Chronic Obstructive Pulmonary Disease - Case Study Example

Chronic Obstructive Pulmonary Disease One of the diseases of increasing prevalence and causes concern is Chronic Obstructive Disease (COPD). It is one of the ailments of the respiratory system specifically the lungs that can result from the exposure to air pollutants and smoking. The susceptibility of the population is another factor considered that can result to the disease. The study was conducted to be able to focus in particular to the patient's conditions in relation to the causative agents and the possible outcomes of the ailment. Another aim is to clearly present the diagnosis and possible recommendation in relation to the results of the tests that are undertaken. Generally, the ultimate goal is to present a case study on a chosen patient which is diagnosed to have COPD. The case is then presented and analyzed on the basis of the physiological functions, the effects on the systemic balance of the patient, the probable care required while taking into consideration of the history and past ailments of the patient. Introduction The prevalence of lung diseases is considered as one of the concerns of the present generation of medical care. One of the respiratory diseases that cover a variety of ailments and symptomatic indications is the Chronic Obstructive Pulmonary Disease (COPD). The disease commonly includes lung deficiencies such as chronic bronchitis, emphysema or overlapping cases of such diseases. This disease mainly involves the increasing malfunction of the lungs mainly due to building up impediment in the respiratory passages (National Heart, Lung, and Blood Institute or NHLBI, 2003). One of the leading causes of Chronic Obstructive Pulmonary Disease is the increasing amount of pollutants in the atmosphere and high percentage of smokers. The data gathered from study of cases related to COPD is limited but it can be surmised that due to the fact that the exposure to agents causing this ailment is relatively high, the cases of recorded COPD is only a small portion of the actual number of those affected. Based on general studies on the exposure to smoking in particular that reaches to 1.2 billion of the world population, the susceptibility of the population is related to this total number (Davis and Novotny, 1989; Sharma, 2006). Causes of Chronic Obstructive Pulmonary Disease To specifically present the possible causes of Chronic Obstructive Pulmonary Disease factors such as causative agents and susceptibility to the disease are presented. Causative agents are cigarette smoking and air pollution. On the other hand the contributing factor such as airway hyper responsiveness and Alpha1-antitrypsin deficiency are also important. These two factors determine the risk that a patient faces in relation to COPD (Sharma, 2006). One of the main reasons for the incidence of COPD is smoking. Of the recorded cases of COPD gathered from hospital records, 15% are caused by cigarette smoking. The severity of the condition and in relation to the mortality can be attributed to factors such as the age that a patient started smoking, the rate of smoking and even the exposure to other smokers. The factor such as continued smoking even in the incidence of observance of the possible indications of COPD is also considered. The highest proportion which is 90% risk of rate can be attributed to tobacco consumption. The non-smokers that are in close association to the smokers are also in great risk of acquiring lung diseases which includes asthma and deterioration of the lung processes. The pollution in the air is another causative agent in the onset and progressive development of COPD. Although this is the case, there is less effect when compared to smoking. Smoke and other particulates in the atmosphere along with the household consumption of fuel also contribute to the increasing incidence of lung ailments (Sharma, 2006). The susceptibility of the patients to respiratory ailments can also contribute to acquisition of the disease. The "hyper responsiveness of airways" is one factor that is considered due to the fact that this condition can be triggered and result to the ailments that contribute to COPD. The effect of this condition can be magnified in cases wherein the patient also smokes. In cases of hyper responsiveness, causes can be attributed to inflammation that can be found in airways due to other underlying causes such as bronchitis. Another factor that can contribute to the incidence of COPD is the decrease in a particular molecular component in the body. The absence of Alpha 1-antitrypsin in the body or even its presence at very low amount contributes to the development of emphysema at a faster rate, thus, occurring at an earlier age. According to the results of the studies, 40 years old is the usual age. For the recorded cases of patients that do not smoke 53 years old is the mean age of occurrence (Sharma, 2006). In addition to the common causes of COPD is related to the exposure to causative agents in the workplace. This included industrial particles and chemicals which when inhaled cause a variety of effects such as COPD and emphysema. Due to the fact that COPD is continuously developing disease as affected by the exposure to the causes patients with this ailment can show varying level of severity. Some may experience recurring cough and sputum accumulation, difficulty of breathing and chest pains. As there are continued exposure to the causal agents, the condition become more serious and it causes the hindrance in breathing and increasing stress in the lungs and in the heart (NHLBI, 2003). The Pathological Action That Leads to COPD COPD is characterized transformations that can occur in the lungs and its airways specifically the central and peripheral passages including the surrounding tissues. The obstruction occurs when there is multiplication of the multinucleated leukocytes or WBC and macrophages that counteracts infection. These acts through the elastases discharged in the system that can cause negative effects to the respiratory system specifically the lungs. Apopsis can also be an effect of the exposure to free radicals in the cigarette along with the reaction of the molecular bi-products of the reaction to counteract the process of eliminating these agents that cause infection (O' Donnell and Parker, 2006). The obstruction in breathing of patients with COPD is due to the increased level of sputum. There is accumulation of sputum due to the irritation brought about by the neutrophil chemotactic agents that are released in the action of macropages in fighting the causative agents found in cigarettes. Neutrophils are the cells that are greatly affected in the condition of COPD. The level of hindrance in the breathing process and respiration can be determined by the amount of sputum that has accumulated in the neutrophils (O' Donnell and Parker, 2006; Sharma, 2006). The pathological action in COPD, thus, can be generalized as caused by both a causative agent and the action of the macrophages that supposed to fight the infection that can be caused by these agents. Specifically, the prior researches on the subject revealed that the interaction of causative agents, macrophages, and T lymphocyte CD8+ causes the increasing development of COPD in patients (O' Donnell and Parker, 2006; Sharma, 2006). The action of the COPD is a result of three processes occurring in the respiratory airways. These are the inflammation of the passages, the changes in the physiology in the cells involved and lastly the bronchoconstriction that results in the difficulty in the breathing process. Prior to the observance of symptoms that can be attributed to COPD, inflammation of passages had started the toll. The inflammation can lead to systemic physiological transformation that can initially occur in the airways then ultimately to the lung tissues. This is where the obstruction in the breathing occurs and continually developed if not treated at an early state (Braman and Martinez, 2005). Related Conditions The cases of Chronic Obstructive Pulmonary Disease can be identified as a pulmonary ailment or as a systemic disease. As a pulmonary disease, it can be characterized by certain indications such as dyspnea, cough and high sputum amount and exacerbations. Other symptoms such as decrease in the ability to perform strenuous activities such as exercise, morning headache and confusion and slow mental processes can be observed. On the other hand, as a systemic disease it can be characterized as having under nourishment which can be observed in decrease of weight; dysfunction of the muscles and bones that can lead to osteoporosis; anxiety and depression; cardiovascular ailments; and susceptibility to other recurring diseases (Braman, and Martinez, 2005). One of the conditions associated with COPD is chronic bronchitis. It can be characterized through the changes in the airways and inflammation of the bronchial wall. The inflammation cells which are also the neutrophilia accumulates in the respiratory air passages. This ultimately leads to the distortion of the structures of the walls of these passages. This results to the restriction in the airways. The incidence and the susceptibility to chronic bronchitis increase through old age. Regardless of the age groups on the other hand there is relatively higher percentage of the female population with the disease compared to the male population. Thus, this can either be a result of higher exposure of the female population to air pollutants or higher susceptibility to the disease (NHLBI, 2003; Sharma, 2006). Emphysema is another condition that can be related to COPD, due to the structural effects and symptoms. The occurrence of this ailment can occur through different courses of action. This includes the centriacinar, panacinar and acinar emphysema (Sanders, 1991). Compared to the cases of chronic bronchitis, the cases of emphysema is more prevalent in the male population on ages 25 and above. Similar to the trend in chronic bronchitis though, it also occurs in increasing risk through adulthood (NHLBI, 2003). Emphysema is a condition that specifically targets the bronchioles or the air sacs that are found in the lungs. The three types of emphysema are characterized by the differences in the affected structures in the lungs. For the centriacinar emphysema, the main affected area is the acinus resulting from smoking. This is most prevalent in the upper part of the lungs. The panacinar emphysema on the other hand is the result of the deficit in the amount of the alpha1-antitrypsin that affects the alveoli adjacent to the bronchiole on the extreme parts of the upper lungs. The third type of emphysema is the distal acinar emphysema which affects the distal adjacent parts of the lungs as compared to the first type that affects the central part. This type mainly affects the fibrous septa, thus, it is also referred to as paraseptal type of emphysema. Although this type of emphysema can be related to the COPD due to the effects that it can cause to the respiratory structures, paraseptal emphysema do not result into pulmonary obstruction (Sanders, 1991). Rationale of the Study The study is aimed to present a definite case on Chronic Obstructive Pulmonary Disease (COPD) which is one of the cases of highest incidence specifically in the emergency department. This includes the review of the heath history of the patient, the present health status accompanied by the tests that are conducted to be able to make diagnosis and recommendations for the patients. This is done on the basis of clinical standards such as the parameters set by the National Institute for Clinical Standards. Review of Related Literature The studies prior to the research conducted serves as the baseline data and the foundation for exploratory studies such as the conducted case study on a particular patient. The research on Chronic Obstructive Pulmonary Disease revealed significant results on the frequency of incidence and the percentage of mortality. Frequency of the Cases of COPD The cases of COPD internationally are recorded as having the highest frequency in ages 46-69, which is 9.1%. The cases of occurrence in men are higher compared to women. Approximately 4 to 6 percent of the population of adult men have emphysema and COPD. The women population that are affected by the disease is 1 to 3%. In the study conducted in the United States, similar generalization was made on the prevalence between the male and the female population. Based on the study conducted, 8 to 17 percent of the recorded cases are men while 10 to 19 percent are women (Halbert, Natoli, and Gano, 2006; Sharma, 2006). In relation to the types of cases COPD cases, there are 14.2 million recorded cases in the United States. The cases of chronic bronchitis are 12.5 million and the 1.7 million people have recorded emphysema. The recorded cases are observed to increase in percentage from the period starting in 1982, which is 41.5%. In considering the occurrence worldwide of these diseases the chronic bronchitis comprises 6.4% and 1.8% for the emphysema cases. The COPD cases on the other hand reach 7.5 percent of occurrence (Halbert, Natoli, and Gano, 2006; Sharma, 2006). Although there are wide range of studies being undertaken and was conducted in relation to COPD and respiratory diseases and 12.1 million COPD cases in 2001 that was recorded, there is still a large percentage of unrecorded cases. In the study conducted by the National Heart, Lung, and Blood Institute, approximately 24 million people are not properly being given cure to COPD (2003). Mortality and Morbidity The effect of COPD in the population can be determined by the mortality rate in relation to the disease. In this case the prevalence of the COPD can be related to the percentage of cases that can result to this disease. The recorded cases of death in ages 25 and above, there are an estimated 119,000 death. The trend of deaths in relation to COPD was changed in 2000 when the cases of mortality in women exceeded that for men (Halbert, Natoli, and Gano, 2006; NHLBI, 2003). In the United States, the study conducted showed a higher percentage of males out of the 100,000 under studied which 200 or 0.2% while on the other hand there are 80 out of the 100,000 patients that had died due to COPD. Cases of mortality due to COPD in countries worldwide are also recorded. The highest percentage of death in Romania that can be attributed to airflow obstruction is 400 out of the 100,000. In Japan, there is 100 mortality that is attributed to COPD out of the 100, 000 population affected with COPD. It is regarded as being in the fourth place of conditions that causes death in the United States. Studies on the disease showed that in the year 2020, COPD can climb to the third place for diseases that can cause the highest frequency of death (Halbert, Natoli, and Gano, 2006; NHLBI, 2003). Emergency Cases Being one of the diseases that required immediate attention in cases of attack such as in times of difficulty in breathing due to obstruction, the occurrence in the Emergency Department is one of the primary steps in gathering data. In the data presented by the National Heart, Lung, and Blood Institute, there are approximately 1.5 million cases of emergency incidents attributed to COPD in 2000. These cases cover the ages from 25 years old to no upper age limit. In the comparative study between made and female, there are more emergency cases in the male population compared to the male. The specific figure depicts that there is an almost 200,000 difference in the figures between male and female cases. The female comprise 898,000 emergency cases related to COPD while the male population has a total of 651,000 recorded cases (2003). On the other hand the cases that were taken cared of in the emergency department can be admitted and, thus, the hospitalization percentage is also studied. Based on conducted studies, there are approximately 726,000 cases that are admitted in 2000. In relation to a higher frequency of the female population that sought out emergency care there are also a higher number of cases admitted due to COPD. This reaches to 404,000 females and 322,000 male COPD cases (NHLBI, 2003). Methodology In the study that was conducted, a particular patient was observed and the pertinent information was noted. This is conducted through the observation of patients in the Emergency Department. The vital symptoms were considered and certain parameters were taken into consideration. The chief complaints of the patient were primarily noted. This is to be able to determine the primary conditions of the patient that needed immediate care such as exacerbation. The history of the patient health conditions was then noted to be able to determine the background information for possible diagnosis, recommendations, prescriptions and any contraindications. In this case the ailments that are related to the present condition can be properly attributed. One method that can be done is to make a review of the parameters that can be tested such as diagnostic indications of the present illness. This can be related to the past diseases and ailments of the patient (Ferguson and Cherniack, 1993). Diseases that are not directly related to the respiratory system are also taken into consideration for the prescription and recommendations that is given to the patient. Prior to the treatment though diagnostic examinations are given to be able to determine possible underlying causes of the disease. This includes laboratory examinations, vital signs and pulmonary tests. The laboratory examinations include blood sampling that can determine the physiological condition of the patient. Other parameters such as hematocrit can also be monitored in patients with this ailment. Some vital signs can also be observed in the blood such as presence of infection that can be detected through the percentage of blood composition. Aside from the examination of the blood components, the physical examination is also detrimental to the baseline information that is needed for the detection of the health state of the patient. The physical information includes the body temperature, the pulse and heart rate and chest examinations. The measurement of heart signs such as ECG can also determine the stress that is related the present illness. Other essential tests that are spirometry and pulmonary function test (Ferguson and Cherniack, 1993). Upon the preliminary determination and analysis of the results of the diagnostic tests that was undertaken the diagnosis is given both for the Emergency Department and in the follow-up medical support that is required. Analysis of the particular case under study was on the basis of the guidelines and standards system set by the National Institute for Clinical Excellence (NICE, 2004). Results Background Information and Medical History of the Patient The primary data needed to determine the condition of the patient is the data related to COPD. The patient which is a 71 year old male was taken to the emergency care due to difficulty of breathing (DOB) caused by recurring chest pains for almost 2 months. The particular episode took longer time before subduing which is more than 5 minutes, thus, primary care was sought out. The past and present smoking habits of the patient were determined. He confirmed that he has a history of being a smoker with almost one third of a cigarette pack consumed daily that was ceased 5 yrs ago. This contributes to the high risk factor of the patient to COPD. Although the habit was stopped, there had been an accumulation of agents in cigarettes that were activated. The capacity to conduct tedious tasks was also significantly reduced, even walking a few meters or up a flight of stairs. In addition to the chest pains, he also has a recurring cough for more than two months and with sputum production. Physical Examination The initial baseline information on the present condition of the patient was taken. This information includes the vital signs such as body temperature, blood pressure, heart and respiratory rates. The general physiological appearance of the patient was also taken into consideration. The result presented in Table 1. Table 1. Results of the physical examination of the patient. Parameters Results Body Temperature 98.6 Pulse Rate 82 Respiratory Rate 19 Blood Pressure 150/82 General Observation Fully conscious, alert and have orientation of the surroundings Chest Radiography Hazziness observed Extremities There are minimal oedema that can be observed The results of the baseline parameter are normal. The blood pressure is normal and no indication of high blood pressure. The body temperature, on the other hand is also normal, thus, showing that the patient has no fever which is a sign of possible infections. The respiratory rate of the patient is above the normal rate which is 16 breaths per minute. Thus, further respiratory examination was done. Upon physical examination, the skin of the patient appears to be bluish in colour skin due to lack of oxygen in the skin and some inflammation and accumulation of fluid in diff body parts which are symptoms of chronic bronchitis which falls under COPD. The patient was also ask to cough out sputum and examined along with blood sample. Results showed high percentage of macrophages in the sputum that affirms chronic bronchitis. Blood sample on the other hand were taken to determine other underlying diseases such as pneumonia. Results came back negative though. The chest of the patient was also examined and puffing and murmuring sounds were heard that is also another indication of chronic bronchitis. This breathing sound is due to the excessive accumulation of sputum in the air passages. Pulmonary Function Test Results using Spirometry Spirometry is the test used to be able to focus on the level of the COPD of the patient. The spirometry test revealed a moderate obstruction in the breathing process a post bronchodilator measurement of slightly below 0.65 FEV1/FVC was measured. Spirometry measures the ratio between the forced expiratory volume in the first second and the forced vital capacity in maximum inspiration. The sputum of the patient was also tested and revealed a high macrophage component. Radiograph Tests The results of the Chest x-rays showed dirty lungs. The lungs appear to have many markings due to dense walls of airways that contain excessive sputum. Although this test can validate the possible diagnosis, it is not recommended for diagnostic examination because the disease can only show symptoms that can be detected in the x-ray at the latter stages of the disease which has the possibility that the patient already know the disease. Treatment To be able to monitor the development of the patient, he was admitted. This will also enable to further study other possible underlying ailments that are not given enough attention. Follow-up examinations were conducted. Another session of bronchodilator was made. This second session used a long acting beta agonist that gave a positive result. The spirometry reading increased to 0.72 FEV1/FVC. The treatment that was conducted uses a levelled approach that increases the duration or the doses to be able to treat the patient's condition. Bronchodilators are the primary treatment because it causes airways to open and allow for increase in respiration. The patient was first given an anticholinergic ipratropium (Atrovent) administered through metered-dose inhaler. Minimal response was observed, thus, a beta agonist was added. This improved the respiration of the patient; hence the next level of treatment was not needed such as anti-inflammatory agents corticosteroid and even surgery. On the other hand, treatment of associated conditions was undertaken. Expectorant, specifically guaifenesin, was given to treat coughing and excessive sputum. This is administered due to the fact that patient did not experience acute exacerbation. In cases that a patient experiences such conditions it can have negative effect because it can result to significant decline in lung function. The Possible Side Effects In cases such as COPD, wherein there is a high level of mortality, the responsibility of the physician in the treatment plan administered to the patient is important. One factor that can be considered is the fact that the levelled treatment requires reaction of the patient which is usually the improvement in the condition. This can only mean that observation and monitoring is detrimental in this process. Another reason is the cases of end life treatment which increases the accountability of the physician not only in the treatment process that all the time considers the possibility of the death of the patient but also the proper communication with the relatives on the condition of the patient. Possibilities of side effects of the medicines that are administered are needed to be explained. Some side effects of anticholinergic agents are haziness in vision and difficulty in urination. For beta agonists on the other hand, results can be headaches, restlessness and anxiety. Contraindications are important. Anticholinergics are not recommended for those patients that have sensitivity for soy and peanut products. Beta agonists on the other hand are not recommended for patients that take other medications due to possibility of reaction. Discussion On the basis of the condition observed from the patient under study, there is a complex interaction in the diagnosis and the ailments that have to be considered. The particular patient was taken into emergency care due to chest pain and cough. This can be due to different factors both related to his health history and the present health condition. The primary focus of the study is the case of progressive COPD of the patient. This can be attributed to the habit of smoking and drinking contributed largely to the health conditions that are detected in his system. This is the primary cause of the weakening of the respiratory system and ultimately the cardiac system. The attention on the cases of COPD was due to the factors that hade contributed to the need for the treatment. The primary reason is the progression of the disease that can endanger the health of the patient as attributed to the need of the patient to be given emergency care. The age of the patient is also an important consideration and the fact that he is diagnosed for many underlying diseases (Blonshine and Fink, 2000). Due to the symptoms observed such as difficulty of breathing and excessive sputum production, pulmonary test was conducted. Spirometry is the most essential examination to determine the severity of the COPD. It measures the volume capacity of the lungs. The lower the percentage of air inhaled compared to the total capacity, the higher the obstruction present in the airway. Based on the result of the spirometry test of the patient, the formerly diagnosed mild COPD had developed into a moderate case, which is 0.65 FEV1/FVC. It belongs to the 50-75% moderate range. The mild and severe COPD ranges are >0.75 and Read More