Angeles University Foundation

Angeles City
College of Nursing

CHRONIC OBSTRUCTIVE

PULMONARY DISEASE

Bonifacio, Rayne

Pangilinan, Geneveive

Torculas, Jacinth

Vasquez, Hailalyn
 A. Definition
Chronic obstructive pulmonary disease (COPD) is defined as a common,
preventable disease characterized by airflow limitation that is not fully reversible and is
usually progressive. COPD includes two primary phenotypes that frequently overlap
each other, chronic bronchitis and emphysema.

Chronic bronchitis is defined as hypersecretion of mucus and chronic productive

cough that continues for at least 3 months of the year (usually the winter months) for at
least 2 consecutive years. Inspired irritants promote bronchial inflammation, causing
bronchial edema, increases in the size and number of mucous glands and goblet cells
in the airway epithelium, smooth muscle hypertrophy with fibrosis, and narrowing of
airways. Hypersecretion of thick, tenacious mucus occurs and cannot be cleared
because of impaired ciliary function. The lung's defense mechanisms are therefore
compromised, increasing susceptibility to pulmonary infection, which contributes to
airway injury and ineffective repair. Frequent infectious exacerbations from bacterial
colonization of damaged airways are complicated by bronchospasm with dyspnea and
productive cough. Initially chronic bronchitis affects only the larger bronchi, but
eventually all airways are involved. The thick mucus and hypertrophied bronchial
smooth muscle narrow the airways and lead to obstruction, particularly during expiration
when the airways are constricted. Obstruction also leads to ventilation-perfusion
mismatch with hypoxemia.

Emphysema is abnormal permanent enlargement of gas-exchange airways

(acini) accompanied by destruction of alveolar walls without obvious fibrosis. Both
phenotypes are associated with an enhanced chronic inflammatory response in the
airways to noxious particles or gases. Emphysema is characterized by destruction of
alveoli through the breakdown of elastin within the septa caused by an imbalance
between proteases and antiproteases, oxidative stress, and apoptosis of lung structural
cells. The number of neutrophils is increased in the airways of individuals with
emphysema and they release elastase and proteases that cleave structural collagen
and promote tissue breakdown, thus destroying bronchial and alveolar structures.
Macrophages also are recruited to the lungs and enhance the release of
proinflammatory mediators.

Emphysema can be centriacinar (centrilobular), paraseptal, or panacinar

(panlobular); these variations can also occur in combination depending on the site of
involvement. In centriacinar (centrilobular) emphysema, septal destruction occurs in the
respiratory bronchiolar walls and alveolar ducts in the center of the pulmonary lobule,
usually in the upper lobes of the lung. The alveolar sac (alveoli distal to the respiratory
bronchiole) remains intact. This type of emphysema tends to occur in smokers with
chronic bronchitis. Paraseptal emphysema is similar to centriacinar emphysema but
occurs adjacent to the pleura and septa of the pulmonary lobule and is associated with
large bullae formation. Panacinar emphysema involves the alveolar and respiratory
bronchiolar walls, resulting in global air space expansion with damage more randomly
distributed and involving the lower lobes of the lung. It tends to occur in older adults and
in those with α1 -antitrypsin deficiency. Alveolar destruction also produces large air
spaces within the lung parenchyma (bullae) and air spaces adjacent to pleurae (blebs).

B. Possible Causes
• Important risk factors or the possible causes for COPD includes lifestyle, age,
socioeconomic, family clustering and lung infections.
• Lifestyle. Cigarette smoking is far the most important risk factor or the reason why
COPD happen, for short it might be the cause. Cigar and pipe smoking can cause
COPD. Air pollution and industrial dusts and fumes are other important risk factors. Age,
chronic bronchitis is more common in people over 40 years old; emphysema occurs
more often in people 65 years of age and older. Socioeconomic class, COPD - related
deaths are about twice as high among unskilled and semi-skilled laborers as among
professionals. Family clustering, it is thought that heredity predisposes people in certain
families to the development of COPD when other causes, such as smoking and air
pollution, are present. Lung infections make all forms of COPD worse.
• Emphysema, chronic bronchitis, asthma or any of these disordered whether combined
or not, these diseases are part of the cause of the Chronic Obstructive Pulmonary
disease.

C. Signs and Symptoms

The first symptoms of chronic bronchitis are cough and mucus production. These
symptoms resemble a chest cold that lingers on for weeks. Later, shortness of breath
develops. Cough, sputum production, and shortness of breath may become worse if a
person develops a lung infection. A person with chronic bronchitis may later develop
emphysema as well. In emphysema, shortness of breath on exertion is the predominant
early symptom. Coughing is usually minor and there is little sputum. As the disease
progresses, the shortness of breath occurs with less exertion, and eventually may be
present even when at rest. At this point, a sputum-producing cough may also occur.
Either chronic bronchitis or emphysema may lead to respiratory failure a condition in
which there occurs a dangerously low level of oxygen or a serious excess of carbon
dioxide in the blood.

D. Treatment and Nursing Responsibilities

TREATMENT:

Treatment is designed to relieve symptoms and prevent complications. Because

most COPD patients receive outpatient treatment, they need comprehensive patient
teaching to help them comply with therapy and understand the nature of this chronic,
progressive disease. If programs in pulmonary rehabilitation are available, encourage
the patient to enroll.

Urge the patient to stop smoking. Provide smoking cessation counseling or refer
him to a program. Avoid other respiratory irritants, such as secondhand smoke, aerosol
spray products, and outdoor air pollution. An air conditioner with an air filter in his home
may be helpful.
 Most patients will be treated with beta-agonist bronchodilators (albuterol or
salmeterol), anticholinergic bronchodilators (ipratropium), and corticosteroids
(beclomethasone or triamcinolone). These are usually given by metered-dose inhaler,
requiring that the patient be taught the correct administration technique.

Antibiotics are used to treat respiratory infections. Stress the need to complete
the prescribed course of antibiotic therapy.

Lung volume reduction surgery is a new procedure for carefully selected patients
with primarily emphysema. Nonfunctional parts of the lung (tissue filled with disease and
providing little ventilation or perfusion) are surgically removed. Removal allows more
functional lung tissue to expand and the diaphragm to return to its normally elevated
position.

NURSING RESPONSIBILITIES

Administer low concentrations of oxygen as ordered. Perform blood gas analysis

to determine the patient's oxygen needs and to avoid carbon dioxide narcosis. Patients
with COPD rarely require more than 2 to 3 L/minute to maintain adequate oxygenation.
Higher flow rates will further increase the partial pressure of arterial oxygen, but patients
whose ventilatory drive is largely based on hypoxemia will often develop markedly
increased partial pressure of arterial carbon dioxide tensions. In these patients,
chemoreceptors in the brain are relatively insensitive to the increase in carbon dioxide.
Teach patients and family that excessive oxygen therapy may eliminate the hypoxic
respiratory drive, causing confusion and drowsiness, signs of carbon dioxide narcosis.

Emphasize the importance of a balanced diet. Because the patient may tire
easily when eating, suggest that he eat frequent, small meals and consider using
oxygen, administered by nasal cannula, during meals.
 Help the patient and his family adjust their lifestyles to accommodate the
limitations imposed by this debilitating chronic disease. Instruct the patient to allow for
daily rest periods and to exercise daily as his physician directs.

As COPD progresses, encourage the patient to discuss his fears.

To help prevent COPD, advise all patients, especially those with a family history
of COPD or those in its early stages, not to smoke.

Assist in the early detection of COPD by urging persons to have periodic physical
examinations, including spirometry and medical evaluation of a chronic cough, and to
seek treatment for recurring respiratory infections promptly.

References

Longe, J. L. (2002). The gale encyclopedia of medicine. United States of

America. Gale group.

Springhouse (2005). Diseases: a nursing process approach to excellent

care. Ambler, PA: Lippincott Williams & Wilkins