CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Abstract: Chronic obsCorrent answers in green.
1) When a person inhales, oxygen moves into the lungs to the ________ where oxygen is transferred into the bloodstream through the capillaries.
- bronchi
- trachea
- alveoli
- arterioles
2) Chronic obstructive pulmonary disease (COPD) is a combination of two separate but closely related diseases: emphysema and ___________.
- chronic bronchitis
- fibrosis
- tuberculosis
- pneumonia
3) Most cases of COPD are caused by chronic:
- obesity.
- air pollution.
- cigarette smoking.
- chronic pneumonia.
4) A patient with COPD may experience rapid breathing, which is called:
- cyanosis.
- tachypnea.
- hyperventilation.
- hypoventilation.
5) If a patient appears to be having a COPD exacerbation, ___________.
- adjust the patient’s oxygen flow rate.
- immediately notify a supervisor.
- tell the patient to stay calm since this is a normal occurrence with COPD.
- the patient should exercise to help increase oxygen to the lungs.
6) If a patient has COPD and the patient permanently quits smoking:
- pulmonary function will fully recover.
- a decrease in pulmonary function will continue.
- the patient will be able to remedy or cure the attendant emphysema.
- the progression of COPD will stop.
7) Exercise programs for a COPD patient:
- should be avoided because they lead to COPD exacerbation.
- should only include breathing exercises.
- help prevent lung infections.
- should be avoided because they lead to cyanosis.
8) The nasal cannula is the most common way supplemental oxygen is administered to a COPD patient and the cannula should be washed with soap and water __________.
- several times a week and it should be periodically replaced
- each day
- each day and replaced weekly
- once a week
9) If a patient’s prescribed frequency of using an albuterol inhaler is not helping,
- the patient should be given a different inhaler brand.
- the patient’s provider should be informed.
- the patient should use the inhaler more often.
- the health care provider should administer the inhalant because the patient is probably using it incorrectly.
10) It is important that a health care professional who is caring for a patient with COPD allow the patient
- to decide whether he or she wants to exercise.
- to determine when he or she needs to use an inhaler.
- to increase the flow of oxygen, if needed.
- to have reasonable control over his or her environment.
Explanation =>Patients with COPD (Chronic Obstructive Pulmonary Disease) often experience shortness of breath, fatigue, and anxiety. Allowing them reasonable control over their environment helps promote independence, comfort, and a sense of security.
© 2009 - 2026 cnaZone.comtructive pulmonary disease is a combination of two separate but
closely related diseases emphysema and chronic bronchitis. The condition can
be managed with supplemental oxygen and medications but cannot be cured.
Lifestyle changes such as exercise and smoking cessation can help but the
disease is progressive and worsens over time. The health care professional
will need to concentrate on specific aspects of patient care when providing
individualized assistance for a patient diagnosed with chronic obstructive
pulmonary disease, as well as knowing when symptoms are severe enough to
report to the appropriate supervising nurse or provider.
Learning Objectives:
1. Define chronic obstructive pulmonary disease (COPD).
2. Identify the common causes of COPD.
3. Explain the common signs, symptoms, treatment, and
management of COPD.
Introduction
Chronic obstructive pulmonary disease is persistent and progressive. There
is not a single cause of chronic obstructive pulmonary disease (COPD) but
most cases are caused by chronic cigarette smoking. COPD cannot be cured but
it can be managed and treated by the patient making lifestyle changes, with
supplemental oxygen and with the use of medications. The disease will
continue to progress until the patient succumbs to the disease and dies from
respiratory failure or other complications from COPD. As a consequence,
caring for a patient with COPD can be very challenging. Caring for patients
with COPD requires that the health care professional be familiar with the
disease. The health care professional must learn each patient’s abilities
and limitations. It is also important to provide the patient with the
emotional support and care unique to this medical condition.
Incidence Of COPD
Chronic obstructive pulmonary disease is a chronic disease that affects the
lungs. The word pulmonary refers to the lungs. Chronic obstructive pulmonary
disease is a common condition. More than 16.4 million Americans have COPD
and are highest in the Southeast and Midwest states. It is currently the
third leading cause of death by disease in the United States and over 80% of
these deaths occurred in low and middle-income classes. Chronic obstructive
pulmonary disease is a progressive disease; it gets worse with each
successive year. It can be managed with lifestyle adjustments and
medications but there is no cure.
There is evidence that some people inherit the tendency to develop COPD. It
can also be caused by exposure to chemicals, pollutants, and some rare
medical problems; however, only a small percentage of COPD cases are caused
by environmental or medical factors. The great majority of cases of COPD are
caused by cigarette smoking.
The Centers for Disease Control and Prevention (CDC) reported that “although
age-adjusted death rates for COPD have declined among men between 1999 (57.0
per 100,000) and 2014 (44.3 per 100,000) in the United States, there has
been no significant change among death rates in women (35.3 per 100,000 in
1999 and 35.6 per 100,000 in 2014)”. More than half of adults with low lung
function are not aware they have COPD, which means the data shown above may
actually be higher. The CDC also provides the following facts in 2013 about
group populations more likely to report COPD:
1. People aged 65–74 years and = 75 years
2. American Indian, Alaska Natives, and multiracial non-Hispanics
3. Women
4. Individuals who were unemployed, retired, or unable to work
5. Individuals with less than a high school education
6. Individuals who were divorced, widowed or separated
7. Current or former smokers
8. People with a history of asthma
Pulmonary Anatomy and Physiology
The pulmonary system, also called the respiratory system, starts with the
oral cavity (mouth) and the nose. Attached to the back of the mouth is a
stiff but somewhat flexible tube called the trachea, which is more commonly
called the windpipe. The trachea ends at about the level of the shoulders,
and it is attached to two other stiff but flexible tubes that extend down
into the lungs in the chest cavity. One of these extends into the left lung,
the other goes into the right lung, and these are called the main stem
bronchi.
At the terminal ends of the main stem bronchi are many small, hollow
passages called the bronchial tubes. The bronchial tubes extend from the
ends of the main stem bronchi into the outer parts of the lungs. Eventually,
the bronchial tubes end in small clusters of air sacs called alveoli that
are located at the bottom of the lungs. The alveoli look very much like
clusters of grapes, and there are thousands of them. They are pliable,
elastic, and they have extremely thin walls, a feature that is very
important and will be discussed later in this section.
When a person inhales, the chest expands, air with oxygen moves through the
nose and mouth, down the trachea to the main stem bronchi, through the
bronchial tubes and eventually, it reaches the alveoli. Immediately next to
the alveoli are large numbers of extremely small blood vessels called
capillaries; the alveoli and the capillaries touch one another. The walls of
the alveoli have tiny pores, and the inhaled air that contains oxygen moves
through these pores and combines with the blood that is passing by in the
capillaries. This blood is returning from the body and it contains a very
low level of oxygen, but a relatively high level of carbon dioxide. After
the blood in the capillaries combines with oxygen, it is pumped out of the
lungs, into the heart and from there it is pumped back out to the body. This
exchange of oxygen from the air to the blood happens quite easily because
the alveoli and the capillaries are in such close contact, and it is so
efficient because the surface area of the alveoli and the capillaries is
enormous.
When people exhale, harmful waste products of metabolism (most importantly
the carbon dioxide) move from the blood in the capillaries into the alveoli
and out through the bronchial tubes and the nose and mouth. The alveoli are
where these two gases, oxygen and carbon dioxide move in and out of the
body. The basic purpose of the pulmonary system is to allow the movement of
two gases, oxygen, and carbon dioxide, in and out of the body. When people
inhale, they take in oxygen, and with exhalation, people get rid of carbon
dioxide.
What is COPD?
The name chronic obstructive pulmonary disease is a good description for the
health disease. COPD is a chronic disease, it does not go away and it causes
problems by obstructing the flow of air in and out of the lungs, which are
the primary organs of the pulmonary system.
Chronic obstructive pulmonary disease will be defined here as a chronic
disease that causes permanent scarring to the lung tissue. It is a
combination of two separate but closely related diseases: emphysema and
chronic bronchitis. These diseases can occur by themselves or they can
present together.
Emphysema is a disease that causes slow, progressive, and irreversible
destruction of the lung tissue. Emphysema damages the alveoli. In a patient
with emphysema, the alveoli become weak, enlarged, and scarred. Because of
this, when a patient with emphysema inhales or exhales the normal elasticity
of the alveoli does not function properly and they collapse under the
pressure. Also, because the alveoli are scarred, oxygen and carbon dioxide
cannot move into and out of the blood. The body must have oxygen and must
rid itself of carbon dioxide to survive and the alveoli are where these
processes take place. If the alveoli do not function, the patient’s
respiratory status and the normal gas exchange that takes place in the lungs
both suffer.
Chronic bronchitis is the other component of COPD. Chronic bronchitis
happens when the bronchial breathing passages become permanently inflamed.
This is almost always a result of cigarette smoking. The chemicals and the
particles in the cigarette smoke irritate the sensitive lining of the
bronchial tubes. When that happens, these airway passages become inflamed,
they become swollen and narrowed, and large amounts of mucus are produced.
As with emphysema, these changes prevent oxygen from going through to the
blood when people inhale, and they prevent carbon dioxide from being
expelled when they exhale.
There is also a disease called acute bronchitis. This is the same as chronic
bronchitis but it is caused by an infection. It can be cured with
antibiotics and rest, and it does not cause permanent inflammation of the
bronchial tubes. Whereas, chronic bronchitis is defined as permanent
inflammation of the bronchial tubes.
The person with COPD has bronchial tubes that are narrowed and swollen and
alveoli that are scarred and have lost their elasticity. When someone with
COPD inhales or exhales, air cannot effectively move in or out. To
illustrate this difficulty with breathing, imagine trying to suck molasses
through a tiny straw (the narrowed, swollen bronchial tubes) that collapses
when it is stretched (the inelastic alveoli) and then trying to move it
across a thick piece of cardboard that has been placed over the end of the
straw (the scarred alveoli). This is what happens with a person with COPD.
First, the air cannot effectively move through the bronchial tubes because
they have narrowed. Second, when air gets to the alveoli, it cannot move
past them because the pores in the alveoli are covered with scar tissue, and
the alveoli collapse because they have lost their elasticity.
Causes Of COPD
There are a few unusual medical conditions that can cause COPD, and some
cases of COPD can be caused by air pollution and chronic exposure to
irritants in the air. Most cases of COPD are caused by chronic cigarette
smoking. It may also be possible to develop COPD if a person is exposed to
large amounts of secondhand smoke. There are also rare cases in which
someone has inherited a genetic tendency for developing COPD. For those
people, small amounts of smoking or exposure to low levels of chemicals or
pollution may be enough to cause COPD.
Tobacco smoking accounts for approximately 90% of all cases of COPD.
Approximately 20% of all cigarette smokers will eventually develop COPD, and
the more someone smokes and the greater the number of years that person
smokes the greater the risk of developing COPD. Smoking cigars and/or a pipe
can also cause COPD but the risk is much less. It is not clear why some
people who smoke do not develop COPD.
Tobacco smoke is a very complicated compound. It contains thousands of
chemicals that are toxic, such as carbon monoxide, cyanide, and tar. Other
compounds act as irritants. These chemical toxins and the irritants are only
present in tiny amounts but a smoker is exposed to them on a constant,
day-to-day basis. The result of this continual exposure of the lungs to
these toxins and irritants is an intense inflammation and irritation of the
lung tissue that slowly but surely overwhelms the body’s defenses; the lungs
simply cannot heal themselves or successfully fight off the “chemical
assault.” Given enough time, the irritation and inflammation progresses to
irreversible damage, and the smoker has COPD.
What about secondhand cigarette smoke? Can exposure to smokers cause COPD?
The answer is not clear. Secondhand smoke can damage the lungs but it is not
certain whether secondhand smoke can cause damage that will progress to
COPD.
Cigarette smoking is the primary cause of COPD but it is worth remembering
that tobacco smoke has many other harmful health effects.
1. Smoking increases the risk of developing heart disease by 2 to 4
times.
2. Smoking increases the risk of having a stroke by 2 to 4 times.
3. Smoking decreases circulation; many smokers have cold hands and
feet, and this is because of poor circulation.
4. Smoking causes lung cancer.
5. Smoking has been associated with an increased risk of developing
bladder cancer, cervical cancer, esophageal cancer, laryngeal cancer,
pancreatic cancer, and many other malignancies.
6. Smoking has been associated with reproductive disorders such as
infertility, low birth weight, stillbirth, and sudden infant death syndrome
(SID).
COPD Signs and Symptoms
Chronic obstructive pulmonary disease is a persistent, progressive disease.
The disease gets worse as the patient gets older. Because of the damage to
the alveoli and the changes in the bronchial tubes, people with COPD have
low levels of oxygen and high levels of carbon dioxide in their blood. These
abnormal levels are the basic cause of the signs and symptoms of COPD. Some
of the signs and symptoms of COPD are highlighted here. There is:
1. Difficulty breathing
2. Exercise intolerance
3. Chronic cough
4. Excessive production of sputum (productive cough)
5. Blue coloration of the fingernails (cyanosis)
6. Tachypnea, which is defined as rapid breathing (above 20 breaths per
minute)
7. Wheezing
8. Confusion (late-stage)
9. Barrel chest
10. Abnormally thick downward sloping fingernails (clubbing)
Cough, exercise intolerance, and a productive cough are probably the most
common and the most important of these signs and symptoms. In the first few
years, a patient with COPD can learn to live with the disease. Medications
along with exercise, stopping smoking, and other lifestyle changes can help
but the disease always gets worse over time.
Many patients with COPD cannot even walk a few steps without becoming short
of breath and needing to rest. They become more dependent on medications and
oxygen, and they are also more susceptible to lung infections.
Exacerbation Of COPD
One of the common features of COPD is an event called exacerbation of COPD.
Exacerbation means worsening, and an exacerbation of COPD is an episode in
which a patient who has been stable and breathing well suddenly becomes
short of breath. The patient will also have increased coughing and increased
sputum production. Other signs and symptoms such as fatigue, fever, sore
throat, and weakness may develop. If the patient’s respiratory function and
gas exchange capability are especially poor, he or she may become confused,
cyanotic, and tachypneic.
Exacerbations are common, and most of them are caused by a bacterial or
viral infection in the lungs. However, in some cases, there is no evidence
of an infection and the reason for the sudden deterioration cannot be found.
Regardless of the cause, an exacerbation of COPD is a very serious problem.
People with COPD have poor respiratory function. Their gas exchange, the
oxygen delivery, and carbon dioxide excretion are poor. Any further
disruption in the patient’s ability to breathe will require that the patient
be hospitalized and placed on mechanical ventilation.
Emergency Care
Most people who are having an exacerbation of COPD will have some dramatic
signs and symptoms. They will be tachypneic, they will likely have a
constant cough and wheeze. Speaking in sentences of more than a few words
will be impossible, and it is likely their skin color will be bad. They may
be sweaty and pale and these people will also say their breathing is bad.
Phrases such as “I just can’t catch my breath,” or “I feel like I can’t
breathe,” are common.
However, for some people, the signs and symptoms of a COPD exacerbation can
be a bit more difficult to detect. The patient who is having an exacerbation
may not appear to be in acute distress but if a caregiver has experience
caring for a patient with COPD exacerbation, the caregiver may notice subtle
changes in behavior or appearance, small clues that indicate “something’s
not right.” In these situations, the patient’s input is invaluable since the
patient will be the first one to know if an exacerbation is happening. For
example, a patient who does not have obvious signs of distress may indicate
that he or she is experiencing COPD exacerbation by saying, “My breathing
just doesn’t feel normal.” Serious attention should be given to statements
like this even if more obvious signs are absent.
If a patient appears to be having an exacerbation, the health care
professional should immediately notify a supervisor. Some patients may have
a hand-held nebulizer that they have been instructed to use in these
situations. This is called a rescue inhaler, and they are one of the
bronchodilators such as albuterol. These inhalers provide rapid relief,
usually within minutes, and if the patient has an inhaler they may need help
using it.
Aside from notifying a supervisor and helping the patient find and use the
rescue inhaler, the patient should be encouraged to rest. The more active
someone is the more oxygen the body needs, so activity and exacerbation of
COPD are not a good combination. The medical clinician should also try to
maintain a calm and reassuring demeanor. Even for people who have
experienced it before, an exacerbation of COPD is frightening. No matter how
hard they try and no matter what is done they cannot “catch their breath,”
and the high level of emotion can make breathing more difficult. The health
care professional should stay calm, and try to help the patient stay calm.
Many people who have COPD use supplemental oxygen. A natural response to
someone who is having difficulty breathing during an exacerbation would be
to increase the flow of oxygen, and the patient may ask the health care
professional to do so. However, the health care professional should not
increase the flow of oxygen.
The rate of oxygen flow for a COPD patient is prescribed by a provider, and
it can only be changed if a provider has ordered the flow to be increased or
decreased. There is evidence that increasing oxygen flow to someone who has
COPD may, at a certain point, be harmful by decreasing the respiratory rate.
This will be explained later on.
COPD Treatments and Lifestyle Adjustments
There is no cure for chronic obstructive pulmonary disease. COPD can only be
treated as a progressive disease where the patient will eventually succumb
to the disease and die from respiratory failure or other complications from
COPD. However, COPD can be managed. A patient’s life expectancy can be
significantly expanded, and the quality of life can be greatly improved. The
treatments for COPD can be divided into two groups:
1. Lifestyle adjustments (smoking cessation, diet/hydration, and
exercise)
2. Medical treatments
Smoking Cessation
Smoking cessation is the most important and the most effective treatment for
COPD. Within several days of smoking cessation, the lung irritation and some
of the lung damage caused by constant exposure to cigarette smoke begins to
heal. Over the next few months, lung function improves, the chronic smoker’s
cough diminishes, and the patient’s subjective complaints of shortness of
breath decrease. Other health benefits, for example, decreased risk of heart
disease and stroke, accumulate the longer the person goes without smoking.
Of course, stopping smoking is difficult. Nicotine is physically addictive
in much the same way as illicit drugs such as cocaine and heroin. Most
people will need to be enrolled in a smoking cessation program and/or use
nicotine gum or patches. It can be a long difficult process to stop smoking,
but for someone who has COPD, it is not an option.
Unfortunately for the person with COPD, much of the damage to the bronchial
tubes and the alveoli is permanent. If the patient stops smoking the harm to
the lungs can be limited. Areas that were damaged may recover so long as the
damage was not irreversible. The longer someone smokes and the more
cigarettes he or she smokes, the greater will be the damage to the lungs and
there will be less chance of recovering lung tissue. This will lead to COPD
and faster progress of the disease.
Once COPD occurs, even with smoking cessation and some repair to reversibly
damaged tissue, the decrease of pulmonary function will continue and slowly
worsen over time.
Diet And Hydration
Good nutrition is very important for someone who has COPD. There is evidence
that clearly shows that people who have COPD and have a poor nutritional
status have a decreased tolerance for exercise, their lung function is poor,
and they die earlier. Poor nutrition can weaken the immune system and make
the patient susceptible to infections. Unfortunately, COPD often makes
people nauseated and decreases their appetite. The patient should be
encouraged to eat well and they should have the benefits of a healthy diet
explained to them.
Good hydration is also a critical part of self-care for the person who has
COPD. Dehydration thickens secretions in the lungs. This increases the risk
of pulmonary infections, and it also makes it more difficult for the patient
to cough up and expel those secretions.
Exercise
Exercise for the COPD patient can increase exercise tolerance, help prevent
lung infections, and improve mood. Aerobic exercises such as bike riding,
swimming, walking, etc., and strength-building exercises such as weight
lifting should only be initiated if the patient’s provider has approved.
Starting an exercise program is never easy and sticking with a program,
particularly in the beginning when it is hard to see the benefits, is very
difficult. This is especially so for the patient with COPD who has decreased
exercise tolerance. The patient with COPD should be encouraged to
participate in pulmonary rehabilitation as best as possible.
Discussing the details of an exercise program for someone with COPD is
beyond the scope of this section, but if a health care professional is
working with a patient who has COPD and that patient is actively exercising,
part of the health care professional’s responsibility is patient safety when
the patient is exercising. The health care professional should remind the
patient that if he or she develops shortness of breath or chest pain while
exercising, exercise should be stopped immediately.
Some patients who have COPD may also benefit from breathing exercises. These
are exercises that target the muscles involved in breathing. The number of
times to do them and how often to do them will be prescribed by the
patient’s provider, or perhaps by a physical therapist or respiratory
therapist. Examples of these breathing exercises are reviewed below.
Pursed Lip Breathing
1. The first step is to relax the neck and shoulder muscles.
2. Breathe in for two seconds through the nose while keeping the mouth
closed.
3. Finish by breathing out for four seconds through pursed lips. If
someone cannot breathe out for four seconds, they can simply breathe out for
two seconds, the same amount of time as was spent breathing in.
Diaphragmatic Breathing
1. The patient should be laying on his or her back. If need be, a
pillow can be placed under the knees for support.
2. Place one hand on the stomach, just below the rib cage.
3. Put the other hand on the chest.
4. While counting to three, inhale through the nose as deeply as
possible. Try to keep the chest from moving during the inhalation. The
stomach and the lower ribs should be felt moving up, but the chest should
remain still.
5. Tighten the stomach muscles and exhale for a count of six through
slightly pursed lips.
Medical Treatment for COPD
Chronic obstructive pulmonary disease cannot be cured but it can be managed
with supplemental oxygen and medications.
Supplemental Oxygen
It has been proven that people who have COPD and use supplemental oxygen
live longer and have better exercise tolerance. Oxygen therapy in a
healthcare facility will be managed by a respiratory therapist or a
registered nurse. In a home setting, a commercial service will provide
delivery and equipment. Many patients can, after some instruction and
initial supervision, manage their oxygen therapy at home without assistance
as long as they have someone to contact if there are problems or questions.
A health care professional does not have primary responsibility for managing
a patient’s oxygen therapy but a health care professional can and should be
able to help a patient use oxygen safely. If a patient with COPD requires
supplemental oxygen, the health care professional should perform the
following steps.
Assess Oxygen Therapy for Effectiveness
If the patient is complaining of breathing difficulties, or if the health
care professional believes the patient’s respiratory status is declining,
the oxygen therapy may not be working and a supervisor should be notified
immediately. The decline in respiratory status could be due to the equipment
malfunctioning but this would be unusual. It is more likely that the patient
is having an exacerbation and the patient needs an adjustment in the oxygen
or medications.
Use Oxygen Correctly
The health care professional should remember to never change the rate of
oxygen delivery and to not allow the patient to change the rate of delivery.
Most people who are using supplemental oxygen are receiving a flow rate of
around 2-3 liters/minute.
Use Oxygen Safely
Oxygen supports and accelerates combustion, so oxygen must never be used
near open flames or by someone who is smoking.
Keep Oxygen Equipment Clean
There are a variety of ways supplemental oxygen can be delivered but a nasal
cannula is probably the most common. The cannula should be washed with soap
and water several times a week and it should be periodically replaced.
The health care professional should remember that people with COPD are
susceptible to respiratory infections, and oxygen equipment that is not
cleaned can become contaminated with bacteria.
Keep Oxygen Use Comfortable
Oxygen flowing directly into the nostrils can be very drying. A water-based
moisturizer can be used in the nose to prevent dry and sore nasal passages.
Also, the health care professional should check the skin where the cannula
loops around the ears. This area can become red and irritated from the
constant contact with the plastic, and a bit of gauze placed between the
plastic and the ear will provide protection.
It was mentioned earlier that increasing the flow of oxygen could
potentially harm someone who has COPD. The basis for this is that in COPD
the mechanism for breathing is different than it is for someone who does not
have the disease. COPD patients have a reduced ability to exhale carbon
dioxide adequately, which leads to chronic elevation of carbon dioxide.
COPD patients have a hypoxic drive to breathe and if given oxygen at too
high a level the patient’s drive to breathe will be shut down.
Most people often think that the function of breathing is to take in oxygen.
This is only partly true. Much of the reason people breathe is to get rid of
carbon dioxide. However, because COPD damages the lungs, patients with COPD
cannot eliminate carbon dioxide efficiently and they have abnormally high
levels of carbon dioxide in their blood. Eventually, these people become
adapted to the high levels of carbon dioxide. At that point, the drive to
breathe, which is directed by the brain, comes from the lack of oxygen in
the blood, not the need to expel carbon dioxide.
If the patient with COPD is given too much oxygen, the body senses that no
oxygen is needed and there is interference with the drive to breathe. This
is why oxygen must be used cautiously in the patient who has COPD.
Medications
There are three types of medications that are used to treat people who have
COPD:
1. Bronchodilators
2. Corticosteroids
3. Anticholinergics
Bronchodilators
Bronchodilator medications open the swollen, narrow bronchial tubes.
Bronchodilators are usually used in the form of handheld inhalers. The
inhalers are small, pressurized canisters that fit into the hand. The
patient places the nozzle of the inhaler in his or her mouth presses a
trigger that releases the medication and inhales.
Albuterol is a commonly used bronchodilator. The handheld inhalers are
effective if used correctly, but the patient needs to be able to make a
tight seal around the nozzle and coordinate a deep inhalation with the
delivery of the medication. If the patient complains that his or her
bronchodilator is not working, someone needs to make sure the patient is
using it correctly.
Albuterol and the other bronchodilators can also be used in nebulizers.
Albuterol syrup is also available, but this is typically reserved for use in
children. A commonly used brand of handheld bronchodilator inhaler is
Proventil®, which contains albuterol.
The bronchodilators are designed to open the bronchial passages and to
provide relief for approximately 4-6 hours. Someone who is having difficulty
breathing may be tempted to use a handheld bronchodilator more often than
every 4-6 hours.
Using a bronchodilator for rescue therapy in between the normal, scheduled
use of a bronchodilator is acceptable but if the prescribed frequency of an
albuterol inhaler is not helping, more is not better and could be harmful.
The patient’s physician should be called if he or she feels that the
bronchodilator is not providing relief.
Corticosteroids
Some patients with COPD hear the word corticosteroid and associate these
medications with the illegal steroids used by some athletes. Corticosteroids
are different. These are oral medications or medications delivered by
handheld inhalers that decrease inflammation in the lungs. A commonly used
brand of corticosteroid inhaler is Flovent®, which contains fluticasone.
Anticholinergics
Anticholinergic medications are used in inhalers. They work by opening the
bronchial tubes but in a different way than the albuterol type of drugs.
Anticholinergic inhalers protect the airways from spasms that can suddenly
cause the airway to become narrower (bronchospasm). They also may reduce the
amount of mucus produced by the airways. Spiriva® is a common
anticholinergic used for people with COPD. Some handheld inhalers will have
albuterol and an anticholinergic; Combivent® is a commonly used combination
brand.
Antibiotics
Antibiotics should only be used if a person with COPD has a lung infection.
If the patient with COPD expresses that he/she has been taking an antibiotic
because they have been feeling bad, and they are doing so without a
provider’s orders, the health care professional should notify a supervisor
immediately. Taking antibiotics without a provider’s order can cause lung
infections that are dangerous and difficult to treat.
Vaccinations
According to the Center for Disease Control and Prevention (CDC) individuals
with COPD are at higher risk for serious problems from certain
vaccine-preventable diseases. Getting vaccinated is an important step in
staying healthy. People who have COPD should make sure that they have a
yearly flu shot, and many patients who have COPD should receive a pneumonia
vaccination.
Lung Resection
Lung resection is a surgical procedure that can be used to treat COPD. The
damaged areas of the lung are removed, resected, and for some patients, this
is as close to a cure as possible. However, this procedure is only suitable
for a small percentage of people who have COPD.
Caring For the Patient With COPD
Caring for a patient with COPD can be very challenging. Many of these
patients have limited ability to help themselves. Because even a little bit
of physical exertion can be very tiring, the amount of activities they can
perform can sometimes be severely limited.
Chronic obstructive pulmonary disease can be frightening. The exacerbations
may clear up with rest, oxygen, and bronchodilators, but the exacerbations
can also be very severe. The patient may need to be admitted to the hospital
and placed on a ventilator. Sometimes there is a clear reason why these
exacerbations happen, but quite often there is not. Because of these
unpredictable episodes of shortness of breath, many people with COPD must
live with the constant fear that suddenly and without warning they will not
be able to breathe.
As a result of these physical and psychological issues, many people with
COPD require a lot of physical assistance and emotional support. The
following are the areas a health care professional will need to concentrate
on and be familiar with when caring for a COPD patient.
Emotional Support
The patient with COPD often feels very vulnerable. For no apparent reason
and without warning, that person may not be able to breathe. That leaves the
COPD patient feeling dependent on his or her caretakers.
It is important that the health care professional let the patient with COPD
know that he or she understands the disease. The health care professional
must also communicate and demonstrate to them that he or she is reliable and
dependable. Also, because COPD exacerbations can happen unpredictably, these
patients often feel a great need to establish order, regularity, and control
over their environments. Doing so makes them feel secure, and it is
important that the health care professional understands this and within
reason, supports them in this effort.
Physical Assistance
This aspect of care of the patient with COPD is very individualized. The
patient with COPD will often need help dressing and ambulating, and they may
need help eating their meals. It will certainly take these patients much
longer to complete any physical task. The body needs oxygen to perform
physical work, and the COPD patient does not have adequate amounts of oxygen
in his or her blood.
It will take time for the health care professional to determine exactly what
each patient with COPD is capable of doing. This is also something that the
health care professional needs to discuss with the patient. Many people with
COPD have been living with the disease for a long time. They know exactly
what they can and cannot do.
Health care professionals often feel that they must have all the answers. It
is easy to forget that patients may know about the disease they are
suffering from and can tell the health care professional what they are
capable of doing and what they need.
Monitoring Complications
Monitoring complications is relatively simple. Monitor the patient for any
respiratory difficulties, failure to respond to therapies, or any problems
with the patient’s cardiac or neurological status, such as chest pain,
confusion, or drowsiness.
Notifying a Supervisor
A health care professional should notify a supervisor if a patient with COPD
is eating poorly, does not want to exercise, or becomes short of breath more
than usual when performing daily activities. When a health care professional
is caring for a patient with COPD, he or she should notify a supervisor
immediately when the patient:
1. has a fever.
2. complains of shortness of breath.
3. has tachypnea.
4. has skin that is pale or blue.
5. is requesting that the health care professional increase the flow of
oxygen.
6. has used an inhaler or taken another medication but still complains
of shortness of breath.
Summary
The pulmonary system, also called the respiratory system, is responsible for
the movement of two gases, oxygen and carbon dioxide, in and out of the
body. When people inhale, they take in oxygen, and when they exhale, carbon
dioxide is eliminated. The body must have oxygen and must rid itself of
carbon dioxide to survive and the alveoli are where these processes take
place.
Chronic obstructive pulmonary disease is a combination of two separate but
closely related diseases: emphysema and chronic bronchitis. Most people
with COPD have both emphysema and chronic bronchitis, but how severe each
type is can be different from person to person.
When a patient with COPD inhales or exhales, the normal elasticity of the
alveoli does not function properly and they collapse under the pressure.
Also, when the alveoli of a COPD patient are scarred, oxygen and carbon
dioxide cannot move into and out of the blood. If the alveoli do not
function, the patient’s respiratory status and the normal gas exchange that
takes place in the lungs both suffer.
Chronic obstructive pulmonary disease cannot be cured but it can be managed
with supplemental oxygen and medications. Lifestyle changes such as exercise
and stopping smoking can help but the disease always gets worse over time.
The disease will continue to progress until the patient succumbs to the
disease and dies from respiratory failure or other complications from COPD.
As a result of physical and psychological issues, many people with COPD
require a lot of physical assistance and emotional support. The health care
professional will need to concentrate on specific aspects of patient care
when caring for an individual diagnosed with chronic obstructive pulmonary
disease.
