COPD

Chronic Obstructive Pulmonary Disease

1. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD)

2. ANATOMY AND PHYSIOLOGY

3. DEFINITION Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by the presence of airflow obstruction caused by chronic bronchitis or empysema . Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving airways , pulmonary parenchyma or both. Chronic Obstructive Pulmonary Disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible; sometimes referred to as chronic airway obstruction or chronic obstructive lung disease 2

4. DEFINITION Chronic bronchitis is the presence of chronic productive cough for 3 months in each of two successive years in a patient I whom other causes of chronic cough have been excluded. Emphysema is an abnormal permanent enlargement of airspaces distal to the terminal bronchioles, accompanied by the destruction of the walls and without obvious fibrosis

5. ETIOLOGY / RISK FACTORS

6. PATHOPHYSIOLOGY Inflammation of central airways # inflammatory cells (lymphocytes, macrophage, neutrophils) # inflammatory mediators Leukotriene, interleukin # Increased number of goblet cells and enlarged mucus glands leads to hypersecretion of mucus

7. PATHOPHYSIOLOGY Inflammation of peripheral airways # injury and repair process # structural remodeling # scar tissue and collagen formation -> fibrosis

8. PATHOPHYSIOLOGY CHRONIC BRONCHITIS # hypersecretion of mucus # decresed ciliary function # bronchial walls thickens, mucus -> plug airway # altered function of alveolar macrophages due to fibrotic changes

9. PATHOPHYSIOLOGY Emphysema # imbalances of proteinases and anti proteinases alpha antitrypsin deficiency bullae formation barrel chest impaired gas exchange – hypoxemia, hypercapneia

10. PATHOPHYSIOLOGY Pulmonary vascular changes # thick vessels # inflammatory vessels infiltration # collagen deposit #destruction of capillary bed

11. PATHOPHYSIOLOGY COPD PATHOLOGY # mucus hypersecretion # cilia dysfunction # Airflow limitation # hyperinflation of lungs # gas exchange abnormalities # Pulmonary hypertension # corpulmonale

12. CLASSIFICATION STAGE 0 (AT RISK) - normal spirometry, chronic cough and sputum production STAGE 1 (MILD COPD) - FEV 1 /FVC < 70%, FEV 1 >80% STAGE 2 (MODERATE COPD) - FEV 1 /FVC < 70%, FEV 1 50 - 80% STAGE 3 (SEVERE COPD) - FEV 1 /FVC < 70%, FEV 1 30 -50% STAGE 4 (VERY SEVERE COPD) - FEV 1 /FVC < 70%, FEV 1 30 -50%

13. CLINICAL MANIFESTATIONS CHRONIC COUGH SPUTUM PRODUCTION DYSPNEA ON EXERTION SHORTNESS OF BREATH BARREL CHEST

14. ASSESSMENT AND DIAGNOSTIC FINDING HEALTH HISTORY PULMONARY FUNCTION TEST SPIROMETRY ABG CT CHEST XRAY Α LPHA 1 ANTITRYPSIN

15. COMPLICATION Corpulmonale Exacerbation of COPD Acute respiratory failure Hypoxemia and Acidosis Respiratory infection, pneumonia Cardiac dysrhythmia Peptic ulcer ,GERD Depression and Anxiety

16. MANAGEMENT GOALS Prevent disease progression Relieve symptoms and improve exercise tolerance Prevent and treat complications Promote patient participation in care Prevent and treat exacerbation Improve quality of life and reduce mortality risk .

17. MEDICAL MANAGEMENT Risk reduction Pharmacologic therapy Bronchodilators Corticosteroids Mucolytics Antibiotics Alpha1 antitrypsin Antidepressant and antianxiety

18. MEDICAL MANAGEMENT Management of exacerbation Oxygen therapy Vaccination Aerosol nebulization therapy

19. SURGICAL MANGEMENT LUNG VOLUME REDUCTION SURGERY BULLECTOMY LUNG TRANSPLANTATION

20. RESPIRATORY AND PHYSICAL THERAPY Breathing Retraining # Pursed lip breathing # Diaphragmatic (abdominal breathing) Effective coughing Chest physiotherapy # Percussion, vibration and postural drainage Flutter mucus clearance device Acapella High frequency chest compression( ThAIRaphy Vest)

21. Diaphragmatic (abdominal breathing)

22. Postural drainage position

23. Flutter mucus clearance device

24. Acapella

25. High frequency chest compression ( ThAIRaphy Vest)

26. PULMONARY REHABILITATION NUTRITION THERAPY PALLIATIVE TREATMENT

27. NURSING MANAGEMENT Breathing exercise Inspiratory muscle training Activity pacing Self care activities Physical conditioning Oxygen therapy Sleep Nutrition Coping measures

28. Nursing diagnosis Impaired gas exchange related to alveolar hypoventilation. Ineffective airway clearance related to expiratory airflow obstruction, chronic inhalation of toxins, ineffective cough, increased mucus production. Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstriction. Activity intolerance related to fatigue, hypoxemia and ineffective breathing pattern. Deficient knowledge regarding self-management to be performed at home. Ineffective coping related to reduced socialization, anxiety, depression, inability to work.

29. GARD (Global Alliance against Chronic Respiratory Diseases) WHO movement Goal :- reducing global burden of chronic respiratory diseases Vision :- a world where all people breathe freely Focus :- low and middle income countries and vulnerable population.

30. Journals Resistance training with ankle weight cuffs is feasible in patients with Acute exacerbation of COPD A study to assess the effectiveness of comprehensive nursing interventions on improving respiratory status among patients with COPD at SMVMCH, Puduchery .

31. Bibliography Smeltzer CS, Bare GB, Hinkle LJ, Cheever HK. Brunner & Suddarth’s textbook of Medical-surgical nursing. Volume I. Twelvth edition. NewDelhi:Wolters Kluwer (India) ; 2011. Lewis LS, Dirksen RS, Heitkemper MM, Bucher L. Lewis’s Medical Surgical Nursing Assessment and management of clinical problems. Second edition. Volume 1.India: Reed Elsevier; 2015. Monahan DF, Neighbors M, Sands KJ, Marek FJ, Green JC. Phipps medical surgical nursing health and illness perspectives. Eighth edition. Canada: Mosby Elsevier; 2007. Black MJ, Hawks HJ. Medical surgical Nursing Clinical Management for positive outcomes. Eighth edition. India :Elsevier;2009.