Editor:s Note: The article last week titled “To Treat or Not to Treat” was authored by Rodett Osorio, P.A.
By Gilda Morales, ANP, DC
After seeing two patients in the ER last weekend who came in with difficulty breathing because of smoking, I decided it was time to get on my soapbox and preach about the dangers of tobacco abuse. If the term seems a little harsh, so is the disease. Smokers need to see one of these long-term COPD/Emphysema patients struggling to breathe in what they describe as feeling like they are underwater, then maybe they would think twice about lighting up the next one.
COPD (chronic obstructive pulmonary disease) is a triad of symptoms, including those of chronic bronchitis, emphysema, or asthma. Chronic bronchitis is defined as a productive cough for 3 months during each of two consecutive years. Emphysema is defined as an abnormal, permanent enlargement of the air spaces, making it extremely difficult to breath out, or exhale.
Signs and symptoms include cough, usually worse inn the mornings, which produce a small amount of colorless sputum, acute chest illnesses, and breathlessness, which usually doesn’t occur until a patient reaches his/her 60s.
The patient may also have a fast heart rate and increased shortness of breath with simple activities. There is use of the accessory respiratory muscles like the shoulder and abdominal muscles, swelling in the feet, cyanosis, or lips turning blue. The patient may present with what is known as a “barrel chest,” wheezing, decreased breath sounds, crackles and prolonged expiration.
Treatment for the smoker who has already developed COPD is primarily smoking cessation, use of a short-acting bronchodilator, like albuterol or xopenex, and in later stages, the addition of a long-acting bronchodilator, inhaled glucocorticoids, and progression to oxygen therapy, usually 24 hours per day.
Smokers who have made the decision to quit should contact their healthcare provide and ask about tobacco cessation aids. There are several medications that have proven to be quite helpful in helping those who want to quit, but the ultimate decision has to be made by the smoker.
