Supportive care for COPD patients: A few pointers for rehabilitation during the COVID-19 pandemic

While COPD cannot be cured or reversed completely, rehabilitation can provide patients with a better quality of life.

Chronic obstructive pulmonary disease (COPD)[1] is a common condition today and more than 250 million people are affected by the condition. This is a respiratory disease, which weakens the lungs and reduces their oxygen uptake, lowering their capacity to expel waste. Some symptoms of COPD include persistent cough, breathlessness, wheezing, tightness or heaviness in the chest and excessive mucous production. While COPD cannot be cured or reversed completely, rehabilitation can provide patients with a better quality of life. The COVID-19 pandemic has only made the situation worse for people with comorbidities like COPD. According to studies, the mortality rates due to COVID-19 vary from 2 per cent to 15 per cent and are higher among the elderly and those with conditions such as COPD.[2] They are not just more vulnerable to the infection but also develop the more severe form of COVID-19.[3]

Supportive care essential for COPD patients

There is a need to be well-equipped to manage people with associated health conditions and also explore alternative options for caregiving one of which is community-based care. This is more so because the treatment and management of people with severe respiratory diseases have become a matter of concern during the pandemic. There is a lack of adequate facilities in the primary healthcare centers, more so in rural areas, apart from the risk of contracting the infection during a hospital visit.

Rehabilitation of COPD patients

COPD rehabilitation is a long process which needs patience, hard work and serious lifestyle changes. In many cases, the diagnosis is delayed due to asymptomatic early stage disease or symptoms that are often mistaken for other conditions more recently, COVID-19. It thus requires a special test called spirometry to examine the lung functions. COPD often calls for a pulmonary rehabilitation programme that is symptom-based and requires a multi-pronged approach to deal with the various related complications. A holistic treatment plan for lung disease including dyspnoea, persistent bronchial asthma and interstitial lung disease comprises preliminary patient assessment followed by medicinal treatment, lifestyle modifications, physical exercise, nutritional support, self-awareness and psychological counselling.

Patient awareness is very important

Considering the lack of proper rehabilitation facility at hospitals and the severity of the pandemic, pulmonary rehab can be done at home. Since it is mainly non-medical in nature, patient training and education can be done to achieve complete rehabilitation. This will also resolve the issue of the symptoms in COPD patients being misdiagnosed as those of COVID-19.

Private homecare providers can assist in rehabilitation

Home-based pulmonary rehabilitation can be carried out with the help of private homecare providers that provide all the necessary expertise and medical advice required for COPD patients and their family. In a home set-up, it is also possible to address the psychological aspects of treatment including anxiety, sadness or any other emotional responses in a pandemic crisis. A community-based approach with good communication and trust among patient, family, and clinical team, can address these concerns.

Precautions that are a must for COPD patients

COPD patients should also be encouraged to adopt more restrictive measures in order to minimize exposure to the virus and avoid complications. Staying at home can reduce their contact with suspected or confirmed cases. In such a scenario, they should also be sensitized on proper hand hygiene, and wearing a mask which are crucial to reducing the risk of catching COVID-19. With home healthcare providers, people with COPD can also be managed through appropriate pharmacotherapy, vaccination (influenza and pneumococcal), and rehabilitation. This will ensure that they are not required to be admitted to a hospital and can recuperate in the comfort of their homes.

(This article is written by Dr Vishal Sehgal, Medical Director, Portea Medical)

[1]WHO

[2]https://www.lungindia.com/preprintarticle.asp?id=298430

[3]Lippi G, Henry BM. Chronic obstructive pulmonary disease is associated with severe coronavirus disease 2019 (COVID-19). Respir Med 2020;167:105941. Back to cited text no. 3