R95 Chronic obstructive pulmonary dis (ICD-10:J44.9)

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that causes breathing difficulties and airflow obstruction. It is a significant health issue worldwide, with a high morbidity and mortality rate.^[1] The aim of this guide is to provide a comprehensive overview of COPD, including its symptoms, causes, diagnostic steps, possible interventions, and lifestyle modifications.

Codes

• ICPC-2 Code: R95 Chronic obstructive pulmonary dis
• ICD-10 Code: J44.9 Chronic obstructive pulmonary disease, unspecified^[2]

Symptoms

• Chronic cough: A persistent cough that produces mucus.
• Shortness of breath: Difficulty breathing, especially during physical activity.
• Wheezing: A whistling or squeaky sound when breathing.
• Chest tightness: A feeling of pressure or discomfort in the chest.^[3]

Causes

• Smoking: The primary cause of COPD, with long-term exposure to cigarette smoke leading to lung damage.
• Environmental factors: Exposure to air pollution, chemical fumes, and dust can contribute to the development of COPD.
• Genetic factors: A deficiency of a protein called alpha-1 antitrypsin can increase the risk of developing COPD.^[4]

Diagnostic Steps

Medical History

• Gather information about the patient’s smoking history, including the number of pack-years.
• Assess exposure to environmental factors such as air pollution and occupational hazards.
• Inquire about symptoms such as chronic cough, shortness of breath, and wheezing.
• Identify any family history of COPD or other lung diseases.^[5]

Physical Examination

• Observe the patient’s breathing pattern and listen for abnormal lung sounds.
• Assess the patient’s respiratory rate and effort.
• Measure oxygen saturation levels using a pulse oximeter.
• Evaluate the patient’s overall lung function using spirometry.^[6]

Laboratory Tests

• Complete blood count (CBC): To assess for anemia or infection.
• Arterial blood gas (ABG) analysis: To measure oxygen and carbon dioxide levels in the blood.
• Alpha-1 antitrypsin deficiency testing: To determine if genetic factors contribute to COPD.^[7]

Diagnostic Imaging

• Chest X-ray: To evaluate the structure of the lungs and identify any abnormalities.
• Computed tomography (CT) scan: To provide detailed images of the lungs and assess the extent of lung damage.
• Pulmonary function tests (PFTs): To measure lung capacity and airflow obstruction.^[8]

Other Tests

• Echocardiogram: To assess the function of the heart and detect any complications related to COPD.
• Exercise testing: To evaluate the patient’s exercise tolerance and identify any limitations.
• Bronchoscopy: To examine the airways and collect samples for further analysis.^[9]

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the progression of COPD and adjust treatment as needed.
• Provide education on smoking cessation, proper inhaler technique, and lifestyle modifications to manage symptoms.
• Encourage patients to join support groups or pulmonary rehabilitation programs for additional support and education.^[10]

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for COPD:

1. Bronchodilators (e.g., Albuterol, Tiotropium):
   • Cost: Generic versions can range from $10 to $50 per month.
   • Contraindications: Hypersensitivity to the medication.
   • Side effects: Increased heart rate, tremors, dry mouth.
   • Severe side effects: Chest pain, arrhythmias.
   • Drug interactions: Beta-blockers, diuretics.
   • Warning: Use with caution in patients with cardiovascular conditions.
2. Inhaled corticosteroids (e.g., Fluticasone, Budesonide):
   • Cost: Generic versions can range from $50 to $200 per month.
   • Contraindications: Hypersensitivity to the medication.
   • Side effects: Thrush, hoarseness, increased risk of pneumonia.
   • Severe side effects: Adrenal suppression, osteoporosis.
   • Drug interactions: Strong CYP3A4 inhibitors.
   • Warning: Rinse mouth after use to prevent thrush.
3. Combination inhalers (e.g., Fluticasone/Salmeterol, Budesonide/Formoterol):
   • Cost: Generic versions can range from $100 to $300 per month.
   • Contraindications: Hypersensitivity to the medication.
   • Side effects: Similar to individual components.
   • Severe side effects: Similar to individual components.
   • Drug interactions: Similar to individual components.
   • Warning: Rinse mouth after use to prevent thrush.
4. Phosphodiesterase-4 inhibitors (e.g., Roflumilast):
   • Cost: Brand name can range from $300 to $500 per month.
   • Contraindications: Severe liver impairment.
   • Side effects: Diarrhea, weight loss, nausea.
   • Severe side effects: Suicidal thoughts, liver dysfunction.
   • Drug interactions: Strong CYP3A4 inhibitors.
   • Warning: Monitor for psychiatric symptoms.
5. Oxygen therapy:
   • Cost: Varies depending on the equipment and delivery method.
   • Contraindications: None.
   • Side effects: Dry or bloody nose, skin irritation.
   • Severe side effects: Oxygen toxicity.
   • Drug interactions: None.
   • Warning: Use with caution in patients with certain lung conditions.

Alternative Drugs:

• Mucolytics (e.g., Acetylcysteine): To help thin and loosen mucus in the airways.
• Antibiotics (e.g., Azithromycin): To treat bacterial infections in the lungs.
• Theophylline: To help relax the muscles in the airways and improve breathing.
• Roflumilast: A phosphodiesterase-4 inhibitor used to reduce exacerbations in severe COPD.
• Montelukast: A leukotriene receptor antagonist that may help reduce inflammation in the airways.

Surgical Procedures:

• Lung volume reduction surgery: Removes damaged lung tissue to improve lung function. Cost: $50,000 to $100,000.
• Lung transplantation: Replaces the diseased lungs with healthy donor lungs. Cost: $100,000 to $1,000,000.

Alternative Interventions

• Pulmonary rehabilitation: A comprehensive program that includes exercise training, education, and support to improve COPD symptoms. Cost: $1,000 to $5,000 for a 12-week program.
• Acupuncture: May help reduce dyspnea and improve lung function. Cost: $60 to $120 per session.
• Breathing exercises: Techniques such as pursed-lip breathing and diaphragmatic breathing can help improve breathing efficiency. Cost: Free.
• Herbal supplements: Some herbs, such as ginseng and eucalyptus, may have potential benefits for COPD symptoms. Cost: Varies depending on the specific supplement.
• Yoga: Can improve lung function, reduce breathlessness, and enhance overall well-being. Cost: $10 to $20 per class.

Lifestyle Interventions

• Smoking cessation: The most important lifestyle modification for COPD. Cost: Varies depending on the method chosen (e.g., nicotine replacement therapy, medications, counseling).
• Regular exercise: Helps improve lung function, endurance, and overall quality of life. Cost: Varies depending on the chosen activity (e.g., gym membership, home exercise equipment).
• Healthy diet: A balanced diet rich in fruits, vegetables, and lean proteins can support overall health and lung function. Cost: Varies depending on food choices.
• Avoidance of triggers: Minimize exposure to air pollution, secondhand smoke, and other irritants that can worsen COPD symptoms. Cost: Free.
• Maintaining a healthy weight: Achieving and maintaining a healthy weight can reduce the strain on the lungs and improve breathing. Cost: Varies depending on individual needs and chosen methods (e.g., dietitian consultation, weight loss programs).

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. It is recommended to consult with healthcare professionals for personalized treatment options and cost estimates.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – R95 Chronic obstructive pulmonary dis (ICD-10:J44.9)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Chronic obstructive pulmonary dis effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Chronic obstructive pulmonary dis. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2021 Report. Available from: https://goldcopd.org/
2. World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva: WHO; 2019.
3. Celli BR, MacNee W; ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23(6):932-946.
4. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370(9589):765-773.
5. Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155(3):179-191.
6. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. Eur Respir J. 2017;49(3):1700214.
7. Stoller JK, Aboussouan LS. Alpha1-antitrypsin deficiency. Lancet. 2005;365(9478):2225-2236.
8. Lynch DA, Austin JH, Hogg JC, et al. CT-Definable Subtypes of Chronic Obstructive Pulmonary Disease: A Statement of the Fleischner Society. Radiology. 2015;277(1):192-205.
9. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-e64.
10. Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173(12):1390-1413.