Measures for Exacerbation of COPD - Case Study Example

The Normal of COPD is punctuated by Increasing Frequency and Severity of Exacerbations Table of Contents I. Introduction ................................................................................................... 3 II. Significance of Exacerbations of COPD in Terms of its Effects On Patients and the Health Care Service Provider ..................................... 3 a. Effects on the Patients ..................................................................... 3 b. Effects on the Health Care Service Provider ........................ 4 III. Available Pharmacological Options for the Management of an Exacerbation of COPD in the Community ............................................ 5 a. Bronchodilators ............................................................................... 5 b. Vaccination ...................................................................................... 6 c. Antibiotics and Steroids .................................................................. 7 IV. Available Non-Pharmacological Options for the Management of an Exacerbation of COPD in the Community ............................................ 8 a. Promotion of a Healthy Lifestyle .................................................... 8 b. Pulmonary Rehabilitation ............................................................... 8 c. Oxygen Treatment ........................................................................... 8 d. Lung Surgery ................................................................................... 8 V. Conclusion .................................................................................................... 9 References .............................................................................................................. 11 - 15 Introduction According to NCCCC (2004), Chronic Obstructive Pulmonary Disease (COPD) is usually characterized by progressive airflow obstruction often caused by cigarette smoking or other airborne irritants such as coal dust, asbestos, solvents including meat preservatives containing nitrites. COPD cannot be reversible by treatments and is considered to be the third major cause of mortality and morbidity throughout UK. (Crockett, 2002; Barnes, 1999) As of 2004, almost 900,000 individuals in UK have been diagnosed with COPD. (NCCCC, 2004) Exacerbations related to COPD are known to be a major cause of worsening the symptoms causing a serious impact on the patients’ quality of living. Exacerbation is a serious health condition that could lead to the loss of lung normal functions. (Prince et al., 2004) For this reason, patients that are experiencing exacerbations may be hospitalized and need to go through a long period of recovery. For the purpose of this study, the researcher will determine and discuss the significance of exacerbations of COPD in terms of its effect on the patients and the health care service providers. With regards to the proper management of exacerbations, the researcher will highlight the available pharmacological and non-pharmacological options for exacerbations. Significance of Exacerbations of COPD in Terms of its Effects on Patients and the Health Care Service Provider Exacerbation is defined as the increased in dyspnea, coughing, or sputum expectoration that needs serious medical intervention. (Pauwels et al., 2001) Effects on the Patients Exacerbations in patients with COPD are usually associated with a major decline in the long-term quality of the patients’ life and their lung functioning. (Donaldson et al., 2002; Seemungal et al., 1998) Although the etiology and mechanisms behind a severe COPD exacerbations are not clear, several studies have shown that infections caused by bacteria (White, Gompertz, Stockley, 2003; Sethi and Murphy, 2001) and virus (Rohde et al., 2003; Seemungal and Wedzicha, 2003) are present during an increase frequency of exacerbations. Exacerbations related to COPD are often associated with the increase in airway inflammation related to eosinophilia (Fujimoto et al., 2005; Zhu et al., 2001), neutrophilic (Aaron et al., 2001; Stockley et al., 2000; Sethi et al., 2000), and neutrophils in bronchial biopsies (Qiu et al., 2003). These factors may contribute to the patient’s dyspnea or difficulty in breathing. In line with this matter, it has been reported that roughly 25% of COPD patients have reported having experienced a profound total body pain. (Lynn et al., 2000) Due to the fact that most of patients with severe COPD may experience exacerbations, some patients may experience anxiety due to their functional limitations and hunger for air. Some patients who are not able to handle this kind of situation may end up committing suicide. (Hunter and King, 2001) Effects on the Health Care Service Provider According to NICE guidelines, a multidisciplinary team which includes respiratory nurse specialists and nutritionists working on the case of exacerbating patients with chronic COPD is proven to be more effective than having a single person to provide health care services to these patients. (NCCCC, 2004) Other possible members of the team include dieticians, exercise specialists, doctors, nurses, physical therapists, and respiratory therapists. (NHLBI, 2007) It is more likely that the patients will receive more care-related benefits from a team approach. Basically, the job of the health care providers on COPD exacerbating patients should always be alert in case the patient suddenly needs medication in order to normalize their breathing patterns. Since COPD patients has a tendency to be emotionally disturb, the health care providers should be able to effectively provide the patient with counselling in order to eliminate the emotional burden the patient may be experiencing. Available Pharmacological Options for the Management of an Exacerbation of COPD The guidelines of National Collaborating Centre for Chronic Conditions (NCCCC) stated that the frequency of exacerbation can be reduced with the use of bronchodilators; inhaled steroids such as beclomethasone, mometasone, and fluticasone; and vaccinations. (NCCCC, 2004) Inhaled β2 agonists, inhaled anticholinergics, and corticosteroids usually provide short-term benefits to COPD patients. (Hunter and King, 2001) On the other hand, the use of methylxanthines should be avoided. Even though the use of methylxanthines could improve the functioning of the patient’s diaphragm, this drug could be a potential toxic due to serious drug effects. (Heath and Mongia, 1998) Bronchodilators Bronchodilators such as β2 antagonists, M3 muscarinic antagonists, and cromones are usually used in clinics to relax the smooth muscles of the airway in order improved functioning of the airflow. (American Thoracic Society, 2005) It was reported that most patient breaths better after taking bronchodilators. Inhaled β2 antagonist such as Salbutamol (Ventolin) is considered as a front line therapy and is commonly used to provide immediate relief to COPD patients. Other β2 antagonists include Bambuterol, Clenbuterol, Fenoterol, and Formoterol. Salmeterol, although it is known to provide longer acting β2 antagonists, is considered as a secondary therapy due to its slow relief for dyspnea. The use of Salmeterol is normally used with concomitant corticosteroid since the use of Salmeterol could decrease sensitivity to inflammation. (MedWatch, 2003) Inhaled M3 muscarinic antagonists (Anticholinergics) such as Ipratropium, when used with β2 antagonists Salbutamol, is known to provide effective relief for COPD. (Messer, 2001) Antimuscarinics are usually inhaled in the process to prevent endocrine and exocrine M3 receptors. Tiotropium also provides an improved result of M3 muscarinic receptors. Cromones such as sodium cromoglicate and nedocromil are inhaled stabilizers of mast cells that could help prevent, reduce and minimize the production of histamine including other factors that could trigger inflammation of the airways. (Andersen, 2005) This type of medication is best for mild breathing difficulties that may be caused by asthma. Vaccination It is advisable for patients with COPD to be vaccinated with influenza (Murphy et al., 2000), pneumococcal, and other viral and bacterial related diseases in order to prevent the possibility of death to occur. (NHLBI, 2007; American Thoracic Society, 2005) Considering that the body resistance of COPD patients have already declined significantly, it is best to protect them from possible diseases due to infections. Antibiotics and Steroids Corticosteroids also known as steroids normally act on inflammation and could improve the airway functioning as well. (Andersen, 2005) Even though the use of antibiotics and steroids is less evident on its effectiveness, NCCCC (2004) still recommends and encourage the use of self-management at home in order to treat common pathogens such as Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhalis. Antibiotics such as doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin-clavulanate potassium are commonly used to treat mild to moderate exacerbations of COPD. In case of severe exacerbations of COPD, augmented penicillins, fluoroquinolones, the third-generation cephalosporins or aminoglycosides are normally used as a treatment. (Hunter and King, 2001) Since infection is frequently associated with exacerbation among the COPD patients, it is necessary to treat the cause of infection and its consequences such as antiviral agents for rhinoviruses and RSV. (Pauwels et al., 2001) However, the use of a specific antibiotic and antiviral therapy is not always appropriate since there is a possibility that the bacteria or the virus to increase its immunity with the antibiotics. Anti-inflammatory steroid therapy is also used to treat COPD exacerbations. (Aaron et al., 2001) A recent research study suggests the possibility that the suppression of inflammation could remove the presence of bacteria and eventually improves the symptoms and the abnormality in the functioning of lungs associated with COPD exacerbations. (Papi et al., 2006) Available Non-Pharmacological Options for the Management of an Exacerbation of COPD Promotion of a Healthy Lifestyle A regular exercise, proper diet, weight loss among the obsess individuals, and cessation of smoking are among the few ways in which COPD patients could properly manage exacerbations. Pulmonary Rehabilitation Pulmonary rehabilitation is a treatment program for patients who are experiencing COPD exacerbations. This type of rehabilitation program includes pulmonary disease management, counselling, nutritional guidance, and the promotion of exercises in order to improve the overall health and wellness of the COPD patients. (NHLBI, 2007) Based on a research study, COPD patients who have undergone pulmonary rehabilitation shows sign of relieve in breathing difficulties, fatigue, as well as improvement in the patients’ sense of control over their emotions concerning the disease. (Lacasse et al., 2006) Oxygen Treatment It is possible for some COPD patients to have a very low level of oxygen in their blood. In this case, the physician may advice the patient to receive oxygen treatment to ease the shortness of patient’s breath. Depending on the severity of the patient’s case, it is possible for the physician to recommend the patient to receive extra oxygen each day for more than 15 hours in order to protect their heart and other internal organs from getting damaged and allow them to get enough rest each night. (NHLBI, 2007) Lung Surgery In some cases wherein the patient with severe COPD are having difficulty in breathing which could no longer be cured by simply taking some medication, physicians may recommend either one of the two types of surgery: bullectomy wherein the surgeon removes one or more large bullae from the lungs of patient with emphysema; or lung volume reduction surgery (LVRS) wherein the surgeon remove a section of the damaged lung tissue with emphysema. In rare cases, it is also possible to conduct a lung transplant provided that the patient with severe COPD could find a donor with a healthy lung. (NHLBI, 2007) Conclusion It is necessary to treat acute COPD exacerbations at an early stage in order to reduce the long-term possible complications. Among the available pharmacological options for the management of an COPD exacerbations include the use of bronchodilators such as β2 antagonists, M3 muscarinic antagonists, and cromones; inhaled steroids such as beclomethasone, mometasone, and fluticasone; and vaccinations for influenza and pneumococcal. Inhaled β2 agonists, inhaled anticholinergics, and corticosteroids usually provide short-term benefits to COPD patients. The use of methylxanthines should be avoided. Even though methylxanthines could improve the functioning of the patient’s diaphragm, this drug could be a potential toxic due to serious drug effects. Antibiotics such as doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin-clavulanate potassium are commonly used to treat mild to moderate exacerbations of COPD. In case of severe exacerbations of COPD, augmented penicillins, fluoroquinolones, the third-generation cephalosporins or aminoglycosides are normally used as a treatment. 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