The Management of Chronic Obstructive Pulmonary Disease - Essay Example

?The Management of Chronic Obstructive Pulmonary Disease Introduction In the US and in many industrialized countries, chronic obstructive pulmonary disease, also know n as COPD, is a major health problem. In the US, COPD is the fourth leading cause of mortality. Deaths due to COPD and its complications are increasing yearly compared to the other serious diseases. COPD is characterized by chronic obstruction of the airways, inflammation of lungs, changes in lung pathology in response to certain gases and particles, and significant extra- pulmonary effects. While a serious condition, it is a preventable and treatable condition. The disease progresses irreversibly, thus it is necessary to prevent and manage COPD. The patient in this case of COPD is Maggie, a previous smoker who was diagnosed with mild COPD. In order for Maggie to understand the causes and the management of COPD, she must be informed of the prevalence, risk factors, management and therapeutic option for the disease. The information she will gain will help her to prevent the chances of her disease progressing to a more severe stage, and will help her to understand why she has to take certain medications. Prevalence of COPD In 2000, 2.7 million deaths were attributed to COPD, with majority of the deaths occurring in the Western Pacific Region, China included. In developed and industrialized countries, COPD is to blame for 400,000 deaths (Lopez, et al., 2006). Moreover, in North America 3-4% of adults have COPD. It is estimated that 15-25% of persons forty years old and older have stage 1 mild COPD or airflow limitation. Since smoking was identified to be the biggest risk factor in COPD, the prevalence of COPD is much higher in smokers and ex-smokers in the 40 and above age group compared to younger individuals. COPD is also more prevalent in men than women (Lopez, et al., 2006), but this observation could be due to the higher number of male smokers. However, as the number of women smokers increase, so did the number of female deaths attributable to COPD (Ronnenberg, 2010). Risk factors for COPD Smoking cigarettes comprise the most important risk factor for COPD. Cigarette smoking is responsible for 80%-90% cases of chronic obstructive pulmonary disease. Frequent exposure to second-and smoke also increases the risk of having COPD. However, not all smokers will develop COPD, suggesting that environmental factors and genetic make-up contribute to its prevalence. As an example, COPD has been observed to be more common in whites despite the high number of smokers in the black population. It has also been shown that one type of emphysema is due to the deficiency of alpha-1-protease inhibitor (also known as alpha-1-antitrypsin, or AAT). This genetic defect affects approximately 70,000 Americans and accounts for 1%-3% of COPD cases (Sandford and Silverman, 2002). Another factor that can increase the risk for COPD is a history of childhood lung diseases, which can result in scarring of lungs and reduction of elasticity of the lungs. Exposure to gases, chemical and dust also increase the risk of COPD, and can lead to worsening of the condition, if an individual already has COPD (Ronnenberg, 2010). A study shows that exposure to wood smoke or charcoal smoke is highly related t the development of COPD. This is a common risk factor in developing countries and in Europe where wood or charcoal is used to fuel wood-based ovens (Orozco-Levi, et al., 2006). Stages of COPD severity The severity of COPD is classified by measuring the lung function level using spirometry. This is the process of measuring the breath of an individual. Among the Pulmonary Function Tests, spirometry is the most common. It measures the lung function by measuring the amount (volume) and speed (flow) of air that can be inhaled and exhaled. Spirometry is helpful in the assessment of COPD, asthma, pulmonary fibrosis, and cystic fibrosis (Barreiro and Perillo, 2004). After conducting the initial spirometric test, a bronchodilator is administered. After this, a new round of tests is performed for comparison. The new round will measure the reversibility of the disease condition, thus it is also called a reversibility test, or a post bronchodilator test. The most important spirometric measurement is the forced vital capacity or FVC. In this test, the patient inhales very deeply, and then rapidly and completely exhales. If the lungs are functioning normally, it will empty more than 80% lung volume within six seconds. The volume of air exhaled within a second during the FVC testing is called the forced expiratory volume in 1 second (FEV1) (Barreiro and Perillo, 2004). The normal pulmonary values for FVC and FEV1 are 80-120% (Salzman, 1999). In normal lungs, the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) is 70% and the post-bronchodilator FEV1 is 80% or higher than the predicted value. According to the Global Initiative for Chronic Obstructive Lung Disease (2010), there are four stages of COPD severity. The categories are based on spirometric determinations of the FEV1/FVC ratio, and post-bronchodilator FEV1. In stage 1 (mild) COPD, the FEV1/FVC is Read More