Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease or COPD is a condition of the lungs that is progressive. Airflow is limited and it is not completely reversible. It is an obstruction of pulmonary airflow. The bronchial wall becomes inflamed and there is increased mucus secretion along with decreased lung elasticity (Grossman & Porth, 2014). It is a disease that approximately 5% of the adults in the U.S. have. It is also a leading cause of death. COPD has become a global problem and is climbing on the list as a leading cause of death worldwide.
Smoking (yes that includes tobacco and cannabis), occupational exposure, and pollutants with irritants such as smoke for firefighters, chemicals for farmers, and other factory workers. Antiprotease deficiency and viral infection can lead to COPD. It is a disease that impairs gas exchange in the lungs. It is a combination of chronic bronchitis that blocks the airway and emphysema that destroys the parenchyma of the lungs. Modifiable risk factors are smoking and passive smoke, increased age, occupational dust, indoor pollutants like smoke from the wood fire used for heating. Nonmodifiable risk factors include a lower level of education, poverty, case of pneumonia at an early age, and airway hyperactivity (Domino, Baldor, Golding, & Stephens, 2018).
A good patient history will identify risk factors. Identify if the patient is or has been a smoker, occupation, indoor pollutants. A history of cough, sputum production, and shortness of breath should be reviewed. A physical exam will probably not be diagnostic in finding a diagnosis of COPD. Bronchitis will have wheezing, cough, and sputum (Ferri, 2018). The mnemonic for the chronic bronchitis patient is a “blue bloater” with reference to cyanosis and fluid retention. Emphysema will have barrel chest, diminished breath sounds, and pursed-lip breathing. The mnemonic of “pink puffer” has been attributed to the majority of emphysema patients with identifying factors of pursed-lip breathing and the use of accessory muscles (Grossman and Porth, 2014). Spirometry should be evaluated and monitored for bronchitis and emphysema possibly ABGs. And chest x-ray. Follow up tests for high-risk patients may include chest CT, or PFT as well as staging according to the Global Initiative for Obstructive Lung Disease (Ferri, 2018).
The first treatment is to quit smoking. Treating any existing infections. Oxygen supplementations if PaO2 is <55 mm Hg or pulse ox values < 88%. Patients with this diagnosis should get flu and pneumonia immunizations (Ferri, 2018). Spiriva may slow the disease process. Albuterol should be prescribed as a rescue medication. Long-acting muscarinic antagonists can be used. Long-acting beta-agonists like salmeterol (Domino, Baldor, Golding, & Stephens, 2018). Refer to a pulmonologist.
Patient education for prevention measures is teaching them to not smoke and the risks that imply. A pulmonary function test with an early diagnosis may help decrease the advancement of the condition in patients with an elevated risk.
Unstable patients should be seen monthly. If they are stable they can be evaluated every 6 months. ABG’s, spirometry should be checked on an annual basis. The patient can get more information from the American Lung Association (2017).
American Lung Association. (2017). Lung health and diseases. Retrieved from http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/copd/
Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (2018). The 5-Minute Clinical Consult 2018 (The 5-Minute Consult Series). Philadelphia: Wolters Kluwer
Ferri, F. F. (2018). Ferri’s Clinical Advisor 2018: 5 Books in 1 (Ferri’s Medical Solutions) Philadelphia, PA: Elsevier.
Grossman, S. C., & Porth, C. (2014). Porth’s pathophysiology: Concepts of altered health states. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins