COPD

Chronic Obstructive Pulmonary Disease

COPD – what we’ll talk about…
What is it?
How is it diagnosed?
Management strategies
• Smoking cessation
• Medications
• Vaccinations
• Physical activity
• Stress and anxiety
• Nutrition

Flare ups
Resources COPD 2
What is COPD?

COPD = Chronic Obstructive Pulmonary Disease.

It is a chronic lung disease where the airways

become damaged, swollen and/or partially blocked. 

Includes chronic bronchitis and emphysema. 

No “cure” but It can be treated and managed. 

The Lung Association: www.lungs.ca

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Cardinal symptoms of COPD

• Persistent cough
Signs and • Wheeze
• Shortness of Breath
Symptom • Sputum production
s • Decreased tolerance with
daily activities
 Chronic bronchitis

 makes your
airways swollen
and partially
blocked by mucus. 

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Emphysema
• Damages the
lung tissue
where
carbon
dioxide and
oxygen are
exchanged

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What causes COPD?

In countries like Canada, smoking causes about

80-90% of COPD cases.
Other causes:
 Secondhand smoke

 Air pollution (eg: Dust / occupational chemicals)

 Having repeated lung infections as a child

 A genetic condition called alpha-1 antitrypsin

deficiency

Canadian Lung Association:

www.lung.ca

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How is COPD Diagnosed…
 General screening questions tell if you need
further evaluation:

◦ Do you cough regularly?

◦ Do you cough up phlegm regularly?
◦ Do simple chores make you short of breath?
◦ Do you wheeze when you exert yourself or at night?
◦ Do you get frequent colds that persist longer than
those of other people?

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Evaluation through Spirometry
 A spirometry test is the most reliable way to
diagnose COPD. 
◦ It is a simple breathing test that measures the
speed and the amount of air you are able to blow
out of your lungs. 

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COPD can be Managed
 Stop smoking

 Take the right medications

 Recognize, treat, & prevent flare-ups

 Keep your body strong through

exercise and healthy eating

 Manage stress and anxiety

WRHA Pulmonary Rehab Program
Photo Consent Obtained 2012

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 It’s never too late to stop
Stopping smoking and avoiding second hand smoke is the best way
to reduce the rate of decline in lung function.

Anthonisen NR, et al. JAMA 1994;272(19):1497-505.

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Wanting to reduce/quit?
 Talk to your health care provider
◦ Ask about medications and wellness approaches
 Tobacco Cessation Resources
◦ Manitoba lung association:
 https://www.lung.ca/tobacco
◦ Smokers help line:
 https://www.smokershelpline.ca/
◦ WRHA health management groups:
 Packing it in
 Commit to Quit
 https://wrha.mb.ca/groups/

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COPD Care and Medications:
Medications can help with symptoms, possibly
improve lung function and increase quality of
life

But only if taken properly and as prescribed

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C
Benefits of Medications
 Manage shortness of breath
Same diagnosis DOES
NOT mean same
 Improve health status medications in all
patients.

 Improve exercise tolerance It is important to take

meds as prescribed.

If not working as usual,

 Reduce ‘flare-ups’ talk to a health care
provider

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Types of Medication
 Rescue – short acting bronchodilators

 Daily – long acting bronchodilators

 Corticosteroids

 Oxygen

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How Does Medication Work?
 Bronchodilators  Corticosteroids

 Relax muscles in  Reduce inflammation in

the airways  the airways 
 Treat shortness of  Treat shortness of
breath, some cough, breath, cough, wheeze
wheezing, exercise due to inflammation in
tolerance  the airways 
 Types: Inhaled   Can reduce flare ups
 Types: Inhaled or oral 

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Respiratory Medication Devices
Canadian Lung Association – patient instruction videos

Metered Diskus® Turbuhaler® Ellipta®

Dose Respimat
Inhaler®

HandiHaler® Twisthaler® Aerolizer®​ Genuair® Breezhaler®

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 Reliever/Rescue Medications

 Used when you feel short of breath and need

relief fast
 Fast-Acting:  start to feel relief within 5-10
minutes
 Short-Acting:  only last 4-6 hours
 Intended to be used as needed 
 Carry with you at all times Metered
Dose
Inhaler®
 Ventolin (salbutamol)
 Bricanyl (terbutaline)
 Atrovent (ipratropium)
 Combivent (ipratropium + salbutamol)

Respimat
Benefits of a Spacer
 A spacer allows more drug to enter into the
lungs versus closed mouth technique
 ONLY about 9% of patients using inhaled

medications are actually using them properly

 Preferred method!
Delivery of Medications With and Without
Spacers

Plaza V, Sanchis J, CESEA Group, Medical Personnel and Patient Skill in the use of Metered Dose Inhalers: A Multicentric Study. Respiration 1998; 65:195-198.

Recommended for all asthma/COPD patients!

Canadian Thoracic Society guidelines

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Long-Acting Bronchodilators
 Last longer (12-24 hrs)
 Taken on a regular basis – once or   
twice a day
 Immediate effects may not be
noticed
 Some side effects with these
medications
◦ Dry mouth, heart flutter,
lightheadedness, increase in eye
pressure
◦ Consider risk versus benefit

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 Long-Acting Bronchodilators 

 Spiriva (tiotropium)
 Tudorza (aclidinium)
Click to add text
Incruse (umeclidinium) Click to add textHandiHaler®

Click to add text Respimat
 Seebri (glycopyrronium) Click to add text
Click to add text

Genuair® Ellipta® Breezhaler®

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Long-Acting Bronchodilators 

 Serevent (salmeterol) Diskus® Breezhaler®

 Fordadil (formoterol)
 Onbrez (indacaterol)

Aerolizer®​
Combination Medications
 Inspiolto (olodaterol + tiotropium)
 Anoro (vilanterol + umeclidinium)
 Duaklir (formoterol + aclidinium)
 Ultibro (indacaterol + glycopyrronium)

Respimat Ellipta® Breezhaler® Genuair®

 Combination Medications

 Symbicort (budesonide + formoterol)
 Advair (fluticasone + salmeterol)
 Breo  (fluticasone + vilanterol)

Turbuhaler® Diskus® Ellipta®

Combination Therapy
 Tripple Therapy

 Trelergy (vilanterol + umeclidinium +
Fluticasone)
 ---

Ellipta®
Technique is Important
The basics:
◦ Sit up with your back straight, or stand up.
◦ Breathe out until away from your inhaler.
◦ Seal your lips around the mouthpiece.
◦ Breath in and hold your breath for as long as you
can, (5-10 seconds).
◦ Rinse your mouth with water (don't swallow it).
Rinsing your mouth can cut down on some side
◦ effects.
◦ Every inhaler is different – check instructions
How to use MDI with spacer

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Medication Storage & Care
Where do you store your medications?
 Dry place away from heat and humidity 
 Protect from light (i.e. Spiriva)
 Avoid exposure to extreme heat and cold
 Keep out of reach of children and pets
 Keep track of expiration date and number of

doses  
 Need to clean devices regularly
Oxygen
 Oxygen is a medication
 Requires a prescription by your doctor
 Provincial Home Oxygen Program
 Pharmacare  i.e. Portable tanks
 If you have any questions please consult the

health care provider

Vaccinations
Vaccines
for: The
• Recommended For individuals with
flu a chronic lung disease
(Influenza • offer personal protection against
serious illness, hospitalizations and
) death. 
Pneumoni • Speak with your doctor or
healthcare provider about getting
a and immunized
COVID-19

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Benefits of Exercise
Decreases Improves ability to Improves muscle
shortness of breath perform daily tasks endurance and
and fatigue strength

Reduces frequency Improves overall

Helps keep airways
and severity of health and quality
clear of mucus
lung attacks of life

Source: Canadian Thoracic Society guideline: Optimizing pulmonary

rehabilitation in COPD. 2010.
COPD Essentials 31
 Vicious Cycle of Breathlessness

LivingwellwithCOPD.com

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Things to Keep in Mind:

A small amount of activity is better

than none at all

Always remember to breathe

Exercise IS Medicine and can be fun

COPD Essentials 33
Coping with Change

Individuals with a chronic condition

such as COPD may experience:

Emotional
Loss of Feeling
Distress
physical Sense of overwhelme
Fatigue such a
strength and helplessness d by health
frustration
endurance demands
and anger

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Managing Stress & Anxiety
Physical
Activity

Enjoyment Professional Help

Healthy Coping
Strategies 
Sleep Social Support

Mental Wellness

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Managing Stress & Anxiety
If you are feeling:

 Overwhelmed
 Hopeless
 Like you can’t get through your
daily routine
 Speak with your primary care
provider
 Seek consultation with a licensed
mental health professional  (e.g.
psychologist or counsellor)

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Mental Health Resources
 Anxiety Disorders Association of
Manitoba (ADAM) https://www.adam.mb.ca/
 Mental Health & Wellness Resource Finder
https://sharedhealthmb.ca/health-providers/mental-health-an
d-addictions/mental-health-and-wellness-resource-finder/
 Abiliti CBT https://abiliticbt.com/home
 Mind Shift App
 CBT and Mindfulness through the WRHA

Health Management Guide through My Health

Team

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 Healthy Nutrition
Nutrients to Fuel Your Body
 Canada
Food
Guide

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 • Occurs when your COPD
respiratory symptoms
COPD become much more severe.
• Each time they occur, they
Exacerbatio may leave behind permanent,
n/Flare-up irreversible lung damage; so
it’s important to learn how
you can reduce your risk.

What is a COPD Exacerbation? | COPD.com 40

Manage Symptoms and Flare-ups
 Stay informed and educated about your
condition
 Monitor your symptoms and changes
 Take your medications as prescribed
 Avoid triggers
 Have an action plan and know how to use it

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How do I know if I’m having a
flare-up?
Coughing more
Increase in Using more of your
than
shortness of breath rescue/reliever me
usual/started coug
and/or wheezing  dication​
hing

Changes in phlegm/sputum​
•More phlegm/sputum​
•Turns to yellow or green
or brown​
•Is thicker/stickier than usual​
Symptoms that last longer
then 2 days are signs of a
flare up

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Action Plan Components:

GREEN ZONE: I feel well​

YELLOW ZONE: I feel worse

(environment/stress)​

Prescription for COPD Flare-Up​

RED ZONE: I feel I am in danger

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Key Messages
• It is important to know what to do in the case of
a ‘flare-up’ ​
• Early action is key!​
• Using your action plan can help avoid a trip to
Click to add text
the ER​
• Make a partnership with your Primary Care
Provider and your Pharmacist!​
• Let us help you be an advocate for you!

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Living well with COPD is possible

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Summary
COPD cannot be cured but can be treated and
symptoms can be managed at any stage of the disease

The best way to slow the rate of lung function decline

is to STOP smoking

Medications, action plans and exercise can help reduce

lung attacks and improve quality of life

Better knowledge and understanding = better self-care

and management

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Resources
 Pulmonary Rehabilitation
https://wrha.mb.ca/rehabilitation/pulmonary-rehabilitation-
program/
 Living Well With COPD 
https://www.livingwellwithcopd.com/
 Manitoba Lung Association 
https://mb.lung.ca/Lungtivity
 Get Better Together 
https://wrha.mb.ca/groups/get-better-together/
 Air Quality Index

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Thank you
Questions?
Please complete the
participant feedback survey at:

www.surveymonkey.com/r/WPYYNRZ
(virtual groups)
  
www.surveymonkey.com/r/Q22PS8Y
(in-person groups)
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 Air Quality Health Index
 The outdoor air pollution can vary with
location and time, and is updated on
weather station websites
 Poor air quality can trigger lung attacks
 For more information on the Air Quality
Health Index please contact MB Lung

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 Pulmonary Rehabilitation
 An 8 week program with a focus on exercise and
education
 Ask your Doctor for a referral to 1 of the 3 locations
around the city:
◦ Misericordia Health Centre
◦ Seven Oaks/Wellness Institute
◦ Deer Lodge Centre
 Proven to improve health-related quality of life, and
reduce number of hospitalizations and days in hospital,
perceived intensity of breathlessness, and depression
and anxiety associated with COPD.
Source: American College of Chest Physicians, Joint AACP/AACPR statement
on Pulmonary Rehab, 2007.
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