Advanced Chronic Obstructive Pulmonary Disease - Essay Example

?Introduction In medical profession, health promotion is an important component of the holistic healthcare provision. WHO (2008) defines health promotion as “the process of enabling people to increase control over and to improve their health”. This paper examines health promotion for patients suffering from advanced chronic obstructive pulmonary disease (COPD). In the 21st century, the need for health promotion in society has become more important than ever before. Rennard(2008), argues that a combination of factors such as lifestyle, the level of income, education level, environment among other factors are increasingly playing a critical role in determining health status of people in the society. Chronic obstructive coronary disease is one of the ailments caused by a combination of factors, including smoking tobacco and exposure to dust and particles in the workplaces and in the environment. Health promotion is therefore a critical component in prevention and management of chronic obstructive pulmonary disease in the society by empowering people and formulating relevant public health policies. This paper is divided into three main sections. The first section is a detailed examination of health promotion. The second part is an in depth analysis of chronic obstructive pulmonary disease (COPD). The final part discuses health promotion for patients with advanced chronic obstructive pulmonary disease. In the Ottawa Charter, health promotion is the process that enables people to take control of the various factors that determines health, which eventually leads to improvement of their health (WHO, 2008). Health promotion therefore comprises of concepts and pragmatic strategies, necessary for addressing the key health problems affecting various parts of the world. This concept addresses all types of diseases, including contagious and non-contagious ailments in addition to the various underlying issues affecting health. Therefore, health promotion is a proactive process intended to empower people to take action on issues pertaining to their health. WHO (2008) notes that it is a participatory process for the people, by people and for people targeting individual members or groupings in the society. Health promotion builds the capacities of individual members in the society to take charge over health determinants collectively in order to attain a positive change. The Ottawa Charter indentified three approaches for health promotion. These include advocacy for health to establish the necessary environment for sustainable health in the community. Enabling all persons to attain optimum health potential is the second approach and finally mediating between various stakeholders and interests in the society with the objective of achieving health. The three approaches are reinforced by five prioritized areas of action, included in the Ottawa Charter of health promotion. These areas include building healthy public policy, establish supportive environment for health and strengthening the community action for health. The fourth priority action area is developing personal skills and finally reorientation of health services (WHO, 2007, pp2-4). Health promotion is a broad and multidimensional approach that involves other stakeholders, besides the basic healthcare providers and this underscores the importance of building a healthy public policy (WHO, 2008). Health promotion policy places health issues on the agenda of policy makers in all relevant sectors and in every level. By so doing, it directs and increases their awareness on the effects of their decisions on public health. Building healthy public policy also enables the policy makers to accept their roles and responsibilities in the maintenance of health in the society. To create an appropriate healthy public policy involves application of diverse methods, including the enactment of laws, formulating monetary or fiscal measures, taxation and encouraging organizational change. According to WHO (2008), the approaches are coordinated leading to health, and improvement of social economic factors which encourages creation of a more equitable society. There are eight basic conditions and resources essential for health in society. They include peace, which results from adequate security, habitable and clean shelter, education, food and income. Others include availability of a stable ecosystem, sustainable resources and social justice in addition to equity (WHO, 2008). Creation of a healthy public policies results to production of safer and healthier products and public services in addition to cleaner environments that enhance quality of life of the inhabitants. Health promotion policy requires the policy makers to indentify the inherent health challenges that impede adoption of healthy public policies in sectors that are not related with health with an objective of removing the hindrances (Nicola and Amir, 2010). Creation of supportive environments for promoting health is an important component of establishing an ideal environment for health. The contemporary society comprises of diverse and interconnected factors, which makes it impossible to isolate health from other objectives. The connections between the environment and people form the foundation of formulating a “socioecological” approach to health (WHO 2008). Taking care of each other in the local and global community, protecting our natural environment is the guiding principle of the ensuring healthy coexistence in society. In addition, conservation of our natural environment forms an important component of maintaining and sustaining health in the society (WHO, 2007). A polluted environment creates favourable conditions for breeding and transmission of communicable diseases, and it encourages development or exacerbation of non-contagious diseases such as cancers and chronic obstructive pulmonary disease among others. In addition, changes in lifestyles, work and recreation play a significant role in determining the state of our health. Hence, work, and leisure should enhance but not undermine health of people in the contemporary society. According to WHO (2008), health promotion empowers the society to make conscious actions in creating safe, fulfilling, motivating and pleasant working conditions. Creating supportive working environments also involves systematic evaluation of the health effects of the dynamic working environment. The rapid changes in technology and the related applications in addition to transformations in the workplaces and urban centres necessitate the need for constant evaluation to ensure that they contribute positively to the health of all people in the society (WHO, 2008). Due to the critical role that environment plays, protection of natural and built environments should be addressed in every health promotion program. According to WHO (2007), involvement or participation of the community is crucial for health promotion program to work. Health promotion functions through solid and efficient community involvement in decision-making, setting priorities, planning and executing strategies to improve health. For community to be actively involved, they must be empowered to take control of their activities and attainment of a better and healthy future. The existing human and material resources are essential components of community development (WHO, 2008). These resources promote capacity building through social support, creating flexible mechanisms for enhancing involvement of the public in health related matters. Strengthening community actions also requires availability of funding and current information that should be provided through consistent learning opportunities on health matters. Health promotion facilitates social and individual progression by providing information and health related education that promotes acquisition of important life skills. In the process, it broadens people’s perspectives, enabling them to have wider outlook on issues related to health promotion (WHO, 2008). In addition, the development of personal skills empowers people to exercise greater control of their natural environment and make conscious decisions pertaining to their individual health and other factors that directly or indirectly affect their wellbeing. WHO (2008) emphasize on the importance of continuous learning through out one’s life in order to enhance ones ability of coping with challenges associated with every stage of life. These include chronic illnesses and disabilities associated with the old age. Development of personal skills is done by trained personnel and facilitated in educational institutions, homes, workplaces and other social places. Development of personal skills therefore requires proactive actions that are undertaken by various organizations, individuals and groups with the relevant skills and abilities. Finally, reorientation of health services enables distribution and sharing of health related responsibilities among the various stakeholders. The stakeholders include medical professionals, community groups, government and medical institutions such as hospitals and clinics (WHO, 2007). The stakeholders should not only play their respective roles but coordinate with other groups with the objective of pursuing greater health improvements in the society. Healthcare institutions should have more expanded mandate than just provision of the medical attention in hospitals to support the wider community lead healthier lives. This could be achieved by coordinating healthcare services with environmental, political, economic and other aspects that contributes to acquisition of a holistic and better health. In addition, greater focus to health research and transforming it into a more proactive and focused system, is an important requirement for reorienting health services (WHO 2008, p19-24). In summary reorientation of health services should result to transformation of attitude among all stakeholders towards a more proactive system that addresses all needs of people in the society in order to achieve optimum health levels. Chronic obstructive pulmonary disease (COPD) is a respiratory disorder associated with severe airflow limitation. According to Robert et al (2008) air flow limitation is progressive, but not fully reversible. Airflow obstruction is normally caused by an abnormal inflammatory response of the lungs, especially to toxic particles and gases. Smoking cigarettes is the main cause of chronic obstructive pulmonary disease. However, the disease is preventable and manageable (ATS and ERS, 2006). Chronic obstructive pulmonary disease affects the lungs and RHN (2008) notes that the ailment causes major systemic consequences. Some of the systemic effects include chronic bronchitis and emphysema. Both of these or one of these conditions could be present in patients afflicted with chronic obstructive pulmonary disease. Individuals demonstrating symptoms of persistent coughing, production of sputum or dyspnoea or have long history of exposure to cigarette smoke and other environmental pollutants should be screened for chronic obstructive pulmonary disease. However, the diagnosis of COPD is confirmed using spirometry and a ratio of post bronchodilator FEV1 and forces vital capacity that is less that 0.7 confirms the presence of COPD. In addition, spirometric screening from COPD should be undertaken on individuals with a family history of chronic respiratory diseases. Chronic obstructive pulmonary disease causes severe impairments that drastically undermine the quality of life of the patient (Nicola and Amir 2010, pp 67-68) Although COPD is preventable, Barr, et al (2006) noted that it is the only avoidable disease whose mortality rate is increasing globally. According to ATS and ERS (2006, p 53) COPD is the leading cause of mortality and morbidity in the world. The increasing morbidity and mortality rates associated with the disease impose a heavy financial burden to the global economies. RHN (2008) notes that the prevalence and morbidity rates associated with COPD are significantly underestimated because the disease is usually diagnosed at advanced stages. In United Kingdom, 1% of the total population is diagnosed with chronic obstructive pulmonary disease. However, only 50% of presented patients are correctly diagnosed with the disease in the country (Nicola and Amir, 2010, p141). In addition, only about a quarter of the total patients afflicted with the condition are recognised in the country (Nicola, and Amir, 2010, p144). Because of under diagnosis Nicola and Amir (2010, p169) estimated the potential prevalence of COPD in United Kingdom to be about 3 million people. Globally, the chronic obstructive pulmonary disease is the fourth leading cause of death (RHN, 2008). By 2020, the disease would rank the fifth as world wide economic burden. COPD is the fourth leading cause of death in Europe and United States (Rennard, 2008). According to ATS and ERS (2007, p18), the cost of treating and managing the condition exceeds the expenses associated with management of asthma. Smoking tobacco products is the most significant risk factor for chronic obstructive pulmonary disease in the world although occupational exposures, poverty and genetic constitution contribute considerably to its onset (Punekar, et al 2007). Rennard (2008) noted that the prevalence of COPD increases with age because the disease gradually progresses with time. This explains why over 80% of the total economic burden from chronic obstructive pulmonary disease is recorded on patients aged over 45 years. In addition, patients aged 65 years and above account to over 85% of the total mortality from COPD (ATS and ERS, 2007, p78) The rate of annual hospital admission for patients suffering from advanced chronic obstructive pulmonary disease is about three to four times. The high rate of admission is due to acute exacerbations of the disease, which makes it even more expensive to manage (Knafut, et al 2005). The undesirable effects of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result to poor wellbeing and serious physical incapacity. In addition, loneliness and other psychological problems, including depression and anxiety are some of the major challenges affecting patients with advanced COPD (Nicola and Amir 2010). ATS and ERS (2007) identified eight major challenges that hinder health promotion for patients with chronic obstructive pulmonary disease in primary and community healthcare. Some of the challenges include lack of public awareness about the disease, lack of early screening which hinders health promotion and initiation of preventive programs. Another challenge is lack of detection during the early stages of the disease. Lack of coordination especially in the primary care and fragmented medical response are some of the factors that contribute to poor detection of COPD during the early stages. The fourth challenge is lack of standardization in the treatment, follow-up and management of the disease. Other challenges include the lack of enough skilled staff to take care of patients affected by COPD, and limited access to medical institutions with specialized doctors (ATS and ERS 2007 pp49-55). Secondary care for patients with chronic obstructive pulmonary disease is characterized by several challenges, which include lack of support for patients after their discharge from hospitals. In addition, people responsible for taking care of the discharged COPD patient are not provided with follow up support and necessary medical guidance (Corte, Dordelly and Celli, 2007). Robert, et al (2008) argued that the absence of formal and structured education in primary, community and secondary care for COPD is a major impediment to achieving sustainable health in contemporary society. Another shortcoming is the lack of understanding about the importance of the self-management and advice regarding chronic obstructive pulmonary disease. In addition, the significance of referrals for holistic management and home support for COPD are not acknowledged in the society. Moreover, palliative care requirements for patients suffering from advanced chronic obstructive pulmonary disease are non-existent or not adequately addressed and their choices and independence are ignored (Robert, et al 2008). ATS and ERS (2007, p74) indentified five principles for effective health promotion for patients suffering from chronic obstructive pulmonary disease. They include prevention, early diagnosis and management of stable chronic obstructive pulmonary disease. The fourth and final principles include treatment and support during acute exacerbations and provision palliative care. Prevention of COPD includes primary mechanisms and approaches for reduction of smoking and exposure to second hand smoke (RHN, 2008). Execution of primary COPD preventive approaches requires the involvement of all health stakeholders, including government, community, nongovernmental organizations and other policy makers. This could be achieved through social marketing campaigns that emphasize on changing the smoking lifestyle. The general population and people under higher risks of getting the disease should be specifically targeted by the social marketing campaigns (RHN, 2008). The secondary health preventive strategies include provision of smoking cessation support services (ATS and ERS, 2007). Although ceasing smoking is one of the most effective approaches of managing chronic obstructive pulmonary disease, Barr et al (2006) argued that active smokers in society lack enough support services. Health promotion strategies should involve implementation of relevant policies to ensure that high-risk individuals and the public have accessible support services to help them quit the habit. For example, community pharmacies and drug stores should be allowed to sell nicotine replacement therapy products and other scientifically proven products for reducing addiction among the cigarette smokers. Besides providing supporting services for quitting smoking, appropriate policies that protect non-smokers from being exposed to secondary smoke should be implemented. According to RHN(2008), there is need to formulate strategies to transform the notion of smoking as a lifestyle issue to nicotine addiction, which can be treated using psycho social support and pharmacological interventions. Early diagnosis of the chronic obstructive pulmonary disease is an important strategy of promoting health in the society. Nicola and Amir (2010) emphasize on the importance of providing accessible spirometric services to the communication in order to facilitate early diagnosis of COPD. Early diagnosis of the disease provides health practitioners with the opportunity of initiating early intervention to mitigate the effects of the disease progression (Nicola and Amir 2010). Although many general practitioners are trained in the use of spirometry diagnostic technique, Rennard (2008) argues that the process is time consuming. In addition, challenges in interpretation and analysis of the process have resulted to misdiagnosis of the condition. This implies the need for installing many diagnostic centres especially in highly populated areas. However, this could work in developed countries with adequate medical professions. Therefore, global health promotion to prevent chronic obstructive disease should address the issue of limited diagnostic facilities and work force in developing and least developed countries. Rennard (2008) notes that access to spirometry especially in the private and tertiary health sectors is mostly limited to individuals suspected to have COPD. This practice undermines the major role of spirometry, which is to screen and make new diagnosis of the condition. Robert, et al (2008) argue that this trend has resulted to underuse of spirometry and its accessibility to the public, leading to increasing number of unreported cases of chronic obstructive pulmonary disease in the community. Therefore, it is important to enhance access to diagnostic services in the community to ensure sustainability of health particularly to patients suffering from advanced chronic obstructive pulmonary disease. Management of stable chronic obstructive pulmonary disorder is the third principle of effective health promotion of the disease. Various approaches are available, including pharmacological, pulmonary rehabilitation and long-term oxygen Rx. Other approaches of management of stable COPD include sleep and nutrition (ATS and ERS, 2007). Various effective drugs for COPD are available in the market. According to Punekar et al (2007), pharmacological therapy lessens or eliminates the symptoms, improve exercise capacity and reduce the number and seriousness of exacerbations. In the process, appropriate medical interventions improve the quality of life of a patient with advanced COPD. Drugs for managing COPD are usually in oral and inhaled formulations. Therefore, it is important to educate the patient and caregivers on using the drugs effectively. Oxygen Rx therapy improves the survival, sleep, cognitive functioning and exercise of an individual suffering from advanced COPD (ATS and ERS, 2007). According to NHS (2008), long-term oxygen therapy prevents hypoxia and it reverses hypoxaemia leading to a marked improvement in life expectancy of the patient suffering from COPD. Nutrition is an important component in the management of COPD. This is especially critical in advanced COPD, which results in destabilization of energy and protein equilibrium in the body (Nicola, and Amir, 2010). Nutritional therapy in combination with exercise and other forms of anabolic activities enhances the functional performance of the affected person. However, nutritional therapy should concentrate more on prevention and early treatment of resulting weight loss to ensure a healthy energy balance in the body (Nicola and Amir 2010). Treatment and support during exacerbations is another important aspect of health promotion for patients with advanced chronic obstructive pulmonary disorder. ATS and ERS, 2007, p116) define exacerbations as “an event in the natural progression of the disease associated by a change in the baseline dyspnoea, cough and sputum of the patient, beyond the daily inconsistency, which is enough to merit change in the ordinary management of the disease”. Establishment of community-based services is one way of health promotion for patients suffering from advanced COPD. Rennard (2008) argues that most of mild to moderately acute exacerbations of COPD can be managed at home environment and severe cases requiring advanced medical attention referred to specialized medical institutions. Various factors contribute to exacerbations in patients suffering from COPD. These include exposure to air pollution, unfavourable weather conditions and failure to attend pulmonary rehabilitation and oxygen therapy. Other condition, such as exposure to pathogenic organisms such as virus and bacteria contribute to development of exacerbations (ATS and ERS, 2007). Due to severity of exacerbations, patients with advanced COPD need palliative care, which empowers them with end of life management decisions. Community based support is critical at this stage as it help the critically ill patient to cope with acute dyspnoea. Patients with chronic advanced COPD at the end stage of the disease often become afflicted with incapacitating symptoms of dyspnoea, cough, and depression. Such patients need expert attention from professionals in palliative care (Knafut, et al 2005). Conclusion Health promotion comprises of deliberate and proactive measures driven by people in the society to promote and improve health. The process empowers people in the society to take control over the various factors that determine their health to create a healthier community. The Ottawa Charter laid the foundations of health promotion, which include advocacy, enabling and mediating various factors that determine health. These principles are supported by various community driven activities, including the formulation of relevant policies, creation of supportive environments and building the capacity of individuals to deal with emerging health issues in the society. Health promotion for individuals with advanced COPD involves empowering the community and affected individuals to deal with the various challenges associated with the disorder. Smoking cigarettes and environmental pollution are important causative factors of COPD. To empower the society in dealing with this condition, it is important to have a multidimensional approach that involves formulating policies that control cigarette smoking, protecting the environment and building the capacity of health institutions to deal with the condition. Creating public awareness about COPD, early diagnosis, and management of stable COPD are some of the important aspects of health promotion for patients with advanced COPD. Other principles include treatment and support during acute exacerbations and provision of palliative care. Bibliography ATS and ERS.(2007). Standards for the diagnosis and management of patients with COPD. Retrieved from http://www.copd-ats-ers.org/copddoc.pdf [Assessed on 14 April, 2012]. Barr, R., et al.(2006). Triotropium for stable chronic obstructive pulmonary disease: A meta- analysis. Thorax, 61: 850-862. Corte, C., Dordelly, L., and Celli, B. (2007). Impact of exacerbations on patient-centered outcomes. Chest, 131: 690-703. Knafut, E., et al.(2005). Barriers and facilitators to end of life care communications for patients with OCPD. Chest, 127:2188-99. Nicola, H., and Amir, S.(2010).COPD: A guide to diagnosis and clinical management. New York: Springer. Punekar, Y., et al (2007). 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