Chronic Obstructive Pulmonary Disorder (COPD) is a collective term for several chronic lung diseases, including chronic bronchitis, emphysema, and chronic obstructive asthma. The disease is the fourth leading cause of death globally, and with increasing incidence, the condition is speculated to be the third leading cause of death by 2020 (Cooper, 2019). As of 2019, the rate of incidence of COPD was at more than 5 %, with the disease affecting 16 million people in the US. The full scope of COPD is not well understood as most people have COPD, which has not been diagnosed or treated.
Due to the manifestation of the disease as well as the high prevalence, COPD is associated with high costs. The high costs result from regular visits to the physician office, persistent hospitalization, and the need to have chronic therapy like supplemental oxygen therapy (Cooper, 2019). As such, the need to establish a correct diagnosis of COPD is vital since appropriate management can effectively decrease the symptoms while increasing lung capacity, decrease the severity and frequency of exacerbations while simultaneously improving exercise capacity, enhance the health status and increase survival.
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COPD is characterized by persistent symptoms and airflow hindrances and limitations, leading to breathing problems. The symptoms occur due to physiologic changes that occur in the airways, lung parenchyma, and pulmonary vasculature (Tantucci, 2020). Airways abnormalities as a result of COPD consist of high numbers of goblet cells, constriction, and a decrease in the name of small airways, fibrosis, and mucus gland hyperplasia. The airway abnormalities result from exposure from harmful particles such as cigarette smoke. Loss of tethering triggered by alveolar wall destruction in emphysema may lead to airway collapse, lung inflammation, destruction of tissues and may cause gas exchange issues.
A critical sign of chronic inflammation due to emphysema and chronic bronchitis is the presence of CD 68+ monocytes, neutrophils, and CD8+ T- lymphocytes compared to increased interleukin, eosinophils and CD4+ T-lymphocytes seen in chronic inflammation of asthma (Al Rajeh, & Hurst, 2016). Likewise, lung parenchyma cell destruction leads to either pan acinar emphysema due to enlargement or damage of all parts of the acinus or proximal acinar emphysema due to the abnormal dilation or destruction of the respiratory bronchiole. COPD complications also result from physiologic changes in the pulmonary vasculature, which refers to intimal hyperplasia and smooth muscle hyperplasia or hypertrophy (Al Rajeh, & Hurst, 2016). The hyperplasia and hypertrophy are believed to be the result of chronic hypoxic vasoconstriction of the small pulmonary arteries. Once the alveoli are destroyed, this leads to the loss of adjacent areas of the pulmonary capillary bed, causing breathing complications.
Besides the provision of oxygen, no drug for COPD has indicated its capacity to decrease the elevated risk of mortality in these patients. Hence, most treatment and management plans focus on reducing symptoms, enhancing functional ability, and proactively preventing and treating treat the exacerbations (Kunisaki et al., 2018). For adults with acute exacerbations of COPD, sing a stepwise approach with mild symptoms management using systemic corticosteroids has shown to be effective in both short and long courses. Determining the most appropriate duration for corticosteroids treatment helps determine exposure to potential adverse effects of the treatment.
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Short-acting beta-agonists (SABA) like salbutamol-based inhalers can also be used to enhance functional ability (Kopsaftis et al., 2018). These SABAs should be taken before exercise or to relieve exertional dyspnea. However, patients taking inhalers several times in a week can add a long term acting muscarinic antagonist (LAMA) like tiotropium and aclidinium (Beeh et al., 2018). The second line drugs should include long-acting beta-agonists like formoterol, indacaterol, and vilanterol, which have been shown to affect lung function, exercise tolerance, and SABA use, amongst other effects. At the same time, combination therapy is recommended when the patient’s FEV1 is below 50%, and the individual has had more than one exacerbation in the preceding 12 months (Beeh et al., 2018). Some of the risks associated with inhaled corticosteroids are withdrawal symptoms and increased risk of pneumonia in COPD patients.
The benefits of using dual bronchodilators are increased lung function, improved exercise capacity and decrease the use of SABAs while also reducing COPD exacerbations (Beeh et al., 2018). Similarly, the use of LABAs improves the patient’s quality of life, but their use can trigger adverse cardiovascular effects like ventricular arrhythmias, palpitations, and hypokalemia (Beeh et al., 2018). H0wever, LABAs also decrease lung function. Individuals diagnosed with COPD require education on how to stick to the prescribed COPD treatment regime and include non-pharmacological therapy to have improved patient outcomes (Cooper, 2019).
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Chronic Obstructive Pulmonary Disorder Sample Essay
COPD is a common, avertible, and remediable illness whose clinical manifestations are persistent respiratory symptoms accompanied by airflow obstruction. These obstructions are caused by a combination of small airways diseases like obstructive bronchiolitis as well as emphysema besides small airways narrowing as a result of chronic obstructive asthma (Beeh et al., 2018). The role of nurses in the treatment and management of COPD is utilizing and using evidence-based practices to meet the unique needs of the patients. Understanding the psychologic changes caused by the disease helps understand the manifestation of the disease, and in determining the best prevention, treatment, and management approaches for COPD.
References
Al Rajeh, A. M., & Hurst, J. R. (2016). Monitoring of physiological parameters to predict exacerbations of chronic obstructive pulmonary disease (COPD): a systematic review. Journal of clinical medicine, 5(12), 108.
Beeh, K. M., Burgel, P. R., Franssen, F. M., Lopez-Campos, J. L., Loukides, S., Hurst, J. R., & Valipour, A. (2017). How do dual long-acting bronchodilators prevent exacerbations of chronic obstructive pulmonary disease? American journal of respiratory and critical care medicine, 196(2), 139-149.
Cooper, A. S. (2019). Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Critical Care Nurse, 39(6), 78-80.
Kopsaftis, Z. A., Sulaiman, N. S., Mountain, O. D., Carson-Chahhoud, K. V., Phillips, P. A., & Smith, B. J. (2018). Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: a systematic review. Systematic reviews, 7(1), 213.
Kunisaki, K. M., Dransfield, M. T., Anderson, J. A., Brook, R. D., Calverley, P. M., Celli, B. R., … & Pragman, A. A. (2018). Exacerbations of chronic obstructive pulmonary disease and cardiac events. A post hoc cohort analysis from the SUMMIT randomized clinical trial. American journal of respiratory and critical care medicine, 198(1), 51-57.
Tantucci, C. (2020). Assessment and treatment of airflow obstruction in patients with Chronic Obstructive Pulmonary Disorder: a guide for the clinician. Expert Review of Respiratory Medicine.
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