Chronic Obstructive Pulmonary Disease (COPD) - Does this sound right??

[klmno]

I had a dr appointment today and part of it was to discuss results from a pulmonary test that I had in Jan. (or at least a few mos ago) and was told then that if anything serious showed up on it, I would be notified right away. Today I was told that I had "moderate Chronic Obstructive Pulmonary Disease (COPD)". The intern dr that I saw tried to explain to me what that means, and well, that was about it. Never mentioned any treatment or medications or more tests or anything. Does that sound typical?

I do take medications that are supposed to be rx'd generic equivalent for allegra-d and the majority of the conversation was on that. The intern even called in a licensed md to confront me on "it's not normal to take these three times a day", well that was easily clarified- I don't take them 3x per day- I take it once a day (which is the truth). The MD decided that was normal and continued the rx.

It's the V.A. and normally they are very trustworthy and competent but, they also train people (tdocs, psychiatrists, md interns, etc).

 

[ML]

Both my husband and mom have Chronic Obstructive Pulmonary Disease (COPD) and take stuff like QVAR, Spiriva and Advair. Their quality of life with these medications is soo much better. I don't understand why they didn't discuss treatment with you. I hope you're not smoking girl. Both mom and husband still are

 

[Hound dog]

They should've discussed treatment with you, even if you aren't to the point of needing medicated for it now, they should have discussed what future treatment might mean such as the medications ML stated. You should have been asked if you're a smoker and if so, given treatment options for quitting along with why it is a very good idea to quit as soon as you can manage it.

What it means to you? You're more susceptible to colds, flu, bronchitis, and pneumonia and will probably have a harder time that the average person at throwing such things off. For you it would be wise to get flu and pneumonia shots that are offered. Avoid people with upper respiratory symptoms if possible.

They should not have left with you with just a diagnosis, even if it is MILD. ugh

 

[DammitJanet]

Chronic Obstructive Pulmonary Disease (COPD) is sort of like a catch all term just like ODD is. It can be chronic bronchitis, chronic asthma or emphysema. Any of these can be mild, medium or severe. My dad had Chronic Obstructive Pulmonary Disease (COPD) and his was emphysema and his was pretty much a mild/medium case that was held in check since he was dxd in 1990 with proper medications and great doctors. At the VA by the way...lol. Of course then he got lung cancer last year and it was all down hill from there.

Now I have Chronic Obstructive Pulmonary Disease (COPD) and it is chronic bronchitis. My dad quit smoking when he got his diagnosis. I havent managed yet. Mine doesnt act up much though. I end up on a nebulizer about 4 times a year with it.

 

[susiestar]

Why did they think you took allegra 3x per day? Even an idjit would know not to do that. I am glad they kept you on the rx for it, esp if they pay for it. I HATED it when they took seldane off the market (old version of allegra) and wish I could afford allegra. Never had insurance that owuld pay for it.

The diagnosis means you have to be careful with colds/flu/etc... Keep up with your flu vaccines, make SURE to get the pneumonia vaccine every so many years, and get into a doctor when you have any upper respiratory problem. Have you ever had asthma? That can contribute and needs to be carefully monitored. The Chronic Obstructive Pulmonary Disease (COPD) diagnosis, even if it is mild, puts you into the high risk group that gets the flu vaccine first in any shortage.

With your next cold you need to push to get them to give you a nebulizer and medications. Or at the next appointment if they will give it to you then. It is good to have an inhaler of albuterol also. If you come across something that you are allergic to and you don't have it, you can end up in real trouble as the breathing problems can set in FAST. I had that happen 2 yrs ago from just wlaking past some people smoking. Not a whole lot of smokers, but suddenly I just could NOT breathe. I had thank you's inhaler and otherwise would have passed out and been in BIG trouble, esp as I was around the corner from anyone when the symptoms got really intense. Since then I always have one with me, just in case.

Chances are that at some point you will benefit from an inhaled medication like advair or flovent or symbicort. Make SURE that when you end up with an inhaler that you use a spacer with it. The spacer is a chamber that lets you get most of the medications into your lungs. with-o the spacer, the medications from an inhaler - regardless of medication - end up out in the air and not in your lungs. With a spacer the inhaler is almost as effective as a nebulizer. with-o a spacer the last figures I saw were that you get less than 50% of the medications that are dispensed from the inhaler.

Nebulizers are the most effective way to get the medications into your lungs. They are awesome. Even if you don't need albuterol or a steroid, just using saline in the nebulizer can really help when you have a cold or virus or allergy problem. If at all possible, see if you can get one through the VA. Otherwise check ebay and estate sales. Generally the compressors last a long time and it is just the tubing you have to replace, so a used one usually isn't a problem. Somewhere I have a couple of them, plus a battery powered one that we got when thank you was little because he couldn't go to the zoo, a park, etc... in the spring and summer. Oddly, they call nebulizers "portable" if they have a cord. I think it just means they are light enough that a person can carry them. It does NOT mean what I think of as portable. The Va and most insurances will not pay for the battery for a nebulizer because they are outrageous. To buy the battery alone was more than the cost of an entire nebulizer when we got it. Idiotic, in my opinion, but what can you do?

Anyway, I hope htis doesn't cause you a lot of problems. It could be why you had such a hard time getting over the last couple of viruses. Oh, one last tip for medications - make SURE you have a drink with you when you use them. Esp an inhaler or advair. Advair is a strange delivery system. IT looks like a purple spaceship. the medication is a powder inside it - you move the lever and it dispenses a dose. You hold it flat and put it to your mouth and inhale VERY strongly. It never worked for thank you because he could not inhale strongly enough to get the medicine into his lungs. Advair is very effective when properly inhaled, but it is also very hard on your esophagus and vocal cords. It can cause real problems with your vocal cords if you don't drink and gargle immediately after using.

 

[klmno]

I'll explain a little more detail and it should clarify a couple of things (why they assumed I was taking the medications 3x/day and why possibly they aren't giving me anything more for Chronic Obstructive Pulmonary Disease (COPD), although I'm only speculating that part since reading your informative answers).

I used to get bronchitis once or twice a year and go crawling to my dr after letting it get so bad that I was completely miserable. My regular dr just treated it as bronchitis and I'd get over it and move on. Then I went in once and had to see a different dr and she, being new and unfamiliar with me, read thru my file and noticed a seasonal pattern to when I was coming in with bronchitis. She gave me antibiotics for the bronchitis but also told me she thought it was allergies instigating this, due to the seasonal pattern, and because I smoke my body had a harder time ridding itself of the congestion. She urged me to just try allegra-d after that bout with bronchitis was over. I did and could breath much easier, slept better, and my smoker's cough went away. She told me I could stay on allegra-d long-term and it could very well prolong time before I developed other long term effects from smoking because it would help my body get congestion out. Also, I think since that time, which was about 5 years ago, I've only had bronchitis once or twice. That rx she gave me was for one allegra-d each morning but I could take a second one in the evening if needed. I only took a second one on very rare occasions, like if I'd cleaned the dusty yard shed out that day and my sinuses clogged up.

Fast forward to being unemployed, not having medication insurance, and my rx for allegra-d running out, and ending up going a few months trying to survive sinus headaches by taking OTC allergy medications that did absolutely no good for me, then finally getting medication care from VA last summer-

At my first appointment with VA last summer, I explained all this and was told they don't rx allegra-d, they only rx what they keep in stock because they mail out medications usually (not always). So, they rx'd an antihistamine and the psueodo(????) stuff that is the decongestant. They explained to me that taking one of each would be the equivalent of taking one allegra-d. Fine, so that's what I've been taking (one of each per day). I never read the rx because, well, I figured I already knew everything I needed to as far as when and how often I should take this. What came to light yesterday is that the rx said to take the pseudo(???) every 8 hours, which would be 3x/day, so they assumed I was actually taking it that much. I had never even noticed that it said that believe it or not. They are pretty good with record keeping and coordination between various medication depts so they can easily verify how often I have called in asking for a refill and figure out that it would equate to taking one medication per day, not 3 times as much.

The rx for 3x/day probably happened this way (just speculating)- the licensed md who came in yesterday said that they would never rx 3x/day for long term use and that's why they wanted to take me off of this. She said they rx that dose if a person is already very sick and they need this much for a few weeks to get past a bout of severe sinus congestion. So I assume that when I came in last summer complaining about my head feeling like it was going to explode and that it had felt that way for weeks, the intern got approval from the dr for the rx and they wrote the rx for the higher dose. Then, after I get my old medication records to them and explained all previous stuff, they agreed to write the rx allowing refills for long term use but they never went back and reviewed the dose rx'd so it was still in their system as 3x/day, and thus, they made an assumption. Once I explained to them yesterday that it wouldn't have mattered to me even if I had read the rx for 3x/day, I wouldn't have taken it that much because I knew that 1x/day was sufficient, the licensed dr said it all added up now and what I was saying sounded right so I could stay on it long term and she told the intern to change what the rx says in their computer to 1x/day.

So, going back to Chronic Obstructive Pulmonary Disease (COPD), I assume that taking this decongestant and antihistamine daily is preventing the need for more serious medications, at least for the time period. At some point in time I guess it's likely this won't be enough anymore and then we'll have to discuss options for whatever problems I'm having then. Would that sound like a reasonable speculation, based on your all's experience and knowledge about Chronic Obstructive Pulmonary Disease (COPD)?

And as far as paying for it, it was covered by them when I was unemployed and had no money because I am a veteran and the law had changed allowing vets to get care at VA under those circumstances. Now, I can still get medication care there but since I now have a job and medication insurance, it works just like it does with any other medication care provider. Insurance covers part and I have a copay. I could obviously switch to a private provider now but am choosing not to until I have a more stable job that I can count on lasting longer than this one, just in case I end up in the same boat I was in last year again.

 

[susiestar]

Sounds very reasonable and it is highly probably that the decongestant and antihistamine are doing their job. I would add mucinex to the list as ti works differently. Antihistamines dry up the amt of mucus. with-o a decongestant they can cause real sinus problems because things can get too dry. Decongestants thin out the mucus, making it easier to get it out via coughing, sneezing, runny nose, etc.... Mucinex is an expectorant and makes the mucus less sticky. This means it is easier to get out because it isn't clinging to the body as much. This is why I would add it in times where allergies are bad or you have any slight cough/cold symptoms. The generic versions are fine but be aware that they are not extended release the way mucinex is. So you may need to take it a few times a day when things are bad. Or it might be enough to take it 1-2 times a day in spite of the 4-6 hr repeat dose schedule, it depends on your body.

Given that, I would still see if during a cold or bronchitis you can get the VA to give you a nebulizer. It will help when you have bronchitis and can put off more constant problems. The nebulizer machine should last for many years as infrequently as you would need it. At least get an inhaler of albuterol to use when you get a cold or bronchitis. YOu will be astounded at the difference it will make. There is a newer medication called xopenex that works like albuterol but it is a lot more expensive. An albuterol inhaler has about 200 puffs, each dose is 2 puffs, so when used for colds it could last a year or more. Our pharmacy charges $15 for an inhaler if you don't have insurance, so it is quite reasonable priced even if the VA won't pay. It is also esp handy to have on hand for sudden allergy attacks, like the one I had when I walked past some smokers (as described in my earlier reply).

 

[susiestar]

A neti pot or sinus rinse bottle (sold at most drugstores) that you use to flush your sinuses would also be a good thing. You can either buy the packets of stuff to put into the water or you can mix baking soda and salt - 3 t salt to 1 t baking soda - and use 1/8 tsp per 8 oz water. It costs pennies to mix your own and it lasts forever. They can really halp with congestion and keeping things cleared out. After allergy testing the doctor told me that this will help as much as medications because my body reacts like it is allergic but it isn't actually reacting to any specific allergen. I had NO reactions from over 100 different items (skin pricks) except to the control of histamine. But my body still reacts like I am allergic. But washing the allergens out of my nose/sinuses means that my body doesn't react as long because the irritants are not htere. This is true for anyone with allergies - wash them out and the body won't react as much or as long.

This will sound odd. Get a tube of Ayr saline gel (I think it comes iwth aloe in it mostly, doesn't matter if it does or doesn't have the aloe) when you get the rinse bottle/neti pot. After you use the rinse, wait 3-5 min and put some of the saline gel up your nose with a qtip. IT will keep the tissue moist. Otherwise the rinse takes the covering of mucus away and the tissues can feel very dry and be prone to nosebleeds. But with the gel that doesn't happen nearly as often and you will be more comfortable.

the neti pot is held above your head and water is poured into your nose from it. This is best used in the shower because otherwise it makes a mess (had a good laugh as my mother did this, lol). The sinus rinse bottle (same price, made by NielMed pharmaceuticals - may have misspelled the name) uses the same principal but you lean over the sink and it pushes the water up into your nose instead of using gravity to make it flow down into your nose. I like the bottle because it is easier to use outside of the shower. They both do the same thing, so it is just preference.