Chronic Obstructive Pulmonary Disease - Essay Example

Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease 2 Chronic Obstructive Pulmonary Disease (COPD), or according to The American Heritage Stedman's Medical Dictionary (2002), is also known as, "a chronic lung disease, such as asthma or emphysema, in which breathing becomes slowed or forced". The disease affects the lungs and progresses slowly. COPD's symptoms include chronic cough, mucus and sputum, and shortness of breath which can be quite extreme. Conditions that fall under COPD include chronic obstructive bronchitis, chronic bronchitis, and emphysema. Patients usually have a combination of these. Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million Persons in the United States and is the fourth leading cause of death in this country. (As cited in Kleinschmidt (2005). Although this disease is progressive and many symptoms fall under COPD, it can be minimized and it has a direct correlation to human activity. The best thing an individual can do to stop the disease from progressing is to stop smoking. COPD is a of three disease processes which include chronic bronchitis, emphysema, and a mild form of asthma. The greatest of these diseases in COPD is chronic bronchitis. The American Academy of Family Physicians (2005) defines chronic Chronic Obstructive Pulmonary Disease 3 bronchitis as: Chronic bronchitis is an inflammation, or irritation, of the airways in the lungs. Airways are thetubes in your lungs that air passes through. They are also called bronchial tubes. When the airways are irritated, thick mucus forms in them. Mucus plugs up the airways and makes it hard for you to get air into your lungs. Symptoms of chronic bronchitis include a cough that produces mucus (sometimes called sputum), trouble breathing and a feeling of tightness in your chest. The main cause of chronic bronchitis is smoking due to the lungs' airways being affected by mucus. Other irritants to the lungs include dust, chemicals, pollen, outdoor pollutants, and more. Over time, these can become factors for the development of chronic bronchitis. Emphysema, another part of the triad, is also progressive. The Mayo Clinic (2005) explains that emphysema causes a loss of elasticity in the walls of the small air sacs in (the) lungs. Eventually, the walls stretch and break, creating larger, less efficient air sacs that are not able to handle the normal exchange of oxygen and carbon dioxide. Emphysema is usually not detected in its earlier phases and approximately three million people are diagnosed with emphysema after it has progressed and the effects are irreversible. Like chronic bronchitis, the main cause of emphysema is cigarette smoking. Low protein deficiencies and genetic factors may play a small role also. Asthma is also part of the COPD, as stated earlier. Asthma is a chronic disease that affects your airways, which are the tubes that carry air in and out of your lungs. If Chronic Obstructive Pulmonary Disease 4 you have asthma, the inside walls of your airways are inflamed or swollen (National Heart, Lung, and Blood Institute 2003). The airways become highly sensitive when inflamed and react strongly to irritants and allergens. They react by constricting and becoming smaller; therefore, causing wheezing, air restriction, tightness of the chest, and coughing. COPD leads to a decrease in airflow when an individual exhales. The obstruction of airflow causes the body's system to struggle in order to breathe and this obstruction causes oxygen to be trapped in the lungs. This leads to a decreasing of the aveoli capillaries to decrease. This affects the exchange of oxygen and carbon dioxide. As the disease progresses, decreased oxygen in the blood causes a secondary condition called secondary polycythemia as bone marrow triggers more red blood cells. This oxygen deprivation can cause death if there is no treatment. Early in COPD, physical examination of the chest may not be remarkable except for auscultation of expiratory wheezes. As airway obstruction progresses, hyperinflation of the lungs becomes evident. The anteroposterior diameter of the chest increases because the lungs are near full inspiration and because emphysema increases total lung capacity. The diaphragm is depressed, and its motion limited. Breath sounds are decreased, and heart sounds become distant. Signs of pulmonary hypertension and right ventricular hypertrophy are usually not detectable because emphysematous lung tissue is interposed between the heart and anterior chest wall. A few coarse crackles are often heard at the lung bases. An enlarged, tender liver indicates heart failure. Neck vein distention, Chronic Obstructive Pulmonary Disease 5 especially during expiration, may occur in the absence of heart failure because of increased intrathoracic pressure. Asterixis may accompany severe hypercapnia. The patient with end-stage COPD is often a dramatic sight--standing before a counter leaning forward with arms outstretched and weight supported on the palms. The accessory respiratory muscles of the neck and shoulder girdle are in full use. Expiration often occurs through pursed lips. The chest appears over inflated and draws in the lower interspaces. Cyanosis may be present. The rationality for the abnormality of extra mucous production is due to mucous glands that are enlarged (American Thoracic Society 2005). Cilliary dysfunction is due to the scales of the epithelial cells. The rationality for the abnormality of airflow limitation, which occurs in the smaller conducting airways, is due to fibrosis and narrowing. Alveolar wall destruction and loss of elastic recoil, mucus in the bronchi, and hyperinflation and smooth muscle contraction. Rationality for pulmonary hyperextension in COPD are a combination of symptoms which lead to right ventricular hypertrophy and dysfunction. These problems are changes of pulmonary arteries and their capillary bed, dysfunction of the endothelial, and vasoconstriction. The American Thoracic Society (2005) states that the reason for abnormality in gas exchange is "An abnormal distribution of ventilation-perfusion ratios (due in turn to the anatomical alterations described above) is the main mechanism of abnormal gas Chronic Obstructive Pulmonary Disease 6 exchange in COPD [28]. An abnormal diffusing capacity of carbon monoxide per litre of alveolar volume correlates well with the severity of the emphysema [29]. There is inflammation in the body's systems as well as wasting of the skeletal muscles as is apparent from the symptoms and rationalities listed above in COPD patients. This leads to the worsening of the condition due to the limiting of physical exercise. In 1998, Ferguson states that early identification and active intervention are crucial in the management of COPD. Novartis Found Symp et al's 2001 study found the following regarding the medical management of Chronic Obstructive Pulmonary Disease: There is consensus about what elements should be included, but the purposes of therapy and the timing of its introduction remain poorly defined. Major factors limiting effective treatment beyond those associated with the biology of the condition itself are poor diagnostic methodology, failure to identify relevant co-morbidities and reluctance to devote appropriate resources to maximizing patient gain. Too many patients are identified at the end-stages of their illness when treatment is relatively limited. Most therapy is directed at reducing the impact of the disease in terms of symptoms, exercise performance and exacerbations on the individual and only smoking cessation modifies the evolution of the disease. Treatment of hypoxaemic patients with domiciliary oxygen improves mortality and Chronic Obstructive Pulmonary Disease 7 slows the development of pulmonary hypertension. Effective smoking cessation is relevant at all stages of the disease. It depends on the willingness of the individual to participate, and quit rates can be improved by the use of nicotine replacement therapy and possibly bupropion. Inhaled bronchodilator drugs palliate symptoms and improve exercise performance in pharmacologically predictable ways. In patients with severe disease, reduction in operating lung volumes is more important than 'bronchodilitation' and is better sustained by long acting beta agonists and anticholinergics. Inhaled corticosteroids reduce exacerbation rates and improve health status in established disease but do not modify disease evolution. Pulmonary rehabilitation improves exercise performance and health status without changing underlying pulmonary mechanics. Whether hospitalizations and exacerbations can be modified is still to be established. Nutritional therapy is in its infancy but calorie supplementation alone is insufficient to improve patient well being. Selected individuals can undergo lung volume reduction surgery with benefits extending up to two years but the risks are dependent on the skill of the operators and the appropriateness of patient selection. Lung transplantation is symptomatically helpful but does not modify the natural history of the disease. Hospitalization due to exacerbations of disease is frequent and their treatment with Chronic Obstructive Pulmonary Disease 8 bronchodilators, antibiotics and corticosteroids now have a basis in randomized trial data. Mortality reflects the incidence of respiratory acidosis and noninvasive ventilation has a role in safely managing patients outside of the intensive care unit. Effective prevention of exacerbation should be possible with newer antiviral agents but data are presently lacking. The nursing management of COPD includes Demonstrate clinical competence in nursing COPD being competent in performing cannulation, venepuncture and administration of related therapies and administering medication as prescribed. Assessing, implementing, and evaluating clinical care of patients is also crucial to the nursing management of COPD. High standards of care is very important. Ensuring an effective plan of care/ care pathway should be identified and maintained for each patient. The International Primary Care Respiratory Group (2002) finds: There is some difficulty in assessing interventions in COPD because objective measurements of treatment success or failure do not parallel subjective assessment. There is a need therefore to develop methods to measure the effectiveness of pharmacological interventions, as well as benefits of other interventions such as pulmonary rehabilitation and smoking cessation. There is little definitive information available as to the most appropriate way to treat acute exacerbations of COPD. Much of what is available is opinion based.3 Studies need to be considered which will determine such factors as: Use of systemic steroids (what dose and for how long). The use of antibiotics. Are spacers and MDIs as effective a delivery device in the treatment of acute COPD as they are in asthma. (cf nebulisation). The use of CRP in COPD Self-management plans are commonly used in asthma and have been shown to be of benefit in the management of acute and chronic asthma. In conclusion, COPD is not just one disease but a combination of several conditions. Chronic obstructive bronchitis, chronic bronchitis, and emphysema make up the majority of COPD. Although this disease is progressive and many it can be minimized and it has a direct correlation to human activity, environmental factors, medical intervention, and by many other. However, the best thing an individual can do to stop the disease from progressing is to stop smoking and to follow a plan with various health practitioners, counselors, therapists, and those in the field of health/fitness and nutrition. Regardless of all these professionals and medical interventions, one must make it a priority to take the responsibility to make lifestyle changes. Works Cited American Family of Physicians (2005). Chronic Bronchitis: Primary Care Management. Retrieved December 7, 2005, from http://familydoctor.org/280.xml American Thoracic Society (2005). Pathology, Pathogenesis, and Pathophysiology. Retrieved December 8, 2005, from http://www.thoracic.org/COPD/3/pathophysiology.asp Author, P.K. (2005). Chronic Obstructive Pulmonary Disease and Emphysema. Retrieved December 7, 2005, from http://www.emedicine.com/EMERG/topic99.htm Ferguson, G. T. (1998). Management of COPD. Postgraduate Medicine, Vol. 103, No. 4. Mayo Clinic (2005). Diseases and Conditions. Location: Mayo Clinic for Education and Research. Merriam-Webster's Medical Dictionary (2002). Location: Merriam-Webster, Inc. The American Heritage Stedman's Medical Dictionary. Published by Houghton Mifflin Company. (2002) Location: http://dictionary.reference.com/searchr=2&q=chronic%20obstructive%20pulmonary%20disease International Primary Care Respiratory Group (2000). Research Needs: COPD. Retrieved December 8, 2005, from http://www.theipcrg.org/res_copd/index.php U.S. Department of Health and Human Services. National Institutes of Health. September 2003. What is Asthma Retrieved December 7, 2005, from http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html The Emphysema COPD File: General Studies, 234, 27-34. Ardmore, Pennsylvania: The Center for Current Research, Inc. Read More