CHRONIC OBSTRUCTIVE PULNONARY DISEASE (COPD)

Chronic obstructive pulmonary disease is a disease state in which airflow is

obstructed by emphysema, chronic bronchitis, or both. The airflow obstruction is usually
progressive, irreversible, and associated with airway hyperactivity, resulting in narrowing
of peripheral airways, airflow limitation, and changes in the pulmonary vasculature.

Causes of COPD:
Most cases of chronic obstructive pulmonary disease (COPD) develop after
repeatedly breathing in fumes and other things that irritate and damage the lungs and
airways. Cigarette smoking is the most common irritant that causes COPD. Pipe, cigar,
and other types of tobacco smoke can also cause COPD, especially if the smoke is
inhaled. Breathing in other fumes and dusts over a long period of time may also cause
COPD. The lungs and airways are highly sensitive to these irritants. They cause the
airways to become inflamed and narrowed, and they destroy the elastic fibers that allow
the lung to stretch and then return to its resting shape. This makes breathing air in and out
of the lungs more difficult.

Other things that may irritate the lungs and contribute to COPD include:
- Working around certain kinds of chemicals and breathing in the fumes for many years
- Working in a dusty area over many years
- Heavy exposure to air pollution

Being around secondhand smoke (smoke in the air from other people smoking cigarettes)
also plays a role in an individual developing COPD.

Genes—tiny bits of information in your body cells passed on by your parents—may play
a role in developing COPD. In rare cases, COPD is caused by a gene-related disorder
called alpha 1 antitrypsin deficiency. Alpha 1 antitrypsin (an-te-TRIP-sin) is a protein in
your blood that inactivates destructive proteins. People with antitrypsin deficiency have
low levels of alpha 1 antitrypsin; the imbalance of proteins leads to the destruction of the
lungs and COPD. If people with this condition smoke, the disease progresses more
rapidly.

Signs & Symptoms:

The signs and symptoms of chronic obstructive pulmonary disease (COPD) include:

- Cough
- Sputum (mucus) production
- Shortness of breath, especially with exercise
- Wheezing (a whistling or squeaky sound when you breathe)
- Chest tightness
A cough that doesn't go away and coughing up lots of mucus are common signs of
COPD. These often occur years before the flow of air in and out of the lungs is reduced.
However, not everyone with a cough and sputum production goes on to develop COPD,
and not everyone with COPD has a cough.

The severity of the symptoms depends on how much of the lung has been destroyed. If
you continue to smoke, the lung destruction is faster than if you stop smoking.

Medical Management:
Bronchodilators – It relieve bronchospasm and reduce airway obstruction by allowing
increased oxygen distribution throughout the lungs and improving alveolar ventilation.

Corticosteroids – Inhaled and systemic corticosteroids (oral or intravenous) may also be

used in COPD but are used more frequently in asthma. Although it has been shown that
corticosteroids do not slow the decline in lung function, these medications may improve
symptoms. A short trial course of oral corticosteroids may be prescribed for patients with
stage II or III COPD to see if pulmonary function improves and symptoms decrease.

Other Medications – Patients should receive a yearly influenza vaccine and the
pneumococcal vaccine every 5 to 7 years as preventive measured.

Oxygen Therapy – It can be administered as long term continuous therapy, during

exercise, or to prevent acute dyspnea. Long term oxygen therapy has been shown to
improve the patient’s quality of life and survival.

Nursing Management:
Patient Education – is a major component of pulmonary rehabilitation and includes a
broad variety of topics. Depending on the length and setting of the program, topics may
include normal anatomy and physiology of the lung, pathophysiology and changes with
COPD, medications and home oxygen therapy, nutrition, respiratory therapy treatments,
symptom alleviation, smoking cessation, sexuality and COPD, coping with chronic
disease, communicating with the health care team, and planning for the future.

Breathing Exercise – The breathing pattern of most people with COPD is shallow, rapid,
and inefficient; the more severe the disease, the more inefficient the breathing pattern.
With practice, this type of upper chest breathing can be changed to diaphragmatic
breathing, which reduces the respiratory rate, increases alveolar ventilation, and
sometimes helps expel as much air as possible during expiration. Pursed lip breathing
helps to slow expiration, prevents collapse of small airways, and helps to slow expiration,
prevents collapse of small airways, and helps the patient to control the rate and depth of
respiration. It also promotes relaxation, enabling the patient to gain control of dyspnea
and reduce feelings of panic.
Inspiratory Muscle Training – Once the patient masters diaphragmatic breathing, a
program of inspiratory muscle training may be prescribed to help strengthen the muscles
used in breathing.

Activity Pacing – A patient with COPD has decreased exercise tolerance during specific
periods of the day. This is especially true on arising in the morning, because bronchial
secretions collect in the lungs during the night while the person is lying down.

Self Care Activities – As gas exchange, airway clearance, and the breathing pattern
improve, the patient is encouraged to assume increasing participation in self care
activities.

Physical Conditioning – PC techniques include breathing exercises and general

exercises intended to conserve energy and increase pulmonary ventilations. There is close
relationship between physical fitness and respiratory fitness.

Oxygen Therapy – Oxygen supplied to the home comes in compressed gas, liquid or
contractor systems. Portable oxygen systems allow the patient to exercise, work, and
travel.

Nutritional Therapy – Nutritional assessment and counseling are important aspects in

the rehabilitation process for the patient with COPD.

Coping Measures – Any factors that interferes with normal breathing quite naturally
induces anxiety, depression, and changes in behavior.

Bibliography:
www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_Causes.html
www.aarc.org/klein/causes.asp
Smeltzer, Suzanne & Bare, Brenda. Medical Surgical Nursing. LWW, 2004.