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Chronic Obstructive Pulmonary Disease Overview: Diagnosis, Treatment, Care, and Condition

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a lung condition that mostly affects people who are older than 40 years (Garvey, 2011). Albeit contentious, some researchers argue that COPD is not a disease, but rather, a description of changes in lung functions (Hall, 2012). Nonetheless, COPD often combines chronic bronchitis and emphysema (Hall, 2012; Garvey, 2011). Chronic bronchitis often occurs when inflammation occurs along the airways, thereby causing an increased secretion of mucus, which may cause the airways to narrow (Garvey, 2011). This blockage impedes the breathing process. Comparatively, emphysema often occurs when the tiny air sacs that hold air in the lungs lose their functionality, thereby making it difficult for the sacs to stretch and accommodate the motions of breathing (Garvey, 2011). Collectively, these conditions define COPD. This paper provides an overview of the condition by highlighting its diagnosis, treatment, care, and condition.

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Disease Condition

Risk Factors

Controllable Risk Factors: Smoking is the most common controllable risk factor for COPD. However, other controllable risk factors include exposure to air pollutants and second-hand smoke (Hall, 2012). For example, in developing countries, people develop COPD because of poor ventilation around heating fires and cooking areas (Hall, 2012). Long-term exposure to these risk factors could cause inflammation of the respiratory system, thereby leading to the development of COPD. Chronic responses include emphysema (breakdown of the lung tissue). A mild response is the narrowing of the airways (Hall, 2012).

Uncontrollable Risk Factors: Genetic predisposition is the most common uncontrollable risk factor for COPD (Hall, 2012).

Etiology

Smoking

The primary cause of COPD is long-term exposure to tobacco smoke. Therefore, smokers make up the highest risk group for developing COPD. However, Hall (2012) takes a general understanding of the etiology of COPD by saying it develops through long-term exposure to lung irritants.

Pollutants

Pollutants are the secondary causes of COPD. People who inhale second-hand smoke and those that inhale chemical fumes (occupational hazards) are often high-risk populations (Garvey, 2011).

Genetics

Genetic predisposition to COPD also contributes to its high incidence. Particularly, alpha-1 antitrypsin deficiency (a genetic condition) often causes COPD (Garvey, 2011). Medical research also shows that most people who suffer from this genetic condition could develop COPD because of low levels of alpha-1 antitrypsin (a protein made in the liver) (Hall, 2012; Garvey, 2011). The lack of this protein could cause the development of COPD and liver damage (in extreme cases) (Hall, 2012). Therefore, smokers who are genetically predisposed to COPD could develop the condition easily and experience its rapid deterioration (Hall, 2012; Garvey, 2011). Asthma could also lead to the development of COPD if it remains untreated for long periods. This condition could easily affect asthmatic patients because it causes inflammation and the narrowing of air pathways (Hall, 2012; Garvey, 2011). Nonetheless, Hall (2012) and Garvey (2011) say it is uncommon for people who are younger than 40 years to develop COPD, unless they are genetically predisposed to develop the condition.

Signs and Symptoms

Coughing

Coughing is usually the first symptom of COPD (Burt &Corbridge, 2013). Although it may also symbolize the presence of a milder respiratory condition, its prolonged existence (for more than three months) could signify COPD. In fact, a patient could be suffering from COPD if he produces sputum when coughing (chronic bronchitis) (Burt &Corbridge, 2013). Usually, coughing is a symptom of premature COPD development. The level of sputum production could also signify different stages of COPD development because it could change in hours, or days (Hall, 2012; Garvey, 2011). In extreme cases, coughing may cause a momentary unconsciousness or a rib crack. Usually, people who show these symptoms have long histories of common colds (Burt &Corbridge, 2013).

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Shortness of Breath

Shortness of breath normally manifests when patients feel like they need help to breathe. Often, they say, “I feel out of breath” (Garvey, 2011, p. 18). Others could say, “I cannot get enough air in” (Garvey, 2011, p. 18). The shortness of breath occurs in mild forms (during the early stages of COPD) (Hall, 2012). However, if it progresses for long periods, it could become unsettling for the patients (patients who suffer chronic COPD may experience this problem when resting) (Burt &Corbridge, 2013). Besides causing anxiety among patients, this symptom also creates a poor quality of life for its victims. Some patients often resort to breathing through pursed lips to mitigate this condition (Burt &Corbridge, 2013).

Other Symptoms

Patients who suffer from COPD may experience difficulties breathing out as opposed to breathing in. Occasionally, they may also complain of chest tightness, but those who suffer from closed airways may report wheezing sounds when they breathe (Hall, 2012; Garvey, 2011). When respiratory deterioration continues unabated, patients may report a leg swelling or excessive bulging of their neck veins. Albeit rarely, patients could bite their fingers in a restless posture, but doctors often associate this behavior with more serious conditions such as lung cancer (Hall, 2012; Garvey, 2011).

Pathophysiology

This paper has already shown that COPD is an obstructive lung condition, which affects the respiratory system of its victims. The condition often develops as a chronic inflammation of the respiratory system, but bacterial infections could worsen it (Burt &Corbridge, 2013). In detail, Neutrophil granulocytes and macrophages are common inflammatory cells that worsen the condition (Brulotte & Lang, 2012). Smokers also suffer from Tc1 lymphocyte inflammatory cells that also worsen the inflammation (Burt &Corbridge, 2013). Some victims of COPD have the same response as asthmatic people because they could suffer from eosinophil involvement, which affects both groups of patients. Part of this similarity stems from the presence of chemotactic factors among COPD and asthmatic patients (Hall, 2012). Oxidate stresses are other catalysts for COPD development because they cause lung damage. Smokers are high-risk populations because they have a high concentration of free radicals, which further worsen lung tissue damage. The destruction of lung tissue (especially the connective tissues) causes emphysema. Consequently, the condition leads to poor airflow (poor inhalation and exhalation) (Garvey, 2011). In this regard, air trapping in the lungs often occurs. Obstructive bronchiolitis could also cause the same condition. Different patients have different responses to emphysema and bronchitis (Burt &Corbridge, 2013). The destruction of the airways causes bullous emphysema by creating small pockets of air in the lungs (Garvey, 2011). Muscle wasting is also common among victims who suffer from the above physiological responses because of the presence of inflammatory mediators, which come from the lungs and spread to the blood stream (Garvey, 2011). Inflammation in the respiratory system could also restrict airflow by inhibiting efficient exhalation. Scarring along the airways may also cause the same outcome (Garvey, 2011). Often, patients who suffer from such conditions are unable to breathe out, fully. Therefore, poor airflow is common when they breathe out because the respiratory system depends on the full compression of the airways. When full compression fails to occur, the victims often suffer from air reservation in the lungs because the body is unable to exhale all the air that was in the system when the next inhalation occurs. This is the point where hyperinflation, or air trapping, occurs. Indeed, when hyperinflation occurs, the bloodstream is likely to have low oxygen levels because of high carbon dioxide levels in the blood (Brulotte & Lang, 2012). If low oxygen levels persist, the arteries may narrow. Comparatively, emphysema causes blood vessel damage, thereby making it difficult for patients to breathe (Burt &Corbridge, 2013). When COPD exacerbation increases, inflammation is also likely to increase, thereby causing shortness of breath and poor gas exchanges. Collectively, these factors may cause increased pulmonary pressure in the blood arteries, thereby causing Corpulmonale (Brulotte & Lang, 2012).

Diagnosis

Brulotte and Lang (2012) say people above 40 years should consider taking regular medical checks to know if they have COPD. Similarly, they recommend that any person who manifests any of the symptoms of the disease mentioned in this paper (regardless of age) should seek medical attention (Brulotte & Lang, 2012). When they reach health centers, doctors use different methods to diagnose the disease. The following is a summary of the laboratory and radiology tests used

Laboratory Tests

Spirometry: Doctors use spirometry to measure the volume of airflow. To do so, doctors have to use a bronchodilator to open the airways and measure the flow of air. To examine a patient, doctors use the spirometry technique to measure the forced expiratory volume in one second and the forced vital capacity. If there is irregular, or poor, airflow, the doctors administer further tests to find out whether the patient suffers from COPD, or not.

Blood Count: Medical researchers could look at patients’ blood count to know if they suffer from COPD (Brulotte & Lang, 2012). This test helps to find out whether poor air changes could lead to reduced oxygen levels, or high concentrations of carbon dioxide in the blood.

Radiology

Chest X-ray: Radiologists often use chest X-rays to diagnose COPD by excluding all other conditions that may manifest the same symptoms as COPD. People who suffer from COPD often have over-expanded lungs and a flattened diaphragm (Brulotte & Lang, 2012). The X-rays may also show increased retrosternal space as another manifestation of the condition.

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Treatment

Medicine

Interventions used in COPD management include inhaled bronchodilators, short-course oral steroids, antibiotics, non-invasive ventilation, and mechanical ventilation (Herath & Poole, 2013). Often, doctors use inhaled bronchodilators to increase airflow by reducing obstruction along the air pathways. Comparatively, short-course oral steroids could minimize inflammation and shorten the recovery time of such patients. Occasionally, doctors recommend it to improve hypoxia and lung function (Herath & Poole, 2013). Others use it to minimize the risk of relapse and length of hospital stay (Garvey, 2011). Doctors often prescribe antibiotics when there is a COPD exacerbation that results from bacterial infections. For example, increased sputum purulence is a common sign of bacterial infection (Garvey, 2011). When it occurs, doctors could use the antibiotics to treat/prevent infections and minimize any risk of mortality that may arise from the same infection (Herath & Poole, 2013). The incidence of intubation may also decrease from the same treatment

Surgical Procedures

The surgical treatment of COPD often occurs when non-invasive treatment methods fail. The aim of using the surgical treatment method is to improve oxygenation and acidosis (Brulotte & Lang, 2012). Some common risks associated with surgical treatment methods include hypotension, barotraumas, and new infections caused by ventilator-acquired pneumonia (Brulotte & Lang, 2012). This is why doctors only recommend the use of surgical procedures for COPD treatment when non-invasive treatment methods have failed, or are inappropriate (Brulotte & Lang, 2012).

Preventive Treatment and Education

Relapse is often a common occurrence among patients who have previously suffered from COPD (Simoens, Laekeman, & Decramer, 2013). This is why prevention and education programs are important in managing acute and chronic COPD. This section shows how to manage chronic and acute conditions.

Acute COPD

Medical research often suggests that the best way to prevent acute COPD is to minimize the exposure to the common causes of the disease (Simoens et al., 2013). Often, this process includes educating the public about the risks of smoking. However, it also includes educating the public about the importance of improving their air quality.

Chronic COPD

Health researchers recommend that encouraging victims to quit smoking and allowing them to seek rehabilitation services could improve the management of chronic COPD. However, occasionally, doctors require patients to take vaccinations to prevent them from developing the disease (Simoens et al., 2013). In chronic cases, medical practitioners advise patients to inhale bronchodilators, or steroids, to improve their airflow (Simoens et al., 2013). Here, some people have a better response by undergoing long-term oxygen therapy. In severe cases of COPD, doctors may recommend a lung transplant (Simoens et al., 2013).

Nursing Care

Three most Important Nursing Diagnoses

The main goals of nursing care, for COPD patients, are symptom management, function maximization, and self-care enhancement (Simoens et al., 2013). The three most important nursing diagnoses for a patient suffering from chronic COPD include ineffective airway clearance, impaired gas exchange, and imbalanced nutrition (Brulotte & Lang, 2012). The following section of this report highlights the nursing strategies for each diagnosis.

Nursing Strategies for the Three Nursing Diagnoses

The table below summarizes the nursing strategies for the three nursing diagnoses:

Ineffective Airway Clearance Note adventitious breath sounds
Monitor respirations and breathing sounds
Note the presence and degree of dyspnea
Minimize environmental pollution
Impaired Gas Exchange Elevate head of bed to help the patient to lie in a desired position for easy breathing
Monitor skin and mucous membrane color
Auscultate breathing sounds to note areas of decreased airflow
Palpate for fremitus
Imbalanced Nutrition Assess dietary habits
Auscultate bowel sounds
Encourage a one hour rest period before and after meals
Advise patients to avoid gas-producing foods
Avoid hot and cold foods

Discussion and Conclusion

This paper shows that COPD is a long-term health condition that could potentially cause fatalities, or disabilities, if unattended. Smokers are the highest risk group for developing COPD. However, people who live in polluted environments and experience occupational exposures could similarly develop the condition. These factors often increase the risk of death and minimize lung functions. Since there is no known cure for COPD, the best chances of survival that the victims of COPD have is proper management of the condition. In line with this recommendation, this paper highlights medication, bronchodilation, and the surgical replacement of damaged lungs as possible methods for managing the condition. However, living a healthy lifestyle is the best way to prevent COPD. Minimizing the exposure to air pollutants (improving air quality) could equally reduce the risk of developing the condition.

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References

Brulotte, C., & Lang, E. (2012). Acute exacerbations of chronic obstructive pulmonary disease in the emergency department. Emerg. Med. Clin. North Am., 30(2), 223–47.

Burt, L., & Corbridge, S. (2013). COPD Exacerbations: Evidence-based guidelines for identification, assessment & management. AJN, 113(2), 34-43.

Garvey, C. (2011). Best Practices in Chronic Obstructive Pulmonary Disease. The Nurse Practitioner, 36(5), 16-22.

Hall, M. (2012). Chronic Obstructive Pulmonary Disease and Asthma. Home Healthcare Nurse, 30(10), 603-612.

Herath, S., & Poole, P. (2013). Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev, 11(1), 58-65.

Simoens, S., Laekeman, G., & Decramer, M. (2013). Preventing COPD exacerbations with macrolides: a review and budget impact analysis. Respiratory medicine, 107(5), 637–48.

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