What COPD care at home is really about
COPD care at home is mostly about breathlessness: making ordinary tasks cost less breath, using the treatment properly, and knowing what a flare-up looks like before it becomes an emergency.
Chronic obstructive pulmonary disease, usually shortened to COPD, covers long-term lung conditions such as emphysema and chronic bronchitis that make it harder to move air out of the lungs. It tends to get worse over time, often with flare-ups that can lead to a hospital stay. There is no cure, but a great deal can be done to make daily life easier and to reduce the number of bad weeks.
For a family member or caregiver, the useful mental model is that every task has a breath cost. Showering, dressing, climbing stairs and carrying shopping are expensive. A lot of good COPD care is simply rearranging the day so the person spends their breath on the things they care about.
Breathlessness, and the panic that comes with it
Being short of breath is frightening, and fear makes breathing faster and shallower, which makes breathlessness worse. Breaking that cycle is one of the most valuable skills a household can learn.
- Pursed-lip breathing. Breathe in through the nose, then out slowly through lips held as if blowing out a candle, taking longer to breathe out than in. Respiratory therapists teach this widely because it can slow breathing and ease the sense of air hunger.
- Positions that help. Sitting and leaning forward with forearms resting on the knees or a table, or standing leaning on a counter, often makes breathing easier.
- Moving air on the face. Many people find a small handheld fan pointed at the face eases the feeling of breathlessness. It is cheap and worth trying.
- Your own calm. Speak slowly, stay close, and breathe with them. Rushing them or talking fast tends to transfer the panic.
These techniques help with expected breathlessness. They are not a substitute for treatment when breathing is getting worse, which is covered below.
Inhalers, nebulizers and oxygen
Inhaled medication only works if it reaches the lungs, and poor technique is common. Ask the pharmacist, nurse or respiratory therapist to watch the person use each device and correct it, and to check again periodically, because technique drifts. Know which inhaler is the everyday controller and which is the quick-relief one, and keep the quick-relief one where it can be reached.
If oxygen is prescribed, use it at the flow rate and for the hours prescribed, and do not change it without speaking to the clinician. Oxygen does not explode, but it makes things burn much more readily:
- No smoking and no open flames anywhere near oxygen, including candles, gas stoves and fireplaces. Follow the distance the supplier specifies.
- Ask the supplier about creams and lip balms. Petroleum-based products are commonly advised against with oxygen; the supplier or clinician can suggest alternatives.
- Tubing is a trip hazard. Route it carefully, and keep the length no longer than the supplier recommends.
- Working smoke alarms and a plan for power cuts if the concentrator runs on electricity. Tell the utility and the local fire service if the supplier suggests it.
Have a written action plan for flare-ups
A flare-up, sometimes called an exacerbation, is a period when symptoms get noticeably worse than usual: more breathless, more coughing, more or discolored mucus. Many care teams give patients a written COPD action plan that says what to do at each stage, sometimes including medication to start at home. If the person does not have one, ask for one at the next appointment. It is one of the most useful pieces of paper in the house.
Know the signs that mean call 911 rather than wait: severe breathlessness at rest, being unable to speak in sentences, blue or grey lips or fingertips, new confusion or unusual drowsiness, or chest pain. Calling early is better than calling late.
After a hospital stay for a flare-up, the weeks that follow are a higher-risk period. Our guide to arranging care before a hospital discharge covers what to settle before the person comes home.
Saving breath through the day
Occupational therapists call this energy conservation, and it is the area where help at home makes the largest everyday difference.
Sit down for tasks that are usually done standing: washing, shaving, dressing, preparing food. Use a shower chair and a long-handled sponge. Put on a towelling robe after a shower instead of drying off with a towel. Keep the things used every day within easy reach so there is no bending or stretching. Spread tiring tasks across the day and the week rather than stacking them, and build rest in before the person is exhausted, not after. Our guide to helping someone bathe safely has more on setting up the bathroom.
Smaller, more frequent meals are often easier than large ones, because a full stomach presses on the lungs and eating itself takes breath. Unintended weight loss is common in more advanced COPD and is worth mentioning to the clinician.
Pulmonary rehabilitation, vaccines and smoke
Pulmonary rehabilitation is a supervised program of exercise and education for people with lung disease, and it is one of the treatments most consistently recommended for COPD. Medicare Part B covers it for people with moderate to very severe COPD who have a referral from their doctor, and many other plans cover it too. If the person has never been offered it, ask.
Ask the clinician which vaccines are recommended, since respiratory infections are a common trigger for flare-ups. Keep the home free of tobacco smoke, which matters for everyone in the house, and be cautious with wood smoke, strong cleaning products and aerosol sprays. On poor air quality days, staying indoors with windows closed can help.
What help at home tends to look like
Many people with COPD manage well on their own for years. Help tends to become useful in stages: first with heavy chores, shopping and cleaning; then with bathing and dressing on bad days; later with most of the day's tasks, and with company through the anxiety of breathless nights.
A non-medical caregiver can do a great deal: the chores that cost the most breath, meal preparation, help with washing and dressing, keeping the oxygen tubing safe, prompting the person to use their inhaler as prescribed, and noticing early when things are getting worse. Whether they can give medication, and what counts as giving it, depends on your state and on whether they work through an agency; our guide to what a caregiver can and cannot do explains the line. Share the action plan with anyone who works in the house.
As COPD advances, palliative care can help with breathlessness and anxiety alongside ongoing treatment. Our guide to palliative care at home explains what it is and how to ask for it.
Where do you start?
Ask for a written action plan if there is not one already, and have someone check inhaler technique. Ask whether pulmonary rehabilitation is an option. Then look at which tasks cost the most breath and decide which ones another person should take on. If that means paid help, put the zip code into The Care Royal to see which independent caregivers and agencies work in the area and what they charge. Searching is free for families, and you decide who to hire.
General information for families, not medical advice. COPD differs from person to person; follow the plan from the person's own clinicians, and do not change medication or oxygen settings without their advice. For severe breathlessness, blue lips, chest pain or new confusion, call 911.