Chronic Obstructive Pulmonary Disease (COPD) Bronchial

Chronic Obstructive Pulmonary Disease (COPD) Bronchial

This is characterized by a progressive, partially reversible airflow limitation. It includes bronchial asthma, pulmonary edema, and chronic bronchitis.

Chronic Bronchitis

It is a persistent infection of the lower respiratory tract that causes dyspnea, coughing up too much mucus, and chronic inflammation of the lower respiratory tract.

Pulmonary Emphysema

It is a complex lung disease characterized by destruction of the alveoli, enlargement of distal airspace, and breakdown of alveolar walls.

Types of emphysema are Centrilobular, pan lobular, para septal.

Etiology

• Cigarette smoking,
• Air pollution,
• Occupational exposure,
• Allergy,
• Autoimmunity,
• Infection,
• Genetic predisposition,
• Aging.

Pathophysiology

• Chronic Bronchitis
  • Environmental toxins from smoke irritate the airways,
  • Mucus-producing gland hypertrophy and a rise in goblet clearance secretion,
  • Less ciliated cells and increased mucus. reduced removal of mucus,
  • Accumulation of secretions and airway obstruction.
• Emphysema
  • Wall of the alveoli is destroyed,
  • Alveolar surface area decrease,
  • Increased dead space,
  • Impaired diffusion of oxygen and impair the exchange of O2 and CO2,
  • Hypoxia.

Clinical Manifestation

• A presence of a productive cough lasting at least 3 months a year for 2 successive years.
• Production of thick gelatinous sputum,
• Wheezing,
• Dyspnea,
• Shortness of breath, especially during physical activities,
• Chest tightness,
• Cyanosis,
• Frequent chest infection,
• Lack of energy,
• Unintended weight loss(in later stages).

Diagnostic Evaluation

• Pulmonary function test,
• ABG levels,
• Chest x-ray,
• CT scan.

Management

• Cessation of smoking
• Medication
  • Bronchodilators:- short- acting bronchodilators include albuterol (ProAir HFA, VentolinHFA, others), Levalbuterol (Xopenex), and ipratropium (Atrovent). The long-acting bronchodilators include tiotropium (spirivia), salmeterol, (serevent), formoterol (Foradil, Perforomist), arformoterol (Brovana), indacaterol (Arcapta) and aclidinium(Tudorza),
  • Inhaled steroids:- Fluticasone (Flovent) and budesonide (Pulmicort),
  • Combined inhalers:- Salmeterol and fluticasone (Advair) and formoterol and budesonide (Symbicort),
  • Oral steroids,
  • Phosphodiesterase-4 inhibitors,
  • Theophylline.
• Antibiotics
• Lung therapies
  • Oxygen therapy.
  • a pulmonary rehabilitation program.
• Surgery
  • Lung volume reduction surgery:- In this surgery, surgeon removes small wedges of damaged lung tissue. This creates extra space in chest cavity so that the remaining lung tissue and the diaphragm work more efficiently.
  • Lung transplant.

Nursing Management

• Improving Airway Clearance
  • Eliminate pulmonary irritants,
  • Smoking cessation,
  • Administer bronchodilators,
  • Assess for adverse effect of medication,
  • Auscultate chest before and after aerosol therapy,
  • Postural drainage,
  • Avoid dairy product.
• Improving Breathing Pattern
  • Teach and supervise breathing exercise,
  • Teach diaphragmatic, lower coastal, abdominal breathing using relaxed breathing pattern,
  • Use pursed lip breathing at intervals and during dyspnea,
  • Comfort position,
  • Relief from anxiety.
• Controlling Infection
  • Recognize early sing of infection,
  • Sputum for culture and sensitivity.
• Improving Gas Exchange
  • Observe the patient for any disturbance,
  • Monitor ABG,
  • Oxygen saturation,
  • Assist mechanical ventilation.
• Improving Nutrition
  • Collect nutritional history,
  • Encourage small and frequent feeds,
  • Liquid nutritional supplement,
  • Avoid gas-producing food,
  • Encourage oral hygiene,
  • Encourage pursed-lip breathing in between the meals,
  • Monitor body weight.

References

• https://medlineplus.gov › Medical Encyclopedia
• http://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/treatment/txc-20204923
• www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.asp
• www.healthline.com/health/copd