Hi,
I'm new on these boards. I have questions regarding my mom, she was diagnosed with COPD in Feb. 1999. I am concerned that she is not on the right meds. She has progressively gotten worse, she goes through inhalers like they are candy. She is only 56 and can't even go to the restroom without using her inhaler twice. She has gotten depressed since my dad passed away in August 2002, and her breathing is even worse now. Recently she came to visit and one of my children caught the Flu and then my mom caught it. It turned into Pneumonia and I had to force her to go to the hospital. Her Oxygen sat was 68. Doc immediately addmitted her to the hosp. Even on 3liters oygen her sat was only 84. They said she is a CO2 Retainer. I did some research and learned of the Pursed Lip Breathing and taught her, it helps a little bit. When she goes to her doc. for regular visits her sats are only 78 and up to 82 on room air. He prescribed Oxygen (her Blood Gas was 53) but told her only to use it when short of breath. She is using Combivent and an Albuterol inhaler. She is going through 1 combivent a week and also 1 Albuterol a week. I was wondering if anyone knows of a better medication or what exercises she can do with such a limited ability to breath. She has gained 27 pounds (since quitting smoking in Feb. 99) which she says makes it even harder to breath but can't breath well enough to exercise. She is caught in a vicious circle. Any advice or opinions would be greatly apprecited.

Thank You,
Eve

Hi,
I'm new on these boards. I have questions regarding my mom, she was diagnosed with COPD in Feb. 1999. I am concerned that she is not on the right meds. She has progressively gotten worse, she goes through inhalers like they are candy. She is only 56 and can't even go to the restroom without using her inhaler twice. She has gotten depressed since my dad passed away in August 2002, and her breathing is even worse now. Recently she came to visit and one of my children caught the Flu and then my mom caught it. It turned into Pneumonia and I had to force her to go to the hospital. Her Oxygen sat was 68. Doc immediately addmitted her to the hosp. Even on 3liters oygen her sat was only 84. They said she is a CO2 Retainer. I did some research and learned of the Pursed Lip Breathing and taught her, it helps a little bit. When she goes to her doc. for regular visits her sats are only 78 and up to 82 on room air. He prescribed Oxygen (her Blood Gas was 53) but told her only to use it when short of breath. She is using Combivent and an Albuterol inhaler. She is going through 1 combivent a week and also 1 Albuterol a week. I was wondering if anyone knows of a better medication or what exercises she can do with such a limited ability to breath. She has gained 27 pounds (since quitting smoking in Feb. 99) which she says makes it even harder to breath but can't breath well enough to exercise. She is caught in a vicious circle. Any advice or opinions would be greatly apprecited.

Thank You,
Eve


Does she use any nebulized medications? She may get a better effect from them, since the nebulized meds go deeper into the lung. The nebulizer equivalent of Combivent is DuoNeb and the albuterol is albuterol. The next time you go to the doctor, you could ask for one. Insurance usually covers it.

Does she exercise regularly? Many people with COPD use their oxygen during exercise. A stationery bike may be a good exercise to try since she can stop when she needs to.

She may be overusing her meds, which can cause them to be ineffective. Combivent actually contains albuterol, so she's really double dosing on that. Sometimes when albuterol becomes ineffective Xopenex (levalbuterol) may help,it's more potent but it's EXPENSIVE! There is also Serevent-12 hour duration, with stronger anti-inflammatory effect,but she'd still need a rescue inhaler, because Serevent takes a long time to kick in.Does she take any steroids(like prednisone)-that may also help. Even a leisurely stroll can help weight, along with watching calorie intake. This may not work for your mom, but it may be worth a try.

I just noticed that. Inhalers usually have 200 doses in them, and if she's going through one Combivent inhaler and one albuterol inhaler a week, that's 400 doses. Most pharmacies don't allow you to refill meds any more than every 30 days either to prevent overusage of meds. Have you considered anxiety to be causing problems on top of COPD? Anxiety can leave anyone feeling short of breath, especially someone with emphysema/COPD. Also, has she recently had pulmonary function testing done?

I have COPD. I get up in the morning and I use one inhalation of Advair diskus, then 4 puffs of atrovent and 2 puffs of albuterol and I take one 300 mg. of theophyllin.
Every 4 hours I do the atovent and albuterol inhalers and check my blood pressure, heart rate, and peak flow. At bedtime I do the Advair diskus again and take another theophyllin and a Singulair. When the inhalers are not working I use a nebulizer with Xpenex. The albuterol will raise your heart rate. I am not on supplemental oxygen and my oxygen saturation is usually around 97 unless I have an exacerbation. Hope this helps. If your mom is disabled by the social security administration guide lines and she gets social secirity disability medicare will pay for the Xpenex and it can be delivered to her house.

She's only 78-82% saturated on room air and the doctor told her to only use oxygen when she's short of breath. Eesh.

There is a concern for her that she might begin to hypoventilate if she's getting too much oxygen (since hypoxia is probably her only drive to breathe as being a co2 retainer co2 has no effect on her drive to breathe anymore) but with saturations in the seventies I can't help but think that a little oxygen all the time is a good idea? It would also take some of the work off of her heart as well as helping her feel better.

It isn't going to make her COPD any better -- these things happen and are often because of structural changes in the lungs -- stuff that can't be treated with drugs.

There's experimental surgeries like lung volume reduction surgery (where they whack out a chunk of diseased lung that is just taking up space) to try and give the good lung room to breathe. Nobody's been able to prove that it works but I've met people who've had it done and swear it helped them so it might bear investigating.

She sounds pretty end-stage and while it is very sad to say, COPD *is* a terminal disease and it would probably be a good idea for her to get some advanced directives (like a living will) in order while she's still cognizant.

Hi,
I'm new on these boards. I have questions regarding my mom, she was diagnosed with COPD in Feb. 1999. I am concerned that she is not on the right meds. She has progressively gotten worse, she goes through inhalers like they are candy. She is only 56 and can't even go to the restroom without using her inhaler twice. She has gotten depressed since my dad passed away in August 2002, and her breathing is even worse now. Recently she came to visit and one of my children caught the Flu and then my mom caught it. It turned into Pneumonia and I had to force her to go to the hospital. Her Oxygen sat was 68. Doc immediately addmitted her to the hosp. Even on 3liters oygen her sat was only 84. They said she is a CO2 Retainer. I did some research and learned of the Pursed Lip Breathing and taught her, it helps a little bit. When she goes to her doc. for regular visits her sats are only 78 and up to 82 on room air. He prescribed Oxygen (her Blood Gas was 53) but told her only to use it when short of breath. She is using Combivent and an Albuterol inhaler. She is going through 1 combivent a week and also 1 Albuterol a week. I was wondering if anyone knows of a better medication or what exercises she can do with such a limited ability to breath. She has gained 27 pounds (since quitting smoking in Feb. 99) which she says makes it even harder to breath but can't breath well enough to exercise. She is caught in a vicious circle. Any advice or opinions would be greatly apprecited.

Thank You,
Eve

There is also a medication taking thru Nebs it is call xopenax, if she was to use them often, this does not increase the heart rate or cause agitation, I see you said she is a co2 retainer well I am sharing this with everyone today my son has BPD very similar to COPD but has had it since his premature birth, anyways this is what you do, take a water bottle take a screwdriver (right size hole for straw) and put a hole in lid, fill bottle about 1.5 inches from the top and insert straw and have you mom take a deep breath and blow into straw making bubbles in the bottle tell her to blow as long as she can each time, do this often through out the day, she is retaining co2 because she does not exhale long enough most with copd or bpd don't and exhaling is the only way to reduce co2 levels, this will also help her to keeping taking deeper breaths, also ask your dr to give you a hand held vibrator, it is called G5 check it out on the internet, by having a respitory theripist show you and even your mom how to correctly use one, it will help break up any secretions that have thickined and are sticking in the lungs, making it easier to cough up and get out of lungs,this will also help make breathing easier and reduce co2. let your mom know my thoughts and prayers are with her, and I wish her all the best. Dakotasgrl ;)

Xopenex is still a beta-two agonist, it's still a nervous system stimulant, and in high enough doses it can cause the shakiness and fast heartbeat.

Most people with COPD find that those drugs don't work as well as the other category, which includes things like Atrovent and Spiriva.

It's a structural thing, actually, and it's because your airways in copd get kind of floppy and like to collapse on themselves and trap the air inside your lungs before you're done exhaling it. So what you do is apply extra pressure (called CPAP) onto your airways to splint them open longer and let you exhale more of the stale air!

They use it on little babies with BPD all the time -- my cousin had fun with the nasal cpap. You measure the amount of pressure you're applying by how far below the water the straw is -- it's measured in centimeters of water (which is kind of like millimeters of mercury except way more sensitive a scale -- physics geek!). Most normal people can tolerate five, going as high up as ten if her heart is strong and she's otherwise healthy could be good, but the higher up you go and the more you have to strain to blow the bubbles (even a little bit!) has bad effects on blood flow to the heart, so if she's feeling dizzy or like it's making her sick, it isn't a bad thing to stop. So if it isn't working at how deep it is, put more water in! If she's finding herself feeling dizzy or faint, pour some water out! :)