Chronic Obstructive Pulmonary Disease (COPD)

Definition:

  Chronic Obstructive Pulmonary Disease ( COPD ) is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible . The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases

Couses:

 The specific causes of COPD are not clearly understood . The effects of numerous imitants found in cigarette smoke , however , make smoking the leading risk factor for COPD development.

*Chronic respiratory infections 

*Sinusitis

*Heredity and genetic predisposition

*Tobacco smoking

*Indoor air pollution (e.g . Cooking with biomass fuels)

 

*Occupational exposure (e.g. Coaldust and cadmin) 

*Smoking 

*Antiproteinase deficiency

Pathophysiology :

Due to causes and risk factors of the COPD 

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Affects ciliary cleaning mechanism of respiratory tract    

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Airflow is obstructed and hair becomes trapped behind the destruction

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Alveoli greatly distend and lung capacity decreased

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Increased accumulation of the mucus from mucus gland

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Produce more irritation and infection

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                      Damage to lungs

 

Clinical Manifestation:

*Chronic coughing ( productive with sputum ) phlegm

*Shortness of breath ( dyspnea ) 

*Frequent respiratory infections

*Production of purulent ( cloudy and discoloured ) sputum 

*Acute and chronic respiratory failure 

*Wheezing 

*Increased work of breathing 

*Tightness in the chest

*Weight loss

*Respiratory insufficiency  

*Decreased exercise tolerance 

*Tachypnea 

*Prolonged expiration 

*Pitting peripheral edema 

*Fatigue

Diagnostic Evaluation :

*Pulmonary function studies are used to help to confirm the diagnosis of COPD 

*Spirometry used to evaluate airflow obstruction 

*ABG measurements may used to detect hypoxemia ( SPO2 < 92 % ) 

*X - ray may be obtained to exclude alternative diagnosis 

*CT chest X - ray in late stages and hyperinflation 

 *Alpha anti physician is also a useful in identifying the genetical determined in emphysema

Management : 

1. Supportive Measures :

*Avoidance of cigarette smoking , and other inhaler irritants

*Control of environmental temperature and humidity 

*Proper nutrition and adequate hydration 

2.Specific Therapy : 

*Bronchodilators and antiinflammatory agents (e.g. Salbutamol and Albuterol)

*Antibiotics - Ampicillin or another broad spectrum antibiotic

*Corticosteroids Prednisolone and Nebulization 

*Digitalis - To treat LVF , if present 

*Anticholinergic agent . e.g. Ipratropium bromide ( Atrovent ) 

*Mucolytics are also reduces the sputum viscosity (e.g. Guaifenesin and potassium iodide

*Immunization : Influenza is a respiratory illness and it can be devastating to a patie with COPD

3.Oxygen therapy for patients who are unable to maintain PaO₂ 

4. Chest physiotherapy for secretion clearance and breathing retraining for improved ventilation and control of dyspnea 

5. Regular IV infusion of human alpha - anti trypsin ( prolastin ) as replacement therapy to correct the antiprotease imbalance in the lungs

Surgical Management :

Bullectomy :  A bullectomy is a surgical option to select patients with bullous emphysema 

Lung Volume Reduction Surgery : Lung volume reduction surgery is a palliative surgical option in a selected subset of patients 

Lung Transplantation : Lung transplantation is a viable option for definitive surgical treatment of end - stage emphysema

Nursing Management :

*Eliminate pulmonary irritants , particularly cigarette smoking 

*Administer bronchodilators to improve dyspnea , reduce hyperinflation at rest and with activity , control bronchospasm and dyspnea , and assist with raising sputum 

*Train and monitor patient's inhaler technique 

*Auscultate the chest after administration of aerosol bronchodilators to assess for improvement of aeration and reduction of breath sounds 

*Mobilize the patient when stable 

*Use postural drainage positions to aid in clearance of secretions , if mucopurulent secretions are responsible for airway obstruction 

*Encourage fluid intake within the level of cardiac reserve

*Discuss and demonstrate relaxation exercises to reduce stress , tension , and anxiety 

*Administer prescribed antimicrobials to control bacterial infections in the bronchial tree , thus cleaning the airways . Administer bronchodilators to improve ventialtion  

*Give supplemental oxygen , as ordered , to correct hypoxemia in a controlled manner 

*Take nutritional history , weight , and height . Patients are at risk for cachexia and obesity due to poor nutritional intake and inactivity 

*Offer liquid nutritional supplements , if needed , to improve nutrient intake and provide appropriate calorie intake 

*Encourage foods high in potassium ( including bananas, dried fruits, dates, figs, orange juice, grape juice, milk, peaches, potatoes, tomatoes ) and monitor for low potassium , which may occur with CODP, corticosteroid use , and diuretic use . 

*Restrict sodium, as directed, if fluid retention is a problem

*Avoid the use of sedatives and hypnotics that may cause repiratory depression