Posted by on Oct 20, 2018 in Uncategorized

COPD

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. People with COPD have difficulties breathing, primarily due to the narrowing of their airways. A diagnosis of COPD indicates that damage has occurred to the delicate tissues of the lung: the alveoli or air sacs and a diminished surface area for the function of gas exchange. Even mild exertion can bring on breathlessness or a coughing fit and exacerbate the condition. Reliever medications are often prescribed for COPD and while they may offer temporary relief, but can actually exacerbate the condition in the long term.

COPD can cause coughing that produces large amounts of a slimy substance called mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

Chronic bronchitis is caused by inflammation and increased mucus (phlegm) in the breathing tubes (airways). Because of the swelling and extra mucus the inside of the breathing tubes become smaller causing obstruction in airflow.

Emphysema is caused by damage to the air sacs (alveoli) of the lung. Normally there are more than 300 million air sacs in the lungs. If the walls of the air sacs are damaged they lose their elasticity and trap air. This causes extra air to remain in the lungs after you breathe out. The extra effort required to breathe results in shortness of breath.

COPD is a progressive illness i.e. it has several stages of severity and it tends to creep up on people slowly. This means it can often be several years before symptoms reach a level that will make the sufferer go to the GP.

COPD is currently the 4th leading cause of death worldwide and it is expected to be the 3rd leading cause of death by 2020. According to an article published in the journal.ie in April 2018, official figures published by the Department of Health last year show that an estimated 500,000 people in Ireland have COPD but only half are likely to be diagnosed. The figures also revealed that Ireland has the highest rate of hospitalisation for COPD in the OECD, almost double the OECD average. According to the Chief Executive of COPD Support Ireland, the high rate of hospitalisations could be due to the disease not being diagnosed early enough. He stated:

“The problem seems to be that there is an estimated 250,000 people in Ireland who have COPD but do not know it. As it is not diagnosed early, the symptoms just become worse and worse until the patient has to be admitted to hospital.’’

While COPD usually involves irreversible damage to the lower airways and the alveoli (small air sacs), most people with the condition (approx. 60% to 70%) demonstrate some degree of reversible narrowing of the airways. The difficulty in breathing which results from reversible airway narrowing is not caused by destruction of the lung tissue. Instead, it is due to reversible factors including a combination of inflammation, increased mucus or constriction of smooth muscle in the airways. Airways with a good degree of reversible obstruction can be helped with medication and other proven modalities such as the Buteyko Method.

For the past fifteen years, Buteyko Clinic International has applied the Buteyko Method for persons with COPD. As the Buteyko Method works on reversible airway obstruction, those persons with a greater tendency for reversible airway obstruction will show greater improvements. A rule of thumb to determine the degree of airway reversibility is whether medication helps to make your breathing easier. If you experience significant relief after taking a reliever (rescue) or preventer medication, then Buteyko is very likely to help you as well. If on the other hand, you experience little relief from taking asthma or COPD medication, (steroid or rescue) then the likelihood of Buteyko helping significantly lessens.

The Buteyko Method involves switching from mouth to nose breathing on a permanent basis, along with practising breathing exercises which are specifically designed to bring breathing volume to calmer and more normal levels. As breathing becomes more efficient, the feeling of breathlessness during rest and physical exercise reduces. Furthermore, symptoms such as coughing, wheezing and chest tightness will also reduce.

The key to the success of the Buteyko breathing method in COPD clients is in helping them to reduce the severity of their symptoms through improved breathing efficiency. In addition to nose breathing being encouraged at all times, clients are encouraged to adjust the pace of their everyday activities to accommodate the breathing techniques being learned.

Central to the Buteyko Method is a measurement of breath hold time called the Control Pause. Research has shown a relationship between breath hold time (Control Pause measure) and the severity of COPD. In a study of 35 patients, breath hold time was significantly lower in persons with COPD, and correlated positively with spirometer measurements including FVC (Forced Vital Capacity) and FEV1 (Forced Expiratory Volume in one second).

The goal of the Buteyko breathing method is to improve breathing patterns, as indicated by achieving a higher breath hold time (control pause). Every five seconds improvement to the control pause, results in an alleviation of breathing difficulty and improved control of COPD.

According to Frontline (a publication of the Chartered Society of Physiotherapy):

  • A survey of UK physiotherapists practising the Buteyko breathing method highlighted strong support for the technique, particularly in treating conditions such as asthma and chronic obstructive pulmonary disease (COPD).
  • Dr. James Oliver surveyed 19 physiotherapists, mostly respiratory specialists, who had been trained in the method. He presented his findings to the British Thoracic Society.
  • Almost all of the physiotherapists in the survey were using the Buteyko method in clinical practice, and 40 per cent said they did so frequently.
  • 72 per cent rated the method very useful in treating asthma.
  • Seventy-two per cent also rated it very useful or quite useful in treating COPD, bronchiectasis, and hyperventilation.
  • 89 per cent said they would recommend that other respiratory physiotherapists learn to teach the method.

A study involving 31 patients carried out in the UK was published in The Airways Journal. The study participants consisted of patients with asthma, chronic obstructive pulmonary disease (COPD) and chronic hyperventilation syndrome. The Buteyko method was taught during five once-a-week hourly sessions. At the end of the study, 27 patients reported an improvement in their condition particularly in shortness of breath, breathing rate, chest pain and anxiety. The patients were able to hold their breath for longer, which indicates better control of breathlessness and often leads to a reduction in the need for medication.

 


References

Alejandro Sánchez Crespo, Jenny Hallberg, Jon O Lundberg, Sten G E Lindahl, Hans Jacobsson, Eddie Weitzberg, Sven Nyrén, Nasal nitric oxide and regulation of human pulmonary blood flow in the upright position, J Appl Physiol (1985) 2010 Jan 29;108 (1):181-8. Epub 2009 Oct 29

American Thoracic Society/European Respiratory Society Task Force: Standards for the diagnosis and management of patients with COPD. Version 1.2, New York: American Thoracic Society, 2004. PDF available for download at https://www.thoracic.org/copd-guidelines/resources/copddoc.pdf (accessed March 20, 2009)

Chronic Obstructive Pulmonary Disease, National Medicines Information Centre, St. James’s Hospital, Dublin, Volume 19, No 4, 2013

COPD Guidelines Group of the Standards of Care Committee of the BTS. BTS guidelines for the management of chronic obstructive pulmonary disease, Thorax 1997: 52 (suppl 5):S1-S28

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011, available from: goldcopd.org. Accessed online July 12, 2012

Limb, M, Breathing easy with Buteyko, Frontline (Chartered Society of Physiotherapy), Issue 6, 15 March 2006

Siafakas NM, Vermeire P, Pride NB, et al, European Respiratory Society Task Force: Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995: 8:1398-1420

The Airways Journal (AIRWAYS J; 2006 4(4): 217-9

Viecili RB, Silva DR, Sanches PRS, Müller AF, da Silva DP, et al.(2012) Real-Time Measurement of Maximal Voluntary Breath-Holding Time in Patients with Obstructive Ventilatory Defects and Normal Controls. J Pulmon Resp Med 2:127