Ways to Reduce the Symptoms of Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation. This is caused by significant exposure to noxious particles or gases (GOLD, 2018). The diagnosis of COPD should consider a multitude of risk factors, signs and symptoms. Clinicians use tools to aid information gathering e.g. PROP ForWarD (Presentation, Risk factors, Opinions, Past medical history, Family history, Working history and Drug history). By gaining this information, the clinician can differentiate between COPD and asthma.
The main symptoms of COPD are breathless, cough and sputum production (GOLD, 2018). The pathological changes in patients with COPD is complex. It can occur in four compartments of the lungs, including the large airways, small airways, lung parenchyma and in pulmonary circulation (Siafakas, 2006). The airways become narrowed and the alveoli at the base of the lungs loses its elasticity, therefore unable to effectively allow air in and out of the lungs. This can cause excessive mucus production. Hypersecretion of mucus results in a progressive productive cough which is a characteristic of chronic bronchitis (MacNee, 2006).
The main risk factor for COPD is tobacco smoking (GOLD, 2019). A passive smoking history should be considered. According to a recent study, long-term exposure to second hand smoke during childhood increases the risk of COPD (Diver et al, 2018). To differentiate between COPD and asthma the clinician will include a reversibility-testing spirometry (NICE, 2018).
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There is growing evidence that indoor exposure to fuels used during cooking may predispose women to develop COPD (GOLD, 2019). In a 2002 study, exposure to pollution was found to be responsible for 1-in-3 cases of COPD (Hnizdo et al, 2002). Socio-economic status should be explored. A recent study has shown that social/economic disadvantage has a significant consistent negative impact on COPD (Gershon, 2012). Poor housing, e.g. damp can cause respiratory illness. A 2011 study showed that women with dampness at home had an additional decline in FEV1 (Norback et al, 2011).
It is important to consider Marianne’s exercise tolerance to assess any changes over the last year. If it is progressive this suggests COPD, if it is variable it is suggestive of asthma (NICE, 2018). The clinician should complete a Medical Research Council dyspnoea score (MRC) which shows the degree of breathlessness on a scale of 1-5 of perceived respiratory disability (Stenton, 2008).
Taking a family/social history can help differentiate between COPD/Asthma. There are certain risk factors that put Marianne at risk of developing COPD or asthma, such as a low birth weight, impacting upon lung growth and development (GOLD, 2019). Childhood respiratory infections such as childhood wheezy bronchitis are associated with an increased risk of COPD in later life (Tagiyeva et al, 2016). Genetic factors may predispose Marianne to develop COPD, such as Alpha 1 Antitrypsin (GOLD, 2019). A routine blood test should be undertaken by the clinician to assess the levels of Alpha-1-Antitrypsin. If the levels are low, a genetic screen should be completed to assess for this deficiency (Torres-Durán et al, 2018).
COPD is formally diagnosed through the utility of spirometry (NICE, 2019). Spirometry is defined as the measurement of lung volumes and airflow. The individual blows a series of both forced and relaxed breaths into a machine called a spirometer. The machine, correct procedures and interpretation are vital for COPD diagnosis and should meet the standard for quality assured spirometry (PCRS, 2016).
The clinician must hold the current certificate of competence to undertake and interpret the spirometry which meet the Association for Respiratory Technology and Physiology (ARTP) standards (PCRS, 2016). The clinician should be on the National Register of Certified Professionals and Operators (PCC, 2016). This register is the list of practitioners and operators who have demonstrated their competence in spirometry by undertaking correct training (PCRS, 2016).
The clinician must ensure the spirometry machine is adequately calibrated and cleaned before each spirometry test to achieve a good trace. If the machine does not meet the quality assured standard the result cannot be relied upon (PCRS, 2016). The machine must be calibrated prior to every clinic/session or after every tenth patient and a log must be kept (PCC, 2016). For the calibration to be passed it must read +/- 3% of true limits (PCC, 2016).
Prior to commencing the spirometry, the clinician must assess the patient for contraindications (PCC, 2016). The absolute contraindications are active infection, such as TB, until treated for two weeks. Others include risk factors that may cause serious harm from forced expiration, for example recent surgery, current pneumothorax or abdominal aortic aneurysm (PCC, 2016). Relative contraindications include a suspected respiratory infection in the last 4-6 weeks; hemoptysis; myocardial infarction; pulmonary embolism or stroke (PCC, 2016).
The clinician must check the patient details are correct prior to undertaking the spirometry. Checking the patient’s demographics is important to ensure the spirometry values are correct as this varies between patients. This includes name, age, hospital ID, height, sex, and ethnicity all determine the individual predicted spirometry values (PCC, 2016).
When undertaking a spirometry, the clinician will ask the patient to undertake 3 forced / relaxed blows to ensure accuracy of results. For the main results, FVC and FEV1, the two largest values should be within 5% or 0.1 litre of each other (Richards, 2006). Whilst the patient is undertaking the spirometry, the clinician should ensure the quality of the blows is recorded (PCC, 2016). If the results show an obstructive pattern, a reversibility spirometry is indicated. The features that would indicate irreversible obstruction would be an FEV1 of below 70% (PCRS, 2016). A post-bronchodilator spirometry is used to diagnose obstructive conditions where the baseline spirometry has shown obstruction (PCC, 2016). The spirometry will show the classification of severity of airflow obstruction. This is put into four categories – mild (FEV1 >80%), moderate (FEV1 50-79%), severe (FEV1 30-49%), very severe (FEV1 [Accessed 28 March 2020].
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Ways to Reduce the Symptoms of Chronic Obstructive Pulmonary Disease. (2023, Feb 11). Retrieved from https://phdessay.com/ways-to-reduce-the-symptoms-of-chronic-obstructive-pulmonary-disease/
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