Management of Chronic Obstructive Pulmonary Disease - Article Example

COPD management Objectives This presentation has a broad objective of describing COPD and enhancing an in depth understanding of the disease. The presentation shall provide different definition of COPD as per different scholars as well as highlighting the causes, Pathophysiology, signs and symptoms. In addition, the article shall describe the management of COPD that shall entail preventive measures, available treatment and rehabilitative measures of people living with COPD. Since COPD is a chronic illness, nurses deem to have a pivotal role in helping the patient to cope with the disease. Therefore, this article shall describe the various role of a nurse in people living with COPD. Moreover, the article shall describe various methods of health promotion among COPD patients and interventions to prevent COPD. Rationale of the study The topic was chosen because of the continued increase in prevalence of the disease in the United Kingdom and in Peterborough according to the national statistics of 2011, whereby it was reported in males above 16 years (4.11%) and in females above 16 years (2.3%) (Health and Social Care Information Centre 2014). In addition, (Anzueto 2010) noted that smoking is in the rise among young adults living in UK and Peterborough in particular. They practice the act as a sign of fashion as well as peer pressure but in deed it has got a detrimental life impact. Moreover, WHO has predicted that COPD will be the third most common cause of death by 2030 accounting for 8.6% of all mortality globally (Health and Social Care Information Centre, 2014). Epidemiology and health inequalities It is approximated that more than 3 million people are currently living with COPD in United Kingdom and about 900000 people have been diagnosed with the disease (NICE 2010, P 4). The low number of individuals diagnosed has been due to the assumption of cough as a minor ailment. COPD is ranked as one of the most common disease that causes emergency admission and readmission in UK hospitals (NHS, 2014). NICE report of 2014 showed that COPD accounted for 30000 deaths annually. Haughney et al. (2014), argue that cigarette smoking is the primary cause of COPD; however, Berry & Wise (2010) stated that COPD has been adversely seen in individuals who are non smokers. He identified some of the environmental and occupational factors such as dust, chemicals and other air pollution agents. Sin et al. (2006), stated that diagnosis of COPD should be considered primarily to patient who are over the age of 35 years, however, this argument was challenged by Sin et al. (2006), who noted that COPD can be diagnosed in patients who were as young as 18 years. He stated that, despite age was a factor to consider while diagnosing COPD, lifestyle of an individual played a major factor in causing COPD (Thorn et al. 2012). A study conducted by Huertas & Palange (2011), on the predisposing factors of COPD showed that 15% of all cases were work related and it was concluded that smoking was not the ultimate cause of COPD. Dr David Bellamy a member of the British thoracic society noted that one out of 10 young adults living in UK have early symptoms of COPD and recommended that necessary strategies should be put in place to diagnose the disease early. The health and social care information centre 2015, indicated that one in five adults in UK, approximately 20%, aged above 16 years is a smoker. In 2013, it was estimated that 17% of all deaths of adults aged above 35 years was due to smoking, and this figure has not changed since 2005. (Health and Social Care Information Centre, 2014). The graph below shows prevalence of smoking in UK as per different age groups. Note that majority of individuals who smoke are young adults. Prevalence of Smoking of the hand rolling tobacco in UK In another study carried out in UK, it revealed that there is a steady increase of hand rolling tobacco at home (Health and Social Care Information Centre, 2014). According to a report by the Department of health 2010, Peterborough was leading in cigarette smoking at a prevalence rate of 27% among adults, which is significantly higher than regional figures. It was noted that cigarette smoking was higher among low-income groups that was prevalent at 30% men and 20% women (Health and Social Care Information Centre, 2012). The graph below shows the prevalence of hand rolling tobacco Prevalence of COPD in Peterborough According to the department of public health 2011, prevalence of COPD in Peterborough in individuals who are above 16 years was 3.19%. Male aged above 16 years had prevalence of 4.11% while in females, the prevalence was 2.3%. There was a great disparity in the prevalence of COPD as per different races. For example, the prevalence was 3.32% in white, 3.05% in black and 1.85% in Asian. It is imperative to note that there was a disparity of prevalence as per age group: Age group aged 16-44 years had a prevalence of 1.18%, 45-64years had prevalence of 3.89%, 65-74 years had a prevalence of 7.97% and above 75 years had a prevalence of 8.23% (Health and Social Care Information Centre, 2012) What is COPD? Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction that is only partly reversible, inflammation in the airways, and systemic effects or co-morbidities (Decramer et al. 2012). The National Institute for Health and Care Excellence (NICE) guidelines (2010) defines COPD as a disease that is characterised by airflow obstruction, which cannot be fully reverses and progressive in nature. The parenchyma damage is different from that seen in asthma and is usually as a result of smoking (Rennard et al. 2013). Causes and predisposing factors to COPD Smoking has been is the most dominant cause of COPD, however, other occupational hazards such as working in dusty places, in chemical industries, cement industries may as well predispose an individual to develop COPD. Some studies have linked COPD to be hereditary since it may be seen in certain familial lineage; however, there is no gene that has been pin pointed to be predisposing an individual to COPD (Edition 2010). Childhood respiratory illnesses predisposes a person to COPD because of the damage of the bronchi (Niewoehner 2010) Signs and symptoms Productive cough is one of the major sign and symptoms of COPD, which is usually worse in the morning. At the beginning, the sputum is small in amount but gradually increases. Chest pain, breathlessness and wheezing are usually present in the advanced stage of the disease (NICE guidelines 2010). In addition, occasionally the patient may suffer from tachypnea and respiratory distress (Casey, D. et al., 2011). The advanced signs and symptoms are due to poor tissue supply with oxygen (Bellomi et al. 2010). Pathophysiology COPD causes the airway to constrict and block air flow and it reduces the ability of the lungs to take in oxygen and expel carbon dioxide (Tuder & Petrache 2012). van der Molen et al. (2013), states that as the disease advances, the elasticity of the small air ways are lost. The airways then collapse and close off some of the air passage ways as well as narrowing the large air ways (Tashkin 2010). The continued inflammatory process in the bronchial tree leads to secretion of mucus that clog the airway thus causing an irreversible airway blockage (O’Donnell & Parker 2006). In addition, the mucus secreted provides the best breeding site for bacteria that usually cause pneumonia. This Pathophysiology process of COPD leads to cough, wheezing and difficulty in breathing (Brooke 2013). Treatment of COPD Broncho dilators are medications that cause the relaxation of the smooth muscle of the bronchioles thus making the airway to be patent (Tashkin & Cooper 2010). Anticholinergic bronchodilators are commonly used in COPD and they exist as short and long acting, which can be used in COPD (Tashkin & Cooper 2010). Corticosteroids usually help in reducing inflammatory process in the bronchus. For example, dexamethasone (Roche et al. 2011). Antibiotics helps in eliminating bacterias that continuously multiply in the mucus plug in the bronchus. For example, cephalosporins (Berry & Wise 2010). In severe cases oxygen therapy is administered nasally to boost oxygen availability to the body tissues (Odell et al. 2009). Exercise is essential as it helps in clearing the airway (Langer et al. 2009) What is health and health promotion? WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1948). Ottawa charter of 1986 defined Health promotion as “the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions” (Hills & McQueen 2007) Levels of health promotion Primary prevention aims to prevent disease before it occurs. This is done by preventing exposures to hazards that cause disease, altering unhealthy or unsafe behaviours that can lead to disease. For example vaccination. Secondary prevention aims to reduce the impact of a disease that has already occurred. This is achieved by detecting and treating disease soon as possible to halt its progress, and encouraging personal strategies to prevent more damage (Meijer et al. 2013). Tertiary prevention aims to soften the impact of an ongoing illness that has lasting effects. This is done by helping people manage long-term, often-complex health problems (cottrell, & mckenzie, 2011). Health promotion model (HPM) The nurse has a major role in influencing and changing the behaviour of an individual to adopt healthy living lifestyle. The predetermined behaviour outcomes are based on the need assessment by the nurse and regarded as the core elements of health care activity. The top-down behaviour change model is anchored on the principle that self management of a disease is achieved through top- down awareness, where the nurse significantly teach the patient on the right healthy behaviours. Piper, (2009) study postulated that Access the health needs of the patient and reassuring patient about the quality of health care professionals help to achieve patient co-operation thus making it easier for them to perform their role. Moreover, nurse as a behaviour change agent will be valid when people understand the relationship between physical and mental disease, risk factors and lifestyle. Halpern et al. (2004) stated that several health outcomes are related to lifestyle behaviours such as exercise, diet, smoking and consumption of alcohol. Therefore, the nurse as a behaviour change agent prescribes the desired behaviours and lifestyles regarding specific disease. The primary objective is to make people control and regulate their unhealthy behaviours as well as correct any inadequacies by telling them the risks they face if they fail to change from unhealthy lifestyle. Even though individuals are free to make rational decisions regarding their health related behaviours, these behaviours are the primary determinants of disease. In this regard, nurses need to disseminate health information that are selectively derived from medical research to an individual about the risk factor associated with the disease. This can be achieved through mass media awareness campaigns on selected health topics. The message can contain images that scare, or what might happen to an individual who fail to conform and adopt healthy lifestyles. Piper, (2009) outlines some of the methods in which health messages can reach the target group and they include posters, leaflets, videos and display racks. These resources are strategically placed in various places to reach the target groups such as in waiting rooms, pubs, church entrance among others. However, Halpern et al (2004) noted that provision of information without guidance has failed to change the health related behaviours in majority of the population. Therefore, nurses have to be concerted and methodical while delivering the information, thus should do a follow up and perform a face to face counselling with the target group. Interventions: UK Government strategic policy /plans intervention The government has started implementing the tobacco display provision in the health Act 2009 for large shops from 2012. This legislation helps to reduce the promotion and packaging of tobacco in the country whereby there shall be an end to open tobacco display. A full implementation of this law shall reduce the number of new smokers thus ultimately reducing COPD. The government has continued to defend the legislation regarding protection of second hand smokers. The bylaws have made it illegal to smoke in public areas, but at designated smoking zones only. This shall cushion the public from second hand smoking, which predisposes them to COPD (Department of Health et al. 2011). The government introduced the smoke free legislation that extend to private vehicles carrying children whereby there will be no smoking in vehicles carrying children, moreover, there will be no selling of nicotine inhaling products including e-cigarette to persons under age of 18 years and the laws shall come into force by October 2015 (Department of Health et al. 2015). Introduction of other nicotine mimickers like the nicotine patch have helped smokers who have COPD to quit smoking. Moreover, the government annually increases the tax on tobacco products such as cigarettes. This has helped in making cigarette less affordable to the public thus indirectly reducing the number of smokers. Social groups have been instituted to help in involving youths in various better healthy practices and make them understand that smoking is not a normal behaviour, thus reducing the likelihood of them becoming smokers (Sharif et al., 2013). Sales of tobacco from the vending machine are being prohibited since it increases the chance of several young person’s engaging in smoking behaviours. It is argued that by ending this source of tobacco then the number of young people involved in smoking shall greatly reduce (Department of Health et al. 2011) Nurse’s role in COPD The nurse has a pivotal role in provision of health education regarding the best ways of coping with the disease (Raingruber 2014). Aerobic exercises have been noted to be very imperative in assisting patients to develop good breathing patterns (Gloeckl, Marinov & Pitta 2013). In addition, the exercises help in strengthening specific muscles and improve the functional capacity of the lungs (Divo et al. 2012). The education sessions is aimed at covering the pathology as well as drug therapy including other practices that prevent exacerbations such as proper nutrition. In addition, Disease education helps to reduce anxiety and depression (Barnes 2014: Lamers et al. 2010). The nurse can form support group of people who are having COPD within the community as this shall help them to share in their experiences (Raghavan et al. 2012). The nurse enhances patient capacity to accept their status and perform the daily activities to enhance healthy life (Richardson 2008). The nurse must involve the patient family in management of COPD by educating them on the Pathophysiology as well as changes that may occur in the body (Bourbeau et al. 2006). The nurse shall provide the patients with nicotine patch to help them quit smoking and ensuring that the clients receive annual flu vaccination (Booker 2011). The vaccination helps in protecting individuals suffering from COPD against recurrent attack by pneumonia. The nurses must be committed to all the services she/he is providing to the patient to achieve a robust patient cooperation and expected outcome (NHS, 2014). Making every contact count is another approach that the nurse shall employ in encouraging all members of the public he/she comes across during service delivery. The nurse shall discuss with the client on healthy lifestyle such as cessation or avoidance of smoking, healthy eating habits and avoidance of alcohol abuse. By doing this, several members of the public shall receive the necessary health information (Percival 2014). In overall, nurses have an integral role to play by provision of holistic care to improve the health of the patients, moreover, compassionate and competency is required during service delivery through evidenced based manner (Bourbeau et al., 2006: Fletcher & Dahl 2013). Conclusion Strategy et al. (2010) stated that COPD is a life threatening disease that must be managed appropriately. The symptoms of the disease include cough, wheeze and chest pain (NICE 2010, P 10). When it has progressed it presents with swollen extremities, dyspnoea and weight loss (Jones et al. 2010). Management include cessation of smoking, exercise, bronchodilators, antibiotics and psychological support (Price et al. 2011). Health promotion model as postulated by Piper, offers one of the best ways of promoting healthy living styles among individuals with COPD (Piper 2009). 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