Chronic Obstructive Pulmonary Disease Discussion Paper

 What is Chronic Obstructive Pulmonary Disease (COPD)?

COPD is a disorder in which airflow is severely limited and can be classified into two distinct conditions including emphysema (parenchymal disease) and chronic bronchitis (airway disease). It is ranked high among the leading causes of disability and mortality worldwide, and analyst projections foresee it to be the third most prevalent killer by 2020 (Lopez-Campos et al., 2016). Cigarette smoking is one risk factor that is common in development and advancement of COPD.

Symptoms typically develop after a certain level of lung capacity is impaired, and these can vary from 50% to 70%, resulting in additional breathing effort due to such lung changes. Lung functioning is damaged at two or three times the usual level in individuals with COPD Chronic Obstructive Pulmonary Disease Discussion Paper.

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Pathophysiology

COPD arises from the combined mechanisms of peripheral airway restriction and inflammation of the airways. This results in the restriction of airflow and the damage and depletion of alveoli, terminal bronchioles and adjacent capillary tissues and vessels, leading to the restriction of airflow which results in reduced ability to pass oxygen (Campo et al., 2015). The intensity of the irritation, the existence of exudates or secretions and the formation of fibrosis in the airway determine the degree of airflow restriction. Reduced exhalation airflow contributes to gas trapping, leading to decreased inspiratory strength, which may trigger decreased physical performance and exertion to cause difficult breathing (dyspnoea). In chronic bronchitis, the mucociliary elevator is inactivated and mucus production increases, resulting in the thickening of the airways.

Clinical Manifestations

Difficult breathing with chronic cough and exertion, with or without phlegm, are the most significant COPD symptoms. The breathing difficulty normally deteriorates with time, but in moderate or mild COPD, sometimes it is not present. The cough could be productive or dry. Phlegm and cough often come before dyspnoea on exertion by several years. Chest tightness and wheezing and are also other symptoms. Anorexia, weight loss and fatigue may rise as the disease advances and gets to serious stages. Lung function assessment by spirometry is needed in establishing the diagnosis of COPD Chronic Obstructive Pulmonary Disease Discussion Paper.

Exacerbations or episodes of severe deterioration of respiratory symptoms are a characteristic of COPD. Bacterial or viral infections are major causes of exacerbation. It also seems that excessive air pollution precipitates COPD exacerbations. Some patients are especially likely to be exacerbated while others are not. The most significant sign of a prospective exacerbation is two or more exacerbations during the preceding year.

The decrease in lung function that characterizes COPD is accelerated by exacerbations, leading to a decrease in physical activity, reduced quality of life, and a higher risk of dying. They also account for a significant part of the cost of medical care associated with COPD.

Comorbidities often affect people with COPD. Co-morbidities may have similar risk factors with COPD, specifically smoking.  Extrapulmonary symptoms or COPD complications, such as muscle impairment resulting from lack of activity, may also be represented. Comorbidities may be associated with COPD treatment, such as osteoporosis caused by oral corticosteroid medication. Ischaemic heart disease, anxiety and depression, osteoporosis, skeletal muscle dysfunction, gastroesophageal reflux, anaemia, lung cancer, diabetes, and metabolic syndrome are the most prevalent co-morbidities in COPD. Comorbidity adds to the general severity of the condition and its symptoms. They can arise in severe, moderate, or mild COPD, and they individually raise the risk of COPD hospital admission and death Chronic Obstructive Pulmonary Disease Discussion Paper.

Based in which respiratory symptoms are prevalent, the extent of exacerbations, the degree and rate of deterioration in lung capacity, comorbiditiy frequency,  and the level of emphysema, the clinical effects of COPD indicate significant inter-individual variability.

Common Treatment Options

The aim of COPD treatment is to make it easier for a patient to breathe and to return to normal routines. The common treatment options for this condition include:

Short-Acting Bronchodilators

These medications act rapidly to calm the muscles around the airways and relieve symptoms such as shortness of breath, and coughing. They can be taken via an inhaler. The results are from 4 to 6 hours in length. They are used only when symptoms are apparent or before an activity. These medications can help if one only has symptoms occasionally. Short-acting bronchodilators include: Levalbuterol (Xopenex HFA), Albuterol (ProAir HFA, Ventolin HFA), Levalbuterol (Xopenex HFA), Ipratropium bromide and albuterol (Combivent), and Ipratropium (Atrovent) (Mayo Clinic, 2020).

 Long-Acting Bronchodilators

These drugs also help to calm the muscles surrounding the airway, but their impacts go up to 12 hours. To prevent symptoms, they are taken every day with an inhaler. They include Tiotropium (Spiriva), Salmeterol (Serevent), Indacaterol (Arcapta), Formoterol (Foradil, Perforomist), Arformoterol (Brovana), and Aclidinium (Tudorza Pressair)

 Steroids

Steroids reduce swelling of the airways. Usually, they are breathed via an inhaler. Inhaled steroids might assist if one has a lot of COPD blowups. Steroids can be used as a pill if complications worsen. Examples of inhaled steroids include Fluticasone (Cutivate, Flovent HFA) and Budesonide (Entocort, Pulmicort, Uceris) Chronic Obstructive Pulmonary Disease Discussion Paper

Phosphodiesterase-4 (PDE-4) Inhibitor

A medication known as called roflumilast (Daliresp) can assist with harsh symptoms of COP. This medication opens the airways and treats swelling in the lungs. It can be taken with a long-acting bronchodilator.

Theophylline

This medication works like a bronchodilator, except it’s cheaper. Theophylline may make your lungs function easier, but all of the symptoms may not be managed by it (Mayo Clinic, 2020).

Antibiotics

Infection can make the symptoms of COPD worse. The physician will administer antibiotics to destroy bacteria and manage the infection.

Pulmonary Rehabilitation

Pulmonary rehabilitation is a scheme that help patients diagnosed with COPD manage their condition. It can relieve breathing problems, help patients to perform activities more effectively, and enhance their life quality (Mayo Clinic, 2020). At the healthcare facility, patients work with a group of nurses, physicians, physiotherapists, dietitians and respiratory therapists. Throughout this program, patients learn how to breathe more efficiently, maintain the lungs healthy, eat properly, workout with no shortness of breath and feel healthier physically and emotionally Chronic Obstructive Pulmonary Disease Discussion Paper.

Oxygen Therapy

Serious COPD can hinder one from obtaining sufficient oxygen in the lungs. Oxygen levels in the blood will become too low as a result. To help one feel energetic and healthy, therapy raises these levels (Mayo Clinic, 2020). Using prongs or mask or in the nose, a patent inhales oxygen.

References

Campo, G., Pavasini, R., Malagù, M., Mascetti, S., Biscaglia, S., Ceconi, C., … & Contoli, M. (2015). Chronic obstructive pulmonary disease and ischemic heart disease comorbidity: overview of mechanisms and clinical management. Cardiovascular drugs and therapy, 29(2), 147-157.

COPD – Diagnosis and treatment – Mayo Clinic. (2020, April 15). Mayo Clinic – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685

López‐Campos, J. L., Tan, W., & Soriano, J. B. (2016). Global burden of COPD. Respirology, 21(1), 14-23 Chronic Obstructive Pulmonary Disease Discussion Paper

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Emil Mowry is a 62 y.o., single, Latino rancher who did not complete high school. He remembers rolling his first cigarette when he was 11 years old. He does not remember ever wanting to quit smoking. For the last five years he has had increasing difficulty breathing. Emil was diagnosed by his Family Nurse Practitioner as having emphysema. He was told that he has Chronic Obstructive Pulmonary Disease (COPD). He did not ask his Nurse Practitioner what this means, but he plans to look it up on the Internet. The purpose of this assignment is to create an evidence-based patient-centered educational brochure on the pathophysiology and clinical manifestations of, and common treatment options for, COPD that could be used by Nurse Practitioners or Nurse Educators with their patients newly-diagnosed with this disorder. The proposed brochure should include graphics and citations from your textbook and the external, scholarly-practice literature. You may present the content in the electronic format of your choice: single sheet, folded, tri-fold. In other words, you may use MS Word Document, MS Publisher, or any other software to develop your educational brochure. Since your audience are patients, please keep in mind the literacy and numeracy level (some literature suggests no more than 8th grade level literacy and numeracy). Also, please refer to the Assignment Rubric below for grading criteria and to help you complete this assignment. In regards to APA format, please use the following as a guide: Include transitions in your brochure, if needed (i.e. headings or subheadings) Use in-text references throughout the brochure Spelling, grammar, and organization are appropriate Include a reference list (this could be at the end of the brochure or you may submit a separate document listing your references) Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)