcare team can help develop a management plan that is both safe and effective, and acceptable to the patient.
References
Bausewein, C., Booth, S., Gysels, M., Kühnbach, R., & Higginson, I. J. (2010). Effectiveness of a hand-held fan for breathlessness: A randomized phase II trial. BMC Palliative Care, 9(1), 1-8. Web.
Carette, H., Zysman, M., Morelot-Panzini, C., Perrin, J., Gomez, E., Guillaumot, A.,… & Chabot, F. (2019). Prevalence and management of chronic breathlessness in COPD in a tertiary care center. BMC Pulmonary Medicine, 19, 1-7. Web.
Galbraith, S., Fagan, P., Perkins, P., Lynch, A., & Booth, S. (2010). Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. Journal of Pain and Symptom Management, 39(5), 831-838. Web.
Luckett, T., Phillips, J., Johnson, M. J., Farquhar, M., Swan, F., Assen, T.,… & Booth, S. (2017). Contributions of a hand-held fan to self-management of chronic breathlessness. European Respiratory Journal, 50(2).
Marciniuk, D. D., Goodridge, D., Hernandez, P., Rocker, G., Balter, M., Bailey, P.,… & Canadian Thoracic Society COPD Committee Dyspnea Expert Working Group. (2011). Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: A Canadian Thoracic Society clinical practice guideline. Canadian Respiratory Journal, 18(2), 69-78. Web.
Minakata, Y., Morishita, Y., Ichikawa, T., Akamatsu, K., Hirano, T., Nakanishi, M.,… & Ichinose, M. (2015). Effects of pharmacologic treatment based on airflow limitation and breathlessness on daily physical activity in patients with chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 1275-1282.