Sheer terror was on his face. He looked like he had ran 100 miles. As Mr. Patient came into the ER he was breathing hard and fast while sweat was dripping from his eyebrow. "I...can't...catch...my...breath", he uttered while gasping for air. His skin was thin, his lips were blue-ish, and he was "barrel-chested".
From the real-life scenario I've just explained to you, could you picture it? Can you (without reading the title of the post), from the little bit I've shown you here, tell me what this guy's problem is? If you've worked in the emergency room for less than a week I'm sure you could. This gentleman has advanced COPD and THIS is a COPD exacerbation. I could've probably gone into a few more details that may have completely ruled out a cardiac issue, but I think you now get the idea.
COPD is a really REALLY complex issue. I thought I had a pretty good grasp on what it is and what it isn't until I had to design pharmacotherapy and non-pharmacotherapy treatment around someone with COPD in my Advanced Pharm class for my NP program. It's complex folks. However, with a little help from a few resources I found, I think we can break it down here so you newbies might get a better understanding and you pro's can get a really good review of some of the newer evidence-based guidelines.
ALSO, I am going to throw in a little FREEBIE you can keep with you in the form of a PDF Pocket Edition of the Global Initiative for Chronic Obstructive Pulmonary Disease. It is a quick reference guide for healthcare professionals that goes great in iBOOKS or whatever eReader you use.
What is COPD?
National Institutes of Health
COPD is a pretty big deal. Currently, it's the number 4 cause of death worldwide, but is estimated to become number 3 by 2020. In America approximately 16 million people have a diagnosis of COPD. That's 1 out of every 5 people. The kicker is it's not getting any better. So what EXACTLY is COPD?
The COPD Foundation defines Chronic Obstructive Pulmonary Disease as "a progressive lung disease which includes emphysema, chronic bronchitis, refractory asthma (non-reversible), and some forms of bronchiectasis." The two MAIN types of COPD, however, are chronic bronchitis and emphysema. COPD makes it very difficult to breathe.
MedlinePlus asserts that the main causes of COPD is prolonged exposure to lung irritants, specifically cigarette smoking. As a matter of fact, the National Institute of Health demonstrates that 75% of the cases of COPD result from tobacco smoking. This would mean that it is predominantly a preventative illness. So if you're a COPD patient, here's your warning...STOP SMOKING!
That being said, there are other reasons people develop COPD. Some of these causes could be a result of genetic abnormalities or abnormal lung development, etc.
The most common symptoms you will come in contact with, as a healthcare provider, is dyspnea, cough, wheezing, chest tightness and/or sputum production. As far as diagnosis goes, just because someone has the symptoms doesn't mean they automatically have a diagnosis of COPD.
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD), spirometry is required to make the diagnosis for COPD. It is stated that "a post-bronchodilator FEV1/FVC < .70 confirms the presence of persistent airflow limitation." This means that after giving them a bronchodilator a spirometry test confirms that their forced expiratory volume divided by their forced vital capacity is less than .70. After spirometry confirms a COPD diagnosis, an assessment is performed to determine the extent of their illness.
As far as the assessment goes, GOLD (2017) states that the goal of the assessment is to "determine the severity of the disease, the impact of the disease on the patient's health status, and the risk of future events (exacerbations, hospital admissions, or death) in order to guide therapy.
Here is a great tool called the ABCD Assessment Tool created by the Global Initiative for Chronic Obstructive Lung Disease (GOLD, 2017)...
Because there are quite a few treatment options, the tool above will guide you in determining the right treatment for each COPD patient. However, the very first treatment should include to remove the lung irritant. If the patient is a smoker, it is suggested to STRONGLY URGE the patient to quit smoking and evaluate options to assist them in doing so.
Many of those diagnosed with COPD begin to do less and less because they don't want to become short of breath. Because of this they become less and less tolerant of physical exertion. This is called de-conditioning. Exercising can't cure COPD, but it can make the patient breath better and feel better. The key is starting slow, pacing oneself, and not giving up once feeling better.
Pertaining to other treatment options, there are some updates that each healthcare professional should be aware of. Instead of typing each out, I will go ahead and post the two tables below...
In addition to the above table, the one below will guide you in treatment options according to the stage with which they are identified using the ABCD Assessment Tool above.
Here's a graphical representation of the above table. The blue color points to preferred options...
Beyond pharmacotherapy there are other treatment modalities to consider in advanced stages, including bronchoscopic and surgical interventions. In addition, encouraging the COPD patient to receive routine influenza and pneumococcal vaccinations is suggested to avoid increased risk of lower respiratory tract infections, which can result in exacerbations and hospitalizations.
COPD is a big deal friends. There is far more information out there on the topic and because it is so debilitating globally, there are many organizations working to combat this illness. I've included a few of them above in hyperlinks.
Currently, the National Institute of Health has developed the COPD National Action Plan. Here's a great quick video from their initiative. If you're a healthcare professional and you'd like to get involved or you'd like more info and resources from the NIH on COPD click here.
Know someone with COPD? Here's a useful handout you can print off from here and give to them. It should help guide them to a better quality of life.
If you're a healthcare professional, I have a little something for you from the Global Initiative for Chronic Obstructive Lung Disease. It's called the Pocket Guide to COPD Diagnosis, Management, and Prevention. It includes some of the tables above as well as some other great information that can help guide you in your practice. Enjoy!
Thanks for taking the time to read the blog friends! It's a pleasure to connect with you. I'd love to connect with you on Twitter at @MichaelWardRN. If you're not a subscriber, think it over. ;) I have fairly frequent freebies I give to my subscribers through email, as well as #FreeFriday giveaways through Twitter.