Fighting Denial with Facts about COPD

Mother may be in denial of having chronic obstructive pulmonary disease (COPD), dementia caused by the COPD and at 63 having a body of an 85 year old, but I know the truth. More than 12 doctors in two states have all stated the facts and shown us the results. Each time we visit the doctor and do a breathing test she registers at severely restricted, even after a breathing treatment there is little improvement.

 

The doctors a year ago told her if she continued to smoke, her ability to breath and the pain involved would become so severe the strongest narcotics on the market would not be able to ease the suffering. She would die a slow painful death. In my mind, being told that my own behaviors would cause a complete inability to do even the basics of survival, that breathing would be extremely painful and my death would be ugly, I would listen and make the necessary behavioral changes to prevent such agony and stress of family members. But not mother, where she is concerned denial is not just a river in Egypt and anyone including doctors who all say the same thing in regard to her health are quacks. With that being said, I want to know what she has to look forward to and will present her with the findings. However, I know the result will have no affect or change her behaviors, but at least she will be even more informed of what she is going to experience, so when the time comes and I feel little or no pity for her level of pain, I will know she was fully informed and chose not to listen.

 

COPD is the fourth leading cause of death in the United States and is the term for a group of lung diseases that obstruct the airways I the lungs. Chronic bronchitis and emphysema are the two main deseases falling under the COPD umbrella. Once a person has COPD it can never be cured, however, with treatment and stopping smoking can prevent it from worsening. As COPD progresses the ability to breath becomes increasingly difficult until finally death occurs (Mayo Clinic, n.d.). My mother has both chronic bronchitis and emphysema and refuses to stop smoking despite smoking being the leading cause of COPD. So what does she have to look forward to?

As we have already witnessed by her numerous trips to the hospital and doctor for breathing difficulties acute exacerbations will occur. Acute exacerbation is an increase in shortness of breath and/or wheezing, as well as often an increase in the production of purulent sputum. Hospital stays are often needed to treat the symptoms. Over time the need for increased oxygen will become necessary until the lungs simply are not strong enough to sustain proper airflow for survival without medical intervention (Swierzewski III, 2000).

 

People who have COPD and acute exacerbations have an increased risk of respiratory failure which occurs when respiratory demands exceeds the respiratory systems ability to respond. Without intervention at this point the person will die. Mechanical ventilation is required at this stage. Mechanical ventilation is when a ventilator is used to force air into the lungs instead of having to rely on the respiratory muscles being used to draw in air (Swierzewski III, 2000).

 

There are two types of mechanical ventilation, invasive and noninvasive ventilation. Invasive ventilation is when an endotracheal tube is placed into the trachea and connected to a ventilator. This type of ventilation is most often administered to heavily sedated or unconscious persons. It is also the most effective form of mechanical ventilation.  Noninvasive ventilation is often used on conscious and cooperative patients. A mask is placed over the mouth and nose creating a seal and forcing air into the lungs. Many people if they change the conditions that placed them on the ventilator are able to be weaned off of its use. For those with severe COPD it is impossible to breath on their own so the rest of their life they will be dependant on the use of mechanical ventilation (Swierzewski III, 2000). Due to mother’s non-compliance I believe when the time comes invasive ventilation will be the only option.

 

Another complication to look forward to is Cor Pulmonale, which is pulmonary hypertension and right sided heart failure. Lower extremity swelling is often the first sign of Cor Pulmonale. This is caused by COPD making it necessary for the heart to work harder, especially the right side. Due to the poor gas exchange in people with COPD the decreased oxygen in the blood causing blood vessels to constrict and many of the capillaries surrounding the alveoli are destroyed and thus the heart hast work harder to force blood through the fewer constricted blood vessels. Thus, the right ventricle becomes enlarged, the walls of the heart thicken ad the chamber eventually is unable to contract properly and heart failure occurs (Swierzewski III, 2000).  Mother has already been told the walls of her heart are thickening so I am sure this is a road she will travel down if her lungs do not stop working first.

 

Other possible problems are pneumothorax which is a hole that develops in the lung allowing air to escape into the area between the lung and chest wall causing the lung to collapse. Due to COPD damaging the lungs people with COPD are at increased risk for developing a hole in their lung. The way this is treated is to place a tube into the space between the lung and chest wall to let air escape out of the space and re-expanding the lung. The tube must stay in place until the hole is repaired (Swierzewski III, 2000). Polycythemia is the body’s attempt to adjust to decreased amounts of blood oxygen caused by COPD. It is when the body increases the production of oxygen carrying red blood cells to compensate for the decrease blood oxygen levels. This over production can lead to a clogging of small blood vessels (Swierzewski III).

 

One top of all this COPD can increase the symptoms of dementia. Often if the COPD is treated and the person stops smoking the symptoms of dementia decrease (Merck Manual of Health and Aging, n.d.). I had asked the doctor about this since it appears that the more she smokes the less cognitive ability she has. Since the brain relies on oxygen is makes perfect sense that the more on smokes, making it impossible for the lungs to take in enough oxygen the brain would begin to cease functioning properly. Thus, the less oxygen that gets to her brain the less ability she has to function on a cognitive level.

 

One study found smoking increases the risk of dementia by 50%. The reason for this is smoking increases the risk of cerebrovascular disease which is tied to dementia. And oxidative stress is when the body has too many “free radicals, which are waste products created by chemical reactions in the body, (Such as caused by tar from cigarettes) (Consumers Affairs.Com, 2007).

 

So, while mother is ranting about it being her civil right to smoke (yes she does this), I have to disagree with her, Suicide is considered to be against the law, and yet she is permitted by law to engage in the very behavior which WILL cause her a painful death. In the early stages I tried to force the issue of her not smoking because the idea of a painful death is disturbing to me. However, the law says it is her right and soon she will be out of my home and can do as she pleases. Thus, in a few months at best I am sure she will be in some form of hospice care to attempt to manage unmanageable pain, hooked up to a machine to breath for her. Just as it is her right to do this to herself, it is my right to simply not care anymore and to feel no pity for her pain. After all she knows the consequences for her behaviors, but thanks to her narcissism believes somehow none of this is going to happen to her, after all she is better than everyone else who has ever had this diagnosis.

 

 

 

References

Consumers Affairs.Com (2007, Sept. 4). Researchers Link Smoking To Dementia. Retrieved Jan. 15, 2009, from http://www.consumeraffairs.com/news04/2007/09/dementia_smoking.html

Mayo Clinic (n.d.). COPD. Retrieved Jan. 15, 2009, from http://www.mayoclinic.com/health/copd/DS00916

Merck Manual of Health and Aging (n.d.).   Introduction, Alzheimer’s Disease,  Vascular Dementia, Lewy Body Dementia . Retrieved Jan. 15, 2009, from http://www.merck.com/pubs/mmanual_ha/sec3/ch27/ch27a.html

Swierzewski III, S. (2000, June 1). Chronic Obstructive Pulmonary Disease (COPD). Retrieved Jan. 15, 2009, from http://www.pulmonologychannel.com/copd/acuteexacerbation.shtml