Effective Care for People with COPD: Guidance for Staff in Nursing Homes

Chronic Obstructive Pulmonary Disease (COPD) is, according to international guidelines, a common, treatable and preventable disease characterized by chronic airway obstruction. The obstruction is a blockage that cannot be cured and constitutes functional impairment in the airways that gradually worsens.

Those who develop COPD often also have other diseases. This combined with the gradual deterioration makes the condition difficult to treat. The course of the disease needs to be monitored and the treatment adjusted to alleviate the symptoms. The treatment is lifelong.

People with COPD often also suffer from other diseases
- Cardiovascular diseases
- Osteoporosis
- Malnutrition
- Anxiety and depression

Complements to treatment
- Smoking cessation – the single most important measure. Beneficial also for the most sick elderly, both in terms of symptoms but not least on survival.
- Vaccination against influenza and pneumococci.
- Customized COPD rehabilitation - focusing on instructions in breathing technique, inhalation technique, personalized physical training, and adequate nutrition. Management strategies for dyspnea, anxiety and deterioration are important for this group.

An important measure is to follow up on the inhalation technique. Many with COPD find it difficult to handle the inhalator correctly. The range of treatments has increased in recent years. There are three different groups of drugs that are considered equivalent. Often there are regional treatment recommendations that the doctor follows.

In case of failing inhalation technique, a spray with a breath container or nebulizer should be considered. There are several different systems on the market and consultation with for example a COPD nurse or physiotherapist may be necessary to choose the right aid, for example the right spacer for the right spray inhaler.

In severe COPD, oxygen therapy may be considered. Oxygen therapy is symptomatic and has documentation for increased survival. Note that dyspnea alone is not an indication for oxygen.

For those with difficult to treat COPD or those who cannot quit smoking, there may be many hospital trips as the treatment options in the nursing home become insufficient.

Reflection questions - COPD
Care staff:
- Have you had any residents with COPD?
- Have the treatments worked well?
- Have there been any difficulties with the resident?

Manager, nurse, occupational therapist and physiotherapist:
- Do you have residents with COPD?
- Does the treatment work well?
- In primary care, there are usually special COPD nurses. Do you have someone who is specially knowledgeable about COPD with you?

Residents and relatives:
- Does your relative have any disease or problem area where you would wish that the staff had higher competence?

Erland Olsson
Specialist Nurse
Sofrosyne
Better care every day