copd ppt

Presented By: Fretzie Anne G. Gomez, CMT, RN

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

(COPD)

G OLD

G OLD

lobal Initiative for

Chronic

bstructive

ung

isease

lobal Initiative for

Chronic

bstructive

ung

isease

United StatesUnited States

United Kingdom

ArgentinaArgentina

AustraliaAustralia

AustriaCanadaCanada

Chile

Belgium

ChinaChina

DenmarkDenmarkColumbiaColumbia

EgyptEgypt

GreeceItalyItaly SyriaSyria

Hong Kong ROC

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IndiaIndia

KoreaKorea

UruguayUruguay

MoldovaMoldova

NepalNepal

Macedonia

Malta

New Zealand

PolandPoland NorwayNorway

Portugal

GeorgiaGeorgia

Romania

SingaporeSlovakia

SwedenSweden

ThailandThailand

SwitzerlandSwitzerland

UkraineUkraine

United Arab EmiratesUnited Arab Emirates

VenezuelaVenezuela

Peru Yugoslavia

France

Mexico

Turkey Czech Republic

Pakistan

GOLD National Leaders

PhilippinesTeresita S. deGuia, MD

Philippine Heart Center

Quezon City, PH

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

- COPD is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. (GOLD)

- COPD is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible.(World Health Organization).

COPD is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.(National Heart Lung and Blood Institute)

The airflow limitation is usually progressive & is associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.

COPD is the 4th leading cause of death, and the 2nd cause of disability in the U.S. and yet, COPD is under diagnosed and under-treated:

About 24 million U.S adults have evidence of impaired lung function.

12 million people have been diagnosed with COPD.

5.8 million COPD patients are UNTREATED.

The COPD death rate among women is increasing.

REFERENCES GOLD2008 and American Thoracic Society

Epidemiology of COPD

Chronic Bronchitis- is the chronic inflammation of

bronchi characterized by productive cough that lasts 3 months a year for 2 consecutive years.

Emphysema- is a long-term, progressive disease

of the lungs that primarily causes shortness of breath due to over-inflation of the alveoli (air sacs in the lung).

COPD includes:

Stages of COPD:

STAGE I  (mild)-Often minimal shortness of breath

with or without cough and/or sputum. Usually goes unrecognized that lung function is abnormal

-  FEV >  80% of predicted

STAGE II (moderate)-Often moderate or severe shortness

of breath on exertion, with or without cough, sputum or dyspnea.  Often the first stage at which medical attention is sought due to chronic respiratory symptoms or an exacerbation

-  FEV 50-80% of predicted

STAGE III (severe)-more severe shortness of breath, 

with or without cough, sputum or dyspnea - often with repeated exacerbations which usually impact quality of life,  reduced exercise capacity, fatigue

- FEV 30 – 50% of predicted

STAGE IV (very severe)-appreciably impaired quality of life

due to shortness of breath - possible exacerbations which may even be life threatening at times 

-FEV Less than 30% of predicted  --  or less than 50% with chronic  respiratory failure

Anatomy & Physiology of Respiratory System

Parts of the Resp. System:

1.Nasal Cavity2.Larynx3.Pharynx4.Trachea5.Bronchi6.Bronchioles7.Alveoli8.Lungs

Human Respiratory System

1. Nasal cavity: Air enters nostrils, is filtered by hairs, warmed, humidified, and sampled for odors as it flows through a maze of spaces.

2. Pharynx (Throat): Intersection where pathway for air and food cross. Most of the time, the pathway for air is open, except when we swallow.

3. Larynx (Voice Box): Reinforced with cartilage. Contains vocal cords, which allow us to make sounds by voluntarily tensing muscles.

4. Trachea (Windpipe): Rings of cartilage maintain shape of trachea, to prevent it from closing. Forks into two bronchi.

5. Bronchi (Sing. Bronchus): Each bronchus leads into a lung and branches into smaller and smaller bronchioles, resembling an inverted tree.

6. Bronchioles: Fine tubes that allow passage of air. Muscle layer constricts bronchioles. Epithelium of bronchioles is covered with cilia and mucus.

Mucus traps dust and other particles.

Ciliary Escalator: Cilia beat upwards and remove trapped particles from lower respiratory airways. Rate about 1 to 3 cm per hour.

Mechanics of Breathing

PathogenesisSMOKIN

GEnvironmental & Occupational

Exposure

Childhood Respiratory infectionsGenetic

susceptibility

CD8+ Lymphocy

te

Alveolar Macropha

geNeutrophil

Protease

Airway Inflammation

and Remodeling

Airflow Limitation

Tissue Destruction

Protease Inhibitor

Changes in Lung Parenchyma in COPD

Alveolar wall destruction

Loss of elasticity

Destruction of pulmonarycapillary bed

↑ Inflammatory cells macrophages, CD8+ lymphocytes

Risk Factors for COPD-Genes

-Exposure to particlesTobacco smokingOccupational dustIndoor air pollutionOutdoor air pollution- Gender- Age- Respiratory infections

-Socioeconomic factorsPovertyCongested Living spaceLack of EducationUse of Biomass fuels,

wood stovesInner City population

has more prevalenceStress of environment

Lack of funds for treatment in exacerbations

Malnourishment

Socioeconomic statusAging

Population

Genes

CHRONIC BRONCHITIS

NicotinePATHOPHYSIOLOGY OF CHRONIC BRONCHITIS

Edema of the bronchial wall

Contraction of the smooth

muscle of the bronchioles

Hypersecretion of the bronchial mucus gland

Airway obstruction

Increase airway resistance

Impairment of ventilation

Impairment of gas exchange

Hypoxia

Cyanosis“Blue

bloater”

Long-term Cough-accompanied by increased mucus

production

Shortness of breathWheezingFeverCyanosisChest pain

Manifestations:

EMPHYSEMA

Panlobular (panacinar)-destruction of respiratory bronchiole, alveolar

duct and alveolus.Centrilobular (centroacinar)-pathologic changes take place mainly in the

center of the secondary lobule.

Types of Emphysema:

PATHOPHYSIOLOGY OF EMPHYSEMASmoking

Stimulates alveolar macrophages

Release of protease and

elastase

Loss of the lung elastic recoil

Overdistention of ALVEOLI

Retention of CO2

Impaired ventilation

Hypoxemia, Hypercarbia

Increase in RR

Redness of skin

PINK PUFFER

DOB

CoughDyspneaChest painWheezingBarrel chestCold clammy skinDecreased metabolism - weakness -anorexia -weight loss

Manifestations:

Pulmonary function tests (PFTs)

They measure how much air lungs can hold and the flow of air in and out of lungs.

They can also measure the amount of gases exchanged across the membrane between alveolar wall and capillary membrane.

Diagnostic Exams:

is performed to evaluate the lungs, heart and chest wall.

is rarely useful for diagnosing chronic bronchitis, although they sometimes show mild scarring and thickened airway walls.

Shows increased in AP diameter, overinflation and presence of bullae.

Chest X-ray

Clear signs of COPD include the following:

Abnormally large amounts of air spaces in the lung.

A flattened diaphragm.A smaller heart; if heart failure is present,

however, the heart becomes enlarged and there may not be signs of overinflated lungs.

Exaggerated lung inflation in upper areas.Larger amounts of air in the lower lungs in

patients with A1AD-related emphysema.

These blood tests measure how the lungs transfer oxygen to bloodstream and how effectively they remove carbon dioxide.

Low oxygen (hypoxia) and high carbon dioxide (hypercapnia) levels often indicate chronic bronchitis, but not always emphysema. A blood gas analysis that shows very low oxygen levels is useful for determining which patients would benefit from oxygen therapy.

Arterial blood gases (ABG) analysis

This test involves use of a small device that attaches to the fingertip.

The oximeter measures the amount of oxygen in the blood differently from the way it's measured in blood gas analysis.

To help determine whether patient needs supplemental oxygen, the test may be performed at rest, during exercise and overnight.

Pulse Oximetry

Analysis of cells in sputum can help determine the cause of some lung problems.

Sputum examination

Computerized tomography (CT) scan A CT scan can detect emphysema sooner

than an X-ray can, but it can't assess the severity of emphysema as accurately as can a pulmonary function test.

Physicians will typically test for the protective enzyme alpha-1 antitrypsin in COPD patients who are nonsmokers and who develop emphysema in their 30s.

Test for alpha-1 antitrypsin deficiency

Carbon Monoxide Diffusing CapacityThe lung carbon monoxide diffusing

capacity (DLCO) test determines how effectively gases are exchanged between the blood and airways in the lungs. Patients should not eat or exercise before the test, and they should not have smoked for 24 hours.

Pulmonary Hypertension

COR Pulmonale

Malnutrition

Skeletal Muscle Dysfunction

Atelectasis

COMPLICATIONS:

Pharmacotherapy

-Expectorants (guaiafenesin) / Mucolytic (mucosolvan)

-Bronchodilators (Salbutamol, Theophylline, Terbutaline)

These drugs can help relieve coughing, shortness of breath and trouble breathing by opening constricted airways, but they're not as effective in treating emphysema as they are in treating asthma.

Medical Management

-SteroidsAdministered for anti-inflammatory effects.

(Solu-medrol, Beclomethasone).Although inhaled steroids have fewer side

effects than oral steroids do, prolonged use can weaken bones and increase the risk of high blood pressure, cataracts and diabetes.

-AntibioticsOnly to treat infectious exacerbations of

COPD

Non-Pharmacologic Treatment

Rehabilitation: All COPD patients benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of dyspnea and fatigue.

Oxygen Therapy: The long-term administration of oxygen (> 15 hours per day) to patients with chronic respiratory failure has been shown to increase survival.

Diet- High calorie, High Protein and low

Carbohydrate

Bronchial Hygiene Measures-Steam Inhalation-Aerosol Inhalation-Medimist inhalation

Chest Physiotherapy-Percussion-Vibration-Postural drainage

Lung transplant-Replaces a sick lung with a healthy lung from a

person who has just died.

Lung Volume Reduction Surgery-Removes part of one or both lungs, making

room for the rest of the lung to work better. It is used only for severe emphysema.

Bullectomy-Removes the part of the lung that has been

damaged by the formation of large, air-filled sacs called bullae. This surgery is rarely done.

Surgery in COPD

Ineffective airway clearance r/t excessive, thickened mucus production.

Ineffective breathing pattern r/t shortness of breath, mucus, bronchoconstriction, and airway irritants.

Impaired gas exchange r/t alveolar and capillary changes and ventilation-perfusion imbalance.

Activity intolerance r/t hypoxemia.Knowledge deficit regarding disease

process and prognosis related to less information.

Nursing Management

Plan: Patient will maintain airway patency.

Interventions:1. Adequately hydrate the patient.2. Monitor respirations and breath

sounds.3. Teach and encourage the use of

diaphragmatic breathing and coughing exercise.

4. Elevate head of the bed/ position every 2 hours and PRN.

5. If indicated, perform postural drainage.

Ineffective airway clearance r/t excessive, thickened mucus production.

Plan: Patient will establish effective respiratory pattern AEB absence of cyanosis and other signs of hypoxia.

Intervention:1. Teach patient diaphragmatic and pursed-lip

breathing.2. Encourage alternating activity with rest

periods.3. Elevate head of the bed or have the client

sit up in the chair, as appropriate.4. Assist the client in the use of relaxation

techniques.5. Administer oxygen as indicated in a lower

concentration.

Ineffective breathing pattern r/t shortness of breath, mucus, and bronchoconstriction.

Plan: Patient will demonstrate improved ventilation and adequate oxygenation of tissues AEB ABG within normal limits.

Interventions:1. Position client in the semi-Fowler’s position. 2. Monitor client’s oxygen saturation

continuously by pulse oximetry.  3. Maintain adequate intake and output for

mobilization of secretions.4. Encourage adequate rest and limit activity.5. Keep environment allergen-free or pollutant-

free.

Impaired gas exchange r/t alveolar and capillary changes and ventilation-perfusion imbalance.

Plan: Patient will report measurable increase in activity tolerance.

Interventions:1. Plan care to carefully balance rest periods with

activities.2. Promote comfort measures and provide relief of

pain.3. Assist patient in learning appropriate safety

measures.4. Evaluate client’s actual and perceived limitations

in light of usual status.5. Encourage use of relaxation techniques.

Activity intolerance r/t imbalance between oxygen supply and demand.

Plan: Patient will participate in the learning process.

Interventions:1. Ascertain level of knowledge including

anticipatory needs.2. Provide positive reinforcement.3. Determine client’s ability/ readiness to

learning.4. Help patient identify or develop short and long

term goals.5. Provide information relevant only to the

situation.

Knowledge deficit regarding disease process and prognosis related to less information.

Breathing Exercises-Diaphragmatic breathing-Pursed-lip breathing-Deep breathing exercise

Smoking cessation

Nutritional counselling

Health Education