Diagnosis the patient to control the rate and depth of

The diagnosis of COPD should be considered in anyone respiration.

over the age of 35 to 40 who has shortness of breath, a  It also promotes relaxation, enabling the patient
chronic cough, sputum production, or frequent winter to gain control of dyspnea and reduce feelings of
colds and a history of exposure to risk factors for the panic.
disease b. Self-Care Activities
1. Spirometry- is used to evaluate airflow c. Physical Conditioning
obstruction, which is determined by the ratio of d. Oxygen Therapy
FEV1 (volume of air that the patient can forcibly e. Nutritional Therapy
exhale in 1 second) to forced vital capacity
(FVC)
2. Chest X-ray- help support the diagnosis of CHRONIC BRONCHITIS
COPD by producing images of the lungs to  Is a disease of the airways defined as the
evaluate symptoms of shortness of breath or presence of cough and sputum production for at
chronic cough. While a chest x-ray may not least 3 months in each of 2 consecutive years
show COPD until it is severe, the images may  A nagging cough with plenty of mucus (phlegm)
show enlarged lungs, air pockets (bullae) or a  A "smoker's cough" is typically a sign of chronic
flattened diaphragm. bronchitis. The cough is often worse in the
A chest x-ray may also be used to determine if morning and in damp, cold weather.
another condition may be causing symptoms similar Predisposing factor:
to COPD. • Smoke or other environmental pollutants
3. Chest CT Scan- this exam may be performed
to help support the diagnosis of COPD or
determine if the disease has worsened.
CT is sometimes used to measure the extent of
emphysema within the lungs. It can also help determine
if the symptoms are the result of another disease of the
chest.
Other Diagnostic Test
 CBC complete blood count
 ABG arterial blood gas - is used to determine the
need for oxygen

Complications
Respiratory insufficiency and failure may be chronic
(with severe COPD)
Other complications of COPD include:
1. pneumonia,
2. atelectasis,
3. pneumothorax,
4. cor pulmonale.

Management EMPHYSEMA
The major goals of management are: • A pathological term that describes an abnormal
1. to reduce risk factors, distention of an air spaces beyond the terminal
2. manage stable COPD, bronchioles, with destruction of the walls of the
3. prevent and treat acute exacerbations, and alveoli. It is the end stage of a process that has
4. manage associated illnesses progressed slowly for many years.
• Medical Management • There is an impaired gas exchange (O2, CO2)
results from of the walls of overdistended alveoli.
1. RISK REDUCTION
Stop smoking decreases the risk of death by Two types of emphysema:
18%. 1. Panlobular (pancinar)- there is destruction of
the respiratory bronchiole, alveolar duct, and the
2. PHARMACOLOGIC THERAPY alveoli, all air spaces w/in the lobule are
a. Bronchodilators relieve bronchospasm essentially enlarge, but there is little
and reduce airway obstruction by allowing inflammatory disease.
increased oxygen distribution throughout the Sign & symptoms
lungs and improving alveolar ventilation.  hyperinflated (hyperexpanded) chest (barrel
b. Corticosteroids. Inhaled and systemic chest on PE)
corticosteroids (oral or intravenous)  marked dyspnea on exertion
 weight loss
3. OXYGEN THERAPY  to move air into and out of the lungs, negative
Oxygen therapy can be administered as long- pressure is required during inspiration and an
term continuous therapy, during exercise, or to adequate level of positive pressure must
prevent acute dyspnea. Long term oxygen therapy attained and maintained during expiration
has been shown to improve the patient’s quality of life becomes active and requires muscular effort,
and survival there is increasingly short of breath, the chest
becomes rigid, and the ribs are fixed at their
Nursing Management joints.
PATIENT EDUCATION
a. Breathing Exercises 2. Centrolobular (centroacinar) from, pathologic
 Pursed lip breathing helps to slow expiration, changes take place mainly in the center of the
prevents collapse of small airways, and helps secondary lobule, preserving the peripheral
portions of the acinus. Frequently there is a
 derangement of ventilation-perfusion ratios,
producing chronic hypoxia, hypercapnia
(increased CO2 in the arterial blood),
polycythemia, and episode of right sided heart
failure. This lead to central cyanosis, peripheral
edema, and respiratory failure. The patient may
receive diuretic therapy for edema.

Risk Factors
• Smoking – pipe, cigar & other types of tobacco
smoking
• Passive smoking
• Prolonged & intense exposure to occupational
dusts, chemicals, indoor pollution
• Deficiency in alpha antitrypsin enzyme that
protects the lung parenchyma from injury.
(predisposes young patients to rapid
development of lobular emphysema even in the
absence of smoking

Causes/Predisposing Factors
• Humoral immunodeficiency (low levels of
infection-fighting proteins in the blood)
• Inflammatory bowel disease (Crohn’s disease
and ulcerative colitis)
• Rheumatologic diseases (rheumatoid arthritis
and Sjögren’s disease)
• Alpha1-antitrypsin deficiency (genetic cause of
COPD in some people)
• Chronic obstructive pulmonary disease or COPD
• HIV infection
• Allergic bronchopulmonary aspergillosis (a type
of allergic lung inflammation)