COPD• Chronic obstructive pulmonary disease

• A disease state characterized by airflow limitation that is not full reversible (GOLD)

• COPD is currently the fourth leading cause of death and the twelfth leading cause of disability.

• COPD includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these disorders.

• Asthma is now considered a separate disorder but can coexist with COPD.

Pathophysiology of COPD• Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious

agents.

• Inflammatory response occurs throughout the airways, lung parenchyma, and pulmonary vasculature.

• Scar tissue and narrowing occur in airways.

• Substances activated by chronic inflammation damage the parenchyma.

• Inflammatory response causes changes in pulmonary vasculature.

Chronic Bronchitis• The presence of a cough and sputum production for at least 3 months in each of 2 consecutive years

• Irritation of airways results in inflammation and hypersecretion of mucus.

• Mucus-secreting glands and goblet cells increase in number.

• Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucus may plug airways.

• Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes.

• The patient is more susceptible to respiratory infections.

Pathophysiology of Chronic Bronchitis

Emphysema• Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

• Decreased alveolar surface area causes an increase in “dead space” and impaired oxygen diffusion.

• Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures.

• Hypoxemia is the result of these pathologic changes.

• Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale).

Changes in Alveolar Structure with Emphysema

Normal Chest Wall and Chest Wall Changes with Emphysema

Risk Factors for COPD• Tobacco smoke causes 80-90% of COPD cases!

• Passive smoking

• Occupational exposure

• Ambient air pollution

• Genetic abnormalities

– Alpha1-antitrypsin

Nursing Process: The Care of Patients with COPD: Diagnosis

• Impaired gas exchange

• Impaired airway clearance

• Ineffective breathing pattern

• Activity intolerance

• Deficient knowledge

• Ineffective coping

Nursing Process: The Care of Patients with COPD: Planning

• Smoking cessation

• Improved activity tolerance

• Maximal self-management

• Improved coping ability

• Adherence to therapeutic regimen and home care

• Absence of complications

Improving Gas Exchange• Proper administration of bronchodilators and corticosteroids

• Reduction of pulmonary irritants

• Directed coughing, “huff” coughing

• Chest physiotherapy

• Breathing exercises to reduce air trapping

– Diaphragmatic breathing

– Pursed-lip breathing

• Use of supplemental oxygen

Improving Activity Tolerance• Focus on rehabilitation activities to improve ADLs and promote independence.

• Pacing of activities

• Exercise training

• Walking aids

• Use a collaborative approach.

Asthma• A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus

production

• Inflammation leads to cough, chest tightness, wheezing, and dyspnea.

• The most common chronic disease of childhood

• Can occur at any age

• Allergy is the strongest predisposing factor.

Pathophysiology of Asthma

Medications Used for Asthma• Quick-relief medications

– Beta2-adrenergic agonists

– Anticholinergics

• Long-acting medications

– Corticosteroids

– Long-acting beta2-adrenergic agonists

– Leukotriene modifiers

Examples of Metered-Dose Inhalers and Spacers

Patient Teaching

• The nature of asthma as a chronic inflammatory disease

• Definition of inflammation and bronchoconstriction

• Purpose and action of each medication

• Identification of triggers and how to avoid them

• Proper inhalation techniques

• How to perform peak flow monitoring

• How to implement an action plan

• When and how to seek assistance

Cystic Fibrosis• The most common fatal autosomal recessive disease among the Caucasian population

• Genetic screening can detect carriers of this disease.

• Genetic counseling for couples at risk

• A mutation of a gene causes changes in chloride transport, which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract.

• Pulmonary problems are the leading cause of morbidity and mortality.