Chronic Chronic obstructive obstructive pulmonary pulmonary

diseasedisease((COPDCOPD))

Dr. gehan younisDr. gehan younis

Lecturer of critical care Lecturer of critical care NursingNursing

COPDCOPD Out linesOut lines What is the COPD?What is the COPD? OverviewOverview Causes of COPDCauses of COPD Symptoms of COPDSymptoms of COPD What's the difference between COPD What's the difference between COPD

and asthma?and asthma? Diagnostic tests needed for COPDDiagnostic tests needed for COPD Medical management of COPDMedical management of COPD Preventive measuresPreventive measures Nursing interventionNursing intervention

COPDCOPD DefinitionDefinition

COPDCOPD, or chronic , or chronic obstructive pulmonary obstructive pulmonary disease, is a progressive disease, is a progressive disease that makes it disease that makes it hard to breathe. hard to breathe. "Progressive" means the "Progressive" means the disease gets worse over disease gets worse over time.time.

COPD is a collective name for chronic COPD is a collective name for chronic

bronchitis and emphysema, two diseases bronchitis and emphysema, two diseases

that are almost always caused by that are almost always caused by

smoking. Many of the symptoms of COPD smoking. Many of the symptoms of COPD

are similar to those of asthma (e.g. are similar to those of asthma (e.g.

breathlessness, wheezing, production of breathlessness, wheezing, production of

too much mucus, coughing). too much mucus, coughing).

COPD is a more serious disease than COPD is a more serious disease than

asthma, because the changes in the airways asthma, because the changes in the airways

are much more difficult to treat, and it are much more difficult to treat, and it

usually has a worse outcome. COPD can usually has a worse outcome. COPD can

cause greater long-term disability and have cause greater long-term disability and have

a greater effect on the heart and other a greater effect on the heart and other

organ systems than asthma. organ systems than asthma.

COPD: disease due to COPD: disease due to emphysema or chronic emphysema or chronic bronchitis characterized by bronchitis characterized by airflow limitation that is not airflow limitation that is not fully reversiblefully reversible

COPDCOPD OverviewOverview

COPDCOPD OverviewOverview

In COPD, less air flows in and out of the airways because of one or more of the following:

The airways and air sacs lose their elastic quality.

The walls between many of the air sacs are destroyed.

The walls of the airways become thick and inflamed.

The airways make more mucus than usual, which tends to clog them.

EmphysemaEmphysema DescriptionDescriptionEmphysemaEmphysema DescriptionDescription

Abnormal permanent Abnormal permanent enlargement of the air space enlargement of the air space distal to the terminal bronchiolesdistal to the terminal bronchioles

Accompanied by destruction of Accompanied by destruction of bronchiolesbronchioles

Abnormal permanent Abnormal permanent enlargement of the air space enlargement of the air space distal to the terminal bronchiolesdistal to the terminal bronchioles

Accompanied by destruction of Accompanied by destruction of bronchiolesbronchioles

Chronic BronchitisChronic Bronchitis DescriptionDescription

Chronic BronchitisChronic Bronchitis DescriptionDescription

Presence of chronic productive Presence of chronic productive cough for 3 or more months in cough for 3 or more months in each of 2 successive years in a each of 2 successive years in a patient whom other causes of patient whom other causes of chronic cough have been chronic cough have been excludedexcluded

Presence of chronic productive Presence of chronic productive cough for 3 or more months in cough for 3 or more months in each of 2 successive years in a each of 2 successive years in a patient whom other causes of patient whom other causes of chronic cough have been chronic cough have been excludedexcluded

COPDCOPDCausesCauses

Exposure to pipe, cigar, tobacco Exposure to pipe, cigar, tobacco smokesmoke

Exposure to second hand smokeExposure to second hand smoke Exposure to heavy air pollutionExposure to heavy air pollution Exposure to heavy dustExposure to heavy dust Exposure to chemical/toxic fumesExposure to chemical/toxic fumes Genetic conditionsGenetic conditions

InfectionInfection Major contributing factor to the aggravation and progression of COPDMajor contributing factor to the aggravation and progression of COPD

HeredityHeredity -Antitrypsin (AAT) deficiency (produced by liver and found in lungs).this -Antitrypsin (AAT) deficiency (produced by liver and found in lungs).this

protien protect lung tissue from ensymz of inflamatory cellsprotien protect lung tissue from ensymz of inflamatory cells

Normal from 1.5-3.5 g\L Normal from 1.5-3.5 g\L

Emphysema results from lysis of lung tissues by proteolytic enzymes Emphysema results from lysis of lung tissues by proteolytic enzymes

from neutrophils and macrophagesfrom neutrophils and macrophages

InfectionInfection Major contributing factor to the aggravation and progression of COPDMajor contributing factor to the aggravation and progression of COPD

HeredityHeredity -Antitrypsin (AAT) deficiency (produced by liver and found in lungs).this -Antitrypsin (AAT) deficiency (produced by liver and found in lungs).this

protien protect lung tissue from ensymz of inflamatory cellsprotien protect lung tissue from ensymz of inflamatory cells

Normal from 1.5-3.5 g\L Normal from 1.5-3.5 g\L

Emphysema results from lysis of lung tissues by proteolytic enzymes Emphysema results from lysis of lung tissues by proteolytic enzymes

from neutrophils and macrophagesfrom neutrophils and macrophages

Pathogenesis of COPDPathogenesis of COPD

NOXIOUS AGENT(tobacco smoke, pollutants, occupational

agent)

COPD

Genetic factors

Respiratory infection

Other

Pathophysiology of Chronic Pathophysiology of Chronic Bronchitis and Bronchitis and

Emphysema(COPD)Emphysema(COPD)

Fig. 28-7

COPDCOPD SymptomsSymptoms

Productive cough Breathlessness Chest infection Other symptoms of COPD weight loss, tiredness and ankle swelling.

Signs and symptomsSigns and symptoms

WheezingWheezing CoughingCoughing Sputum productionSputum production Shortness of breath Shortness of breath Chest tightnessChest tightness

Difference between COPD and Asthma

In COPD there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are chronic (persistent). Treatment to open up the airways, is therefore limited.

In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well.

COPD is more likely than asthma to cause a chronic (ongoing) cough with sputum.

Difference between COPD and asthma (cont…)

Night time waking with Night time waking with breathlessness or wheeze is breathlessness or wheeze is common in common in asthma asthma and uncommon and uncommon in COPD.in COPD.

COPDCOPD is rare before the age of 35 is rare before the age of 35 whilst asthma is common in under-whilst asthma is common in under-35.35.

COPDCOPD Diagnostic tests

Symptoms Physical examination Sample of sputum Chest x-ray High-resolution CT (HRCT scan) Pulmonary function test

(spirometery) Arterial blood gases test Pulse oximeter

Objectives of COPD Objectives of COPD ManagementManagement

Prevent disease progression Prevent disease progression Relieve symptomsRelieve symptoms Improve exercise toleranceImprove exercise tolerance Improve health statusImprove health status Prevent and treat exacerbationsPrevent and treat exacerbations Prevent and treat complicationsPrevent and treat complications Reduce mortalityReduce mortality Minimize side effects from treatmentMinimize side effects from treatment

COPDCOPD Medical management

Give antibiotics to treat infection

Give bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema and liquefy secretions.

Chest physiotherapy and postural drainage to improve pulmonary ventilation.

Proper hydration helps to cough up secretions or tracheal suctioning when the patient is unable to cough.

Steroid therapy if the patient fails to respond to more conservative treatment.

COPDCOPD Medical management (cont…)

SStop smokingtop smoking

OOxygenation with low concentration during the acute xygenation with low concentration during the acute episodesepisodes

InIn asthma adrenaline ( epinephrine) SC if the asthma adrenaline ( epinephrine) SC if the bronchospasm not relieved.bronchospasm not relieved.

AAminophylins IV if the above treatment does not help.minophylins IV if the above treatment does not help.

IVIV corticosteroids for patients with chronic asthma or corticosteroids for patients with chronic asthma or frequent attack.frequent attack.

SSedative or tranquilizers to calm the patient.edative or tranquilizers to calm the patient.

IIncrease fluids intake to correct loss of diaphoresis and ncrease fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation.inaccessible loss of hyperventilation.

IIntubations and mechanical ventilation if there is ntubations and mechanical ventilation if there is respiratory failurerespiratory failure..

To prevent irritation and infection of the To prevent irritation and infection of the airways, instruct the patient to:airways, instruct the patient to:

Avoid exposure to cigarette, pipe, and Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and cigar smoke as well as to dusts and powders.powders.

Avoid use of aerosol sprays.Avoid use of aerosol sprays.

Stay indoors when the pollen count is Stay indoors when the pollen count is high.high.

Stay indoors when temperature and Stay indoors when temperature and humidity are both highhumidity are both high

COPDPreventive measures

Use air conditioning to help decrease pollutants and control temperature

Avoid exposure to persons known to have colds or other respiratory tract infection

Avoid enclosed, crowded areas during cold and flu season.

Obtain immunization against influenza and streptococcal pneumonia.

COPDPreventive measures (cont…)

COPDPreventive measures (cont…)

To ensure prompt, effective treatment To ensure prompt, effective treatment of a developing respiratory infection, of a developing respiratory infection, instruct the patient to do the instruct the patient to do the following:-following:-

Report any change in sputum color Report any change in sputum color character, increased tightness of the character, increased tightness of the chest, increased dyspnea, or fatigue.chest, increased dyspnea, or fatigue.

Call the physician if ordered antibiotics Call the physician if ordered antibiotics do not relieve symptoms within 24 do not relieve symptoms within 24 hours.hours.

COPDNursing interventionNursing intervention

Assessment Assessment HistoryHistory Patient's environmentPatient's environment Work history, exercise Work history, exercise

pattern, smoking habitspattern, smoking habits The onset & development of The onset & development of

symptomssymptoms Sleeping positionsSleeping positions

COPDNursing intervention (cont…)Nursing intervention (cont…)

Physical examinationSigns of heavy smokers Observe for clubbing Distended neck vein on expiration The presence of barrel chest Observe for abdominal breathing The use of pursed lips breathing

and chest movement Auscultate the chest& listen for

musical wheezes characteristics of chronic bronchitis

COPDNursing intervention (cont…)Nursing intervention (cont…)

review the results of diagnostic procedure:

Arterial blood gases Pulmonary function tests X-ray films Nursing diagnosis

Ineffective breathing pattern related to increase need of O2

Ineffective airway clearance related to excessive accumulation of secretions

Impaired gas exchange related to impaired expiration &co2 retention

COPDNursing intervention (cont…)Nursing intervention (cont…)

Activity intolerance related to inadequate oxygenation

High risk for ineffective individual coping related to chronic disease, its effects& its treatment

High risk for altered health maintenance

related to insufficient knowledge of prevention, identification and treatment of respiratory complication of COPD

Warning symptomsWarning symptoms

Increasing shortness of breathIncreasing shortness of breath Increasing coughing and Increasing coughing and

wheezingwheezing History of feverHistory of fever

Warning signs*Warning signs*

Increased wheezingIncreased wheezing Decreased pulse ox Decreased pulse ox Fever ( greater than 101 degrees Fever ( greater than 101 degrees

Fahrenheit)Fahrenheit) Increased pulse (greater than 100)Increased pulse (greater than 100) Decreased pulse (less than 60)Decreased pulse (less than 60) Increased respiratory rateIncreased respiratory rate

*ALL vital parameters are determined *ALL vital parameters are determined by RN supervisor and are patient by RN supervisor and are patient specificspecific

COPDCOPDComplicationsComplications

COPDCOPDComplicationsComplications

Pulmonary hypertension (pulmonary Pulmonary hypertension (pulmonary vessel constriction d/t alveolar vessel constriction d/t alveolar hypoxia & acidosis)hypoxia & acidosis)

Cor pulmonale (Rt heart hypertrophy Cor pulmonale (Rt heart hypertrophy ++ RV failure) RV failure)

PneumoniaPneumonia Acute Respiratory FailureAcute Respiratory Failure

Pulmonary hypertension (pulmonary Pulmonary hypertension (pulmonary vessel constriction d/t alveolar vessel constriction d/t alveolar hypoxia & acidosis)hypoxia & acidosis)

Cor pulmonale (Rt heart hypertrophy Cor pulmonale (Rt heart hypertrophy ++ RV failure) RV failure)

PneumoniaPneumonia Acute Respiratory FailureAcute Respiratory Failure