Pathophysiology of COPD
According to the statistics that are presented by the WHO, hundreds of millions of people could have chronic respiratory diseases despite the fact that this type of disease could be prevented and treated properly (Varkey & Maier, 2015). In the list of chronic diseases, COPD takes a leading place. Therefore, it is necessary to learn more about this disease in order to understand its main causes, threats, and treatment methods available to people. Chronic obstructive pulmonary disease (also known as COPD) is defined as a progressive inflammatory disease of lungs (Brashier & Kodgule, 2012). It is usually characterized by sustained inflammation of airways, including emphysema and thickening, chronic bronchitis, and VEGF (vascular endothelial growth factor) (Tuder & Petrache, 2012). COPD occurs when lung tissue is destructed, and the pulmonary function is declined. Smoking is considered as one of the main reasons for such changes in health. As soon as some inhaled irritants reach lungs, bacterial infections could be developed.
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The pathophysiology of COPD includes a number of physiological changes that could easily influence human life. The presence of cigarettes or some other air pollutants causes the development of such cells like macrophages, neutrophils, and lymphocytes (Tuder & Petrache, 2012). Each type of cell has its own impact on an organism. For example, macrophages could enhance fibrosis or the conditions under which antibacterial functions could be weakened. However, these cells could limit the inflammation process. Lymphocytes release cytokines and chemokines, and neutrophils could damage elastic lung tissue (Brashier & Kodgule, 2012). The destruction of lung tissue leads to emphysema that leads to poorly developed airflow and inabilities to absorb respiratory gas. Brashier and Kodgule (2012) also admit that lung hyperinflation is another important feature of COPD pathophysiology that has to be properly diagnosed. Hyperinflation could be present at different stages of the disease. It usually leads to dyspnea that prevents the development of high-quality life.
COPD could also be defined as a genetic disease where a number of environmental factors could interact with genetic determinants (Hobbs & Hersh, 2014). It is necessary to admit that the possibility to investigate and explain the peculiarities of lung functions at the genomic level has been recently introduced. During the last several years, several genome-wide association studies were offered. First, the connection between genetic variants and disease phenotype was investigated on the basis of omics technologies (Hobbs & Hersh, 2014). Then, the correlation of the results taken from omics data to the disease was observed. Finally, multiple omics data sources helped to address the disease and its subtypes.
Nowadays, people could make use of several genetic and genomic studies in order to understand the nature of this disease and the existing external factors. These studies help to clarify how susceptibility loci on different chromosomes could influence the development of the disease (Malhotra & Olsson, 2015). What is known about the subject includes the following information? Chromosome 15q25 is a complex locus that encodes “a family of nicotinic cholinergic receptors, including cholinergic receptors α3 and α5… associated with smoking behaviors” (Hobbs & Hersh, 2014, p. 278). Chromosome 4q31 (hedgehog interacting protein), chromosome 4q22, chromosome 19q13, chromosome 14q32, chromosome 11q22, and chromosome 1q41 were also investigated (Hobbs & Hersh, 2014). Their connection with COPD development was proved. Still, the investigations should not be stopped. The researchers suggest studying the areas where the combination of genomic studies and methylation or other omics data could be taken into consideration (Hobbs & Hersh, 2014). The point is that COPD is a heterogeneous type of disease. Therefore, it is necessary to investigate as many disease-related phenotypes as possible. New applicable diagnostic tools and interventions should be developed to analyze the possible impact of COPD on such diseases as cancer.
Literature Review on the COPD Basics and Treatment
Today, it is possible to find a number of sources that could provide information about COPD basics and the existing variety of treatment methods. As a rule, the researchers and scientists admit that COPD remains to be one of the frequent diseases among the people around the whole world (Tuder & Petrache, 2012). Though tobacco smoking is defined as the main risk factor for COPD, it should not be defined as the only reason. At the same time, smoking should not be introduced as the only factor that could lead to COPD. It was discovered that only 20% of smokers have COPD (Malhotra & Olsson, 2014). In their turn, Brashier and Kodgule (2012) state that 50% of smokers could develop COPD.
Therefore, it is necessary to understand what other factors should be taken into consideration in order to prevent the possibility of COPD or decrease its progression. In addition to the fact that genes and tobacco smoking could be the risk factors of COPD, there is a necessity to remember about such factors as indoor air pollution that could occur because of cooking or heating or occupational dust that come from automobiles, some organic and inorganic dirt, and the development of the industries (Brashier & Kodgule, 2012). The researchers continue to investigate COPD and identify new risk factors that cannot be neglected. For example, Brashier and Kodgule (2012) also define poverty, old age, female gender, poor nutrition, and damage from previous diseases (i.e. tuberculosis or asthma) as the possible causes that could promote the development of COPD in people.
As soon as COPD is diagnosed, it is necessary to choose the treatment and take the steps that could prevent the development of the disease and its effect on the human organism. It is not enough to choose the best drug (Calverley & Vlies, 2015). It is necessary to take the tests, identify all symptoms, investigate all risk factors, and choose an appropriate environment. Antibiotics and corticosteroids are the frequent decisions made by the doctors in regard to their hospitalized patients (Varkey & Maier, 2015).
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Methods of Search
The investigation on the disease like COPD requires much work and a number of steps that should be properly organized. The idea to put the word “COPD” in the Google engine should not be the only one that comes to the mind of a sophisticated researcher. The approach to collect information on the required topic has to be improved and developed accordingly. First of all, it is necessary to identify what kind of information has to be found. In this literature search, it was necessary to find out the information about COPD, its basics, treatment details, and follow-up plans that were crucial for doctors, nurses, and patients. The main keywords chosen for the search are as follows: “chronic obstructive pulmonary disease”, “COPD pathophysiology”, “COPD genomic studies”, “COPD treatment”, and “cases of COPD”.
As soon as the terms are defined, the next step should be taken. It is about the choice of sources to rely on. Scholar. Google, Medscape, and EBSCO Health were the sources for search. If it was necessary to find some general facts or get an idea about COPD and its history, a Google searching engine was used with “site:edu” at the end. Such clarification could help to avoid general harmful sources like Wikipedia, Mayo Clinic, or WebMd but to focus on credible academic sources with the peer-reviewed material. Only peer-reviewed articles had to be chosen for the analysis. Finally, it is obligatory to consider the years of publication. COPD is the disease that was described and investigated by a number of writers and researchers for many years. It is possible to find the material written at the beginning of the 1980s and the 1990s. In this project, the task is to use the up-to-date material. Therefore, it is necessary to establish the time frames and use the sources which were published within the last seven years. As soon as more than ten peer-reviewed articles were found, the most appropriate sources were used in the project.
Clinical Guideline Related to COPD
The aim of any clinical guideline is to provide doctors and other medical workers with clear instructions on how to identify, treat, and prevent disease. At the same time, this document is a helpful guide that contains the number of steps to be followed when a particular diagnose is given. In this project, one of the available COPD clinical guidelines will be investigated. For example, COPD clinical guidelines offered by Piedmont WellStar HealthPlans, Inc., the organization that offers its quality healthcare services across Georgia, are chosen for consideration. It is developed in 2012 and divided into several sections (Piedmont WellStar HealthPlans, Inc.: COPD clinical guideline, 2012). First of all, the developers of the guideline find it necessary to provide some relevance to a population. It is mentioned that 12 million American people are affected by COPD (Piedmont WellStar HealthPlans, Inc.: COPD clinical guideline, 2012). The statistics show that COPD is the fourth leading cause of mortality, and the second leading cause of disability (Piedmont WellStar HealthPlans, Inc.: COPD clinical guideline, 2012). Still, these numbers could be increased by 30% by 2020. The definition and clinical indicators are also given. Spirometry is suggested as the main tool to establish COPD diagnosis. There are four categories of COPD severity. Besides, pharmacological and non-pharmacological treatment methods are described for different groups of patients.
The chosen guideline is easy to read and use the information offered. It helps to understand what has been already discovered about the disease under analysis, what steps should be taken by doctors, and what suggestions could be offered to patients. A list of pharmacological interventions is properly developed with information about doses and the categories of drugs appropriate for treatment. Such guidelines could also be used by ordinary people to clarify if the chosen treatment method is correct, and if there are some alternatives that could help to save patients’ money and time.
Treatment Approaches: Non-Pharmacological and Pharmacological
As a rule, there are two types of treatment that could be offered to patients with COPD. One of them is a pharmacological treatment that includes a number of drug interventions. Another option is a non-pharmacological treatment that includes different types of rehabilitation, therapies, and even surgeries. Each type of treatment has its benefits and shortages. Therefore, the choice depends on the situation of a patient and the possibilities of the chosen medical organization.
Pharmacological treatment methods include inhaled, mucolytic, and antibiotic therapies. For example, Indacaterol is offered as one of possible LABA drugs that should be taken from 75mg t0 300mg from 12 to 52 weeks depending on the patient’s medical characteristics, condition, and the level of COPD severity (Calverley & Vlies, 2015). The same author defines other drugs that could be used to treat COPD, such as Vilanterol with a usual dosage of 25mg and the duration of about 24-28 weeks and Olodaterol 5 or 10 mg to be taken about 48 weeks (Calverley & Vlies, 2015). Albuterol, Salmeterol, Ipratropium, etc. could also be assigned as long/short-acting agonists. Still, this sphere continues developing, and researchers continue investigating the options that could be offered to people.
Non-pharmacological treatment methods promote symptomatic improvements and the development of a better quality of life (Safka & McIvor, 2015). For example, the idea of smoking cessation or long-term oxygen therapies can help to prolong human life. Unfortunately, today, many people forget about the worth of non-pharmacological therapies and choose drugs to solve their health issues. However, the idea to reduce the number of cigarettes or even drop smoking could help to avoid the development of COPD or other diseases. Immunization and vaccinations are used to reduce exacerbations (Safka & McIvor, 2015). Pulmonary rehabilitation is appropriate for adult patients of both genders with moderate, severe, and very severe COPD cases (Safka & McIvor, 2015). When COPD is impossible to treat, lung transportation should be defined as the only option to prolong a human life. Though the survival benefit for COPD patients is not as high as for the patients with hypertension or pulmonary fibrosis, this option should not be neglected because it is a chance not to lose a life (Safka & McIvor, 2015).
Final Selection of the Approach
Regarding the existing variety of treatment approaches and patients’ personal health peculiarities, it is hard to make a certain decision and prove its appropriateness without clarifications from patients. Still, in general, the following treatment could be offered to patients with COPD. First of all, one point of the non-pharmacological treatment approach should be mentioned. If a patient smokes and has COPD, it is important to support the idea of smoking cessation. As soon as a patient reduces the number of cigarettes in their life, the treatment of COPD could be easier and more successful. However, the main idea of treatment should be based on the pharmacological approach. Bronchodilators can help patients to reduce the cases of coughing and relieve shortness of breath.
Patients have a chance to make their breathing easier in case they start using indacaterol 75 mg during the next 12 weeks with Ref. # 20 or Albuterol in the form of Ventolin HFA during the next 15 weeks (Hobbs & Hersh, 2014). It is also possible to use some oral steroids (corticosteroids) like Medrol as the opportunity to prevent the further development of COPD in the organism (Woods, Wheeler, Finch, & Pinner, 2014). Still, it is necessary to remember that any kind of steroid could promote some changes like weight changes or diabetes. Therefore, the period of taking such drugs should be short. For example, it is possible to take Medrol for five days considering that is appropriate to take 1 mg/kg once or twice per day. Antibiotics can be prescribed in case the temperature increases or the signs of pneumonia or bronchitis occur. In general, the pharmacological approach should be coordinated in regards to non-pharmacological suggestions to help patients breathe free and easy.
Follow-up Treatment and Referrals
COPD is a serious disease the outcomes of which cannot be neglected. Therefore, it is important to review people with COPD once or even twice a year during the next five years after the treatment occurs. It is also necessary to provide patients with ventilations and inhalations from time to time to make sure the stabilization of the organism is properly organized. One of the most important issues of follow-up practices is to convince patients that they should drop their smoking habits. Sometimes, it is possible to replace cigarettes with the tools where tobacco is absent.
Patients should address their therapists as soon as they start suffering from a cough or shortness of breathing. As a rule, therapists make their patients address a professional pulmonologist, who focuses on the treatment of various lung diseases. Nutritionists could also be addressed in order to develop an appropriate diet and help patients breathe freely. The only important rule that past COPD patients should follow is to take care of their health, avoid harmful habits, support the idea of a healthy style of life, and address doctors as soon as breathing changes could be observed.
Brashier, B.B. & Kodgule, R. (2012). Risk factors and pathophysiology of chronic obstructive pulmonary disease (COPD). Supplement to JAPI, 60, 17-21.
Calverley, P. & Vlies, B. (2015). New pharmacotherapeutic approaches for chronic obstructive pulmonary disease. Seminars in Respiratory and Critical Care Medicine, 36(4), 523-542.
Hobbs, B.D. & Hersh, C.P. (2014). Integrative genomics of chronic obstructive pulmonary disease. Biochemical and Biophysical Research Communications, 452, 276-286.
Malhotra, R. & Olsson, H. (2015). Immunology, genetics and microbiota in the COPD pathophysiology: Potential scope for patient stratification. Expert Review of Respiratory Medicine, 9(2), 1-7.
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Piedmont WellStar HealthPlans, Inc.: COPD clinical guideline. (2012). Web.
Safka K.A. & McIvor, R.A. (2015). Non-pharmacological management of chronic obstructive pulmonary disease. Ulster Medical Society, 84(1), 13-21.
Tuder, R.M. & Petrache, I. (2012). Pathognesis of chronic obstructive pulmonary disease. The Journal of Clinical Investigation, 122(8), 2749-2755.
Varkey, B. & Maier, L.A. (2015). Chronic respiratory diseases: Challenges in diagnosis and prevention. Current Opinion in Pulmonary Medicine, 21(2), 111-113.
Woods, J.A., Wheeler, J.S., Finch, C.K., & Pinner, N.A. (2014). Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease, 9(1), 421-430.