Chronic obstructive pulmonary disease (COPD)- Preeti sharma

COPD is a type of obstructive lung disease and related conditions. it is very helpful presentation to you about information of COPD.
It includes all things that is definition, causes, symptoms, pathophysiology, diagnostic evaluation, types, treatment and role of nurses for COPD patient.

1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE BY- PREETI SHARMA MSC. NSG. 1 st YR.

2. INTRODUCTION Chronic obstructive pulmonary disease (COPD) is comprised primarily of three related conditions - chronic bronchitis, chronic asthma, and emphysema. In each condition there is chronic obstruction of the flow of air through the airways and out of the lungs, and the obstruction generally is permanent and may be progressive over time. COPD is also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD).

3. DEFINITION Acc. to WHO- “ Chronic obstructive pulmonary disease is a lung disease characterized by chronic obstruction of lung airflow that interferes with the normal breathing and its compulsory reversible.” OR “Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease characterized by long term breathing problems and poor airflow.”

4. ANATOMY & PHYSIOLOGY

5. CLASSIFICATION COPD CHRONIC BRONCHITIS EMPHYSEMA

6. CONT… Emphysema- It is a type of COPD involving damage to the air sacs (alveoli) in the lungs. As a result, your body does not get the oxygen it needs. It makes it hard to catch your breath. You may also have a chronic cough and have trouble breathing. Chronic Bronchitis- It is defined as the presence of cough and sputum production for at least 3 months.

7. RISK FACTORS Cigarette & Smoke Occupational dust & chemicals Environmental tobacco smoke Nutrition Socio-economic status Infection Indoor & outdoor air pollution

8. ETIOLOGY Cigarette, smoke- This is the most common reason people get COPD. Secondhand smoke- Even if you aren’t a smoker, you can get COPD from living with one. Pollution and fumes- you can get COPD from air pollution. Breathing in chemical fumes, dust or toxic substances at work can also cause it. Age- Most people are 40 or older when their symptoms start up.

9. CONT… Genes - In rare cases, people with COPD have a defect in their DNA, the code that tells your body how to work properly. This defect is called “alpha-1 antitrypsin deficiency”. When you have this, your lungs don’t have enough of a protein needed to protect them from damage. This can lead to severe COPD. Infections- If you had lots of respiratory infections in childhood, you have a greater chance of COPD in adulthood.

10. PATHOPHYSIOLOGY Abnormal inflammatory response of the lungs due to toxic gases Response occurs in the airways, parenchyma Narrowing of the airway takes place Destruction of parenchyma leads to emphysema Destruction of lung parenchyma leads to an imbalance of proteinases / antiproteinases

11. CONT… Pulmonary vascular changes Thickening of vessels Collagen deposit Destruction of capillary Mucus hyper secretion (cilia dysfunction, airflow limitation, corpulmonale (RVF)) Chronic cough and sputum production

12. SIGN & SYMPTOMS Coughing up lots of mucus Shortness of breath, especially when you’re physically active Wheezing when you are breathe Tightness in the chest Frequent colds or flu Blue fingernails Low energy Losing weight Swollen ankles, feet or legs Respiratory infections

13. DIAGNOSTIC EVALUATION 1 . History - medical history Whether you've recently had a cold or the flu Whether you smoke or spend time around others who smoke Whether you've been exposed to dust, fumes, vapors, or air pollution 2. Spirometry - It is the most common test. You’ll breathe into a large, flexible tube that’s connected to a machine called a spirometer . It’ll measure how much air your lungs can hold and how fast you can blow air out of them.

14. CONT… Chest X-ray- It can help out emphysema, other lung problems, or heart failure. CT Scan- This uses several X-rays to create a detailed picture of your lungs and can tell the doctor if you need surgery. Arterial blood gas test- It measures how well your lungs are bringing in oxygen and taking out carbon dioxide.

15. MANAGEMENT There is no cure for COPD. However, there are many things you can do to relieve symptoms and keep the disease from getting worse. The goals of COPD treatment include: Relieving your symptoms Slowing the progress of the disease Improving your exercise tolerance (your ability to stay active) Preventing and treating complications Improving your overall health

16. MEDICAL MANAGEMENT Persons with COPD MUST stop smoking. This is the best way to slow down the lung damage.   Treatment The appropriate medications for COPD depend on its stage of severity as determined by symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has proposed a strategy that is widely accepted. GOLD categorizes COPD severity as follows:

17. CONT… Stage I: Smoker's cough, little or no shortness of breath, no clinical signs of COPD, FEV1 greater than 80% of predicted. Stage II: Shortness of breath on exertion, sputum-producing cough, some clinical signs of COPD, FEV1 50 - 80% of predicted. Stage III: Shortness of breath on mild exertion, FEV1 30 - 50% of predicted. Stage IV: Shortness of breath on mild exertion, right heart failure, cyanosis, FEV1 less than 30% of predicted.

18. CONT… Treatment calls for: Patients with GOLD stage I - IV: Treatment with an inhaled anticholinergic or inhaled short-acting beta2-agonist. Patients with GOLD stages II - IV: Addition of an inhaled long-acting bronchodilator in place of a short-acting beta2-agonist. A combination of bronchodilators may be used. In patients who do not respond to bronchodilators, slow-release theophylline may be used.

19. CONT… Patients with GOLD stages III - IV: Regular use of inhaled corticosteroids for those with repeated exacerbations. Systemic corticosteroids for severe exacerbations . Patients with GOLD stage IV: Long-term oxygen therapy, consideration of surgical options.

20. PHARMACOLOGY MANAGEMENT Medications used to treat COPD include: Inhalers (bronchodilators) to open the airways, such as ipratropium ( Atrovent ), tiotropium ( Spiriva ), salmeterol ( Serevent ), formoterol ( Foradil ), or albuterol Inhaled steroids to reduce lung inflammation Anti-inflammatory medications such as montelukast ( Singulair ) and roflimulast are sometimes used Oxygen administered.

21. SURGICAL MANAGEMENT When a patient no longer responds to medications, surgery becomes a possible option. In rare cases, surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines. Surgery may be used, but only a few patients benefit from these surgical treatments : Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with emphysema Lung transplant for severe cases.

22. CONT…. Surgeries for people who have COPD that's mainly related to emphysema include bullectomy and lung volume reduction surgery (LVRS). A lung transplant may be done for people who have very severe COPD. Bullectomy Lung transplantation Lung volume reduction surgery (LVRS)

23. Cont… Bullectomy When the walls of the air sacs are destroyed, larger air spaces called bullae form. These air spaces can become so large that they interfere with breathing. In a bullectomy , doctors remove one or more very large bullae from the lungs . Lung Volume Reduction Surgery In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.

24. CONT… Lung Transplant A lung transplant may benefit some people who have very severe COPD. During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor.

25. COMPLICATIONS Respiratory infections- COPD can boost your chance of getting colds, flu and pneumonia. It makes harder you to breathe and could cause more lung damage. Heart problem- COPD can raise your risk of heart disease, including heart attack. Lung cancer- People with COPD are more likely to get lung cancer. Pulmonary hypertension- COPD may rise blood pressure in the arteries that bring blood to your lungs. Depression- Trouble breathing can stop you from doing things you like, and living with a chronic illness can lead to depression.

26. NURSING DIAGNOSIS 1. Ineffective breathing pattern related to accumulation of the secretion to the region evidenced by breathlessness, restlessness and shortness of breath. 2. Impaired body temperature related to chest infection as evidenced by chest pain and elevated temperature 3. Impaired nutrition less than body requirement related to loss of appetite. 4. Ineffective coping related to anxiety prolonged hospitalization as evidence by reduce socialization, depression.

27. HEALTH EDUCATION Advices the patient to walk slowly and small distance slowly increase how far you walk. Try not to talk when you walk if you get short of breath. Use pursed lip breathing when breathing out (to empty your lungs before the next breath). Avoiding very cold air Making sure no one smokes in your home Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. If it is hard to keep your weight up, talk to a dietitian about eating foods with more calories .

28. CONCLUSION Chronic Obstructive Pulmonary Disease (COPD) makes it hard for you to breathe. Coughing up mucus is often the first sign of COPD. Chronic bronchitis and emphysema are common COPDs. Cigarette smoking is the most common cause of COPD. Breathing in other kinds of irritants, like pollution, dust or chemicals, may also cause or contribute to COPD. Quitting smoking is the best way to avoid developing COPD.