COPD

OT Dude Academy’s Free NBCOT® Exam Prep Course Pulmonology COPD
  • Chronic obstructive pulmonary disease (COPD) is a progressive long-term lung disease that includes chronic bronchitis and emphysema.
  • COPD makes it hard for people to breathe.
  • It affects millions of Americans and is the 3rd leading cause of disease-related death in the US.
  • Deaths resulting from COPD are higher in women than in men likely due to a historical increase in women smoking, anatomical factors, and estrogen playing a role in worsening lung disease.1 
  • The airways in the lungs become inflamed and thicken and the tissue for oxygen exchange is destroyed.
  • Often preventable – smoking is the leading cause of COPD.
  • Can also be attributed by long-term exposure to environmental irritants such as air pollution, fumes, or dust
  • A genetic alpha-1 antitrypsin (AAT) deficiency can also cause the disease.
  • Pathophysiology: decreased gas exchange for oxygen and carbon dioxide occurs due to poor elastic quality in alveoli ‘air sacs’. The walls between the alveoli are destroyed and may become thickened and inflamed. Increased mucus may be produced when coughing. Most people with COPD have both emphysema and chronic bronchitis. Symptoms often develop slowly and worsen over time.
  • Goals/Prognosis: There is no cure for COPD but treatments help to alleviate symptoms, slow disease progression, improve exercise tolerance and activity, prevent and treat complications, and improve overall health.
  • Symptoms: coughing, production of mucus, wheezing, shortness of breath, chest tightness, chest congestion.
  • Severe symptoms may present with edema, weight loss, and lower muscle endurance. Emergency care may be needed for dyspnea, cyanotic or grey lip and fingernails, decreased level of alertness, tachycardia, or worsening of symptoms.2 
  • The morning time is often the worst time of day for symptoms as reported by patients due to cough and sputum production.3 4 
  • Nighttime symptoms include sleep disturbances, decreased sleep quality, and duration.5 6 
  • Long-term complications include impacts on cognition, anxiety, depression, decreased exercise capacity decreased quality of life, and increased mortality.7 
  • Symptoms are often perceived as a burden on daily life including ADLs for patients with COPD and as a burden on others.8 
  • Lifestyle modifications may help with slowing disease progression. These include quitting smoking, avoiding lung environmental lung irritants, medications, remaining active, getting vaccinated, pulmonary rehabilitation, oxygen therapy, surgery, and disease management.2 
  • Cycle of muscle deconditioning – patients may reduce physical activity levels (and occupational participation) in order to avoid symptoms such as dyspnea, however, physical activity is associated with better disease prognosis, reduced hospitalization, and mortality.9 10 11 12 13 14 
  • Contributes to workplace absenteeism and may decrease participation in IADLs.4 
  • Anxiety and depression are often comorbidities that contribute to negative effects on quality of life, exacerbation rates, hospitalization stays, and mortality.15 
  • Outcome Measures: 6-minute Walk Test, COPD Assessment Test, Hospital Anxiety and Depression Scale (HADS), Medical Research Council, Canadian Occupational Performance Measure (COPM), Chronic Respiratory Disease Questionnaire, Goal Attainment Scaling (GAS), BORG scale, pulse oximetry 16 
  • Personalized pulmonary rehabilitation (as opposed to group) that includes occupational therapy improves the prognosis of advanced COPD.
  • Intervention – In order to achieve clinically relevant and long-lasting effects, multiple sessions of occupational therapy may be necessary.17 
  • See Pulmonary Rehabiltation
    • Education
    • Activity training and occupation participation
    • Energy conservation (e.g., planning, prioritizing)
    • Breathing techniques18 
    • Stretch and relaxation
    • Problem-solving for daily living activities19 
    • Environmental modifications
    • Body positioning
    • Assistive devices20 21 
    • Family-based psychosocial support22 
    • Referral to other treatment modalities
  1. American Lung Association. (n.d.). Learn About COPD. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/learn-about-copd[↩]
  2. National Heart, Lung, and Blood Institute. (n.d.). COPD. Retrieved from https://www.nhlbi.nih.gov/health-topics/copd[↩][↩]
  3. Partridge MR, Karlsson N, Small IR. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey. Curr Med Res Opin. 2009;25:2043–8.[↩]
  4. Roche N, Small M, Broomfield S, Higgins V, Pollard R. Real world COPD: association of morning symptoms with clinical and patient-reported outcomes. COPD. 2013;10:679–86.[↩][↩]
  5. Agusti A, Hedner J, Marin JM, Barbé F, Cazzola M, Rennard S. Night-time symptoms: a forgotten dimension of COPD. Eur Respir Rev. 2011;20:183–94.[↩]
  6. Lange P, Marott JL, Vestbo J, Nordestgaard BG. Prevalence of night-time dyspnoea in COPD and its implications for prognosis. Eur Respir J. 2014;43:1590–8.[↩]
  7. Miravitlles, M., & Ribera, A. (2017). Understanding the impact of symptoms on the burden of COPD. Respiratory research, 18(1), 1-11.[↩]
  8. Kessler R, Partridge MR, Miravitlles M, Cazzola M, Vogelmeier C, Leynaud D, et al. Symptom variability in patients with severe COPD: a pan-European cross-sectional study. Eur Respir J. 2011;37:264–72.[↩]
  9. Troosters T, Sciurba F, Battaglia S, Langer D, Valluri SR, Martino L, et al. Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respir Med. 2010;104:1005–11.[↩]
  10. Watz H, Waschki B, Meyer T, Magnussen H. Physical activity in patients with COPD. Eur Respir J. 2009;33:262–72.[↩]
  11. Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J. 2012;40:1115–22.[↩]
  12. Pleguezuelos E, Esquinas C, Moreno E, Guirao L, Ortiz J, Garcia-Alsina J, et al. Muscular dysfunction in COPD: systemic effect or deconditioning? Lung. 2016;194:249–57.[↩]
  13. Reardon JZ, Lareau SC, ZuWallack R. Functional status and quality of life in chronic obstructive pulmonary disease. Am J Med. 2006;119:32–7.[↩]
  14. Troosters T, van der Molen T, Polkey M, Rabinovich RA, Vogiatzis I, Weisman I, et al. Improving physical activity in COPD: towards a new paradigm. Respir Res. 2013;14:115.[↩]
  15. Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TA, Ward DL. Anxiety and depression-important psychological comorbidities of COPD. J Thorac Dis. 2014;6:1615–31.[↩]
  16. Koolen, E. H., Spruit, M. A., de Man, M., Antons, J. C., Nijhuis, E., Nakken, N., … & van ‘t Hul, A. J. (2021). Effectiveness of Home-Based Occupational Therapy on COPM Performance and Satisfaction Scores in Patients with COPD. Canadian Journal of Occupational Therapy, 88(1), 26-37.[↩]
  17. Martinsen, U., Bentzen, H., Holter, M. K., Nilsen, T., Skullerud, H., Mowinckel, P., & Kjeken, I. (2017). The effect of occupational therapy in patients with chronic obstructive pulmonary disease: A randomized controlled trial. Scandinavian journal of occupational therapy, 24(2), 89-97.[↩]
  18. Chan, S. C. (2004). Chronic obstructive pulmonary disease and engagement in occupation. American Journal of Occupational
    Therapy, 58(4), 408–415. http://doi.org/10.5014/ajot.58.4.408[↩]
  19. Maekura, R., Hiraga, T., Miki, K., Kitada, S., Miki, M., Yoshimura, K., Yamamoto, H., Kawabe, T., & Mori, M. (2015). Personalized pulmonary rehabilitation and occupational therapy based on cardiopulmonary exercise testing for patients with advanced chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease, 10, 1787–1800. https://doi.org/10.2147/COPD.S86455[↩]
  20. Wingårdh, A. S. L., Göransson, C., Larsson, S., Slinde, F., & Vanfleteren, L. E. (2020). Effectiveness of energy conservation techniques in patients with COPD. Respiration, 99(5), 409-416.[↩]
  21. Probst, V. S., Troosters, T., Coosemans, I., Spruit, M. A., de Oliveira Pitta, F., Decramer, M., & Gosselink, R. (2004). Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Chest, 126(4), 1102-1107.[↩]
  22. Marques, A., Jácome, C., Cruz, J., Gabriel, R., Brooks, D., & Figueiredo, D. (2015). Family-based psychosocial support and education as part of pulmonary rehabilitation in COPD: a randomized controlled trial. Chest, 147(3), 662-672.[↩]
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