COPD: Prevention, Identification & Management

Dr. Kenya V. Beard Ed.D. CNE GNP-BC NP-C ACNP-BC K Beard & Associates, LLC President Hunter College, Assistant Professor [email protected]

Objectives Discuss the role of the nurse in caring for clients with COPD Compare and Contrast Emphysema and Chronic Bronchitis

COPD 4th Leading cause of death in the Untied States COPD mortality rate has increased over the last 30 years Malnutrition- Found in up to 1/3rd of individuals with COPD  Adversely affects exercise tolerance, surfactant production, protein synthesis, and it increases morbidity and mrotality.

Role of Pulmonary System: Ventilation  Gases must move into and out of the lungs  Ventilatory rate measures how many times gas is inhaled and exhaled over one minute  Minute volume aka minute ventilation represents the ventilatory rate x tidal volume (volume of air per breath)  Why is CO2 elimination necessary?  How does the health care professional determine whether ventilation is adequate?

Pulmonary System  Bring oxygen to alveoli, diffuse oxygen into and carbon dioxide out of blood  Alveoli- Functional unit of the respiratory system  Gas Exchange Airways  Respiratory bronchioles  Alveolar ducts  Alveoli (primary gas-exchange unit)  Alveolar Capillary Membrane

Alveoli Facts  Adult lungs contain about 300 million alveoli  Alveoli type 1 cells for structure and type II cells for surfactant  Surfactant is needed to prevent lung collapse  helps alveoli expand during inhalation  reduces surface tension at end-expiration  Pulmonary capillaries surround the alveoli  Alveolar macrophages ingest foreign matter

Pulmonary Capillaries  Pulmonary Artery (Receives blood from right ventricle)  Pulmonary Vein (Blood sent to left atrium)  Pulmonary Capillaries  Wall has an endothelial layer & thin basement membrane  Capillary basement membrane can fuse with alveolar membrane

Alveolocapillary membrane  Site for gas exchange  Made up of alveolar and capillary basement membrane (& both endothelium and interstitial space)  Very fragile (blood or plasma could leak into alveolar space)  Gas exchange is impaired if any disorder thickens the membrane

Chronic Obstructive Pulmonary Disease  Disease state characterized by the presence of irreversible airflow limitation due to chronic bronchitis or emphysema (American Thoracic Society)  A preventable and treatable disease that’s usually progressive and associated with a chronic inflammatory response. It is not fully reversible. (Global Initiative for Chronic Obstructive Lung Disease, 2011)

What’s the biggest risk factor for COPD? 1. 2. 3. 4.

Poor ventilation in the home Tobacco smoke Car exhaust fumes Occupational exposure

Risk Factors  Tobacco smoke (includes environmental tobacco smoke)  Indoor air pollution (biomass fuel used in poorly vented dwellings)  Occupational dusts and chemicals (irritants, fumes or vapors)  Outdoor air pollution (contributes to burden but small effect in causing COPD)

Consider COPD whenever a patient has Chronic mucous production History of exposure to risk factors A chronic cough Dyspnea

CHAD should be Screened

COPD Diagnosis  Spirometry test  Results must indicate  Post-bronchodilator FEV1/FVC ) Palpate: fremitus decreased with COPD Percuss: hyperresonance Auscultate: adventitious sounds (wheezing or ronchi)

Nursing Diagnosis  Impaired Gas Exchange r/t alveolar-capillary membrane changes, decreased size of airway, or hypersecretion of mucus, ventilatory muscle fatigue  Ineffective Breathing Pattern r/t airway obstruction or decrease in energy  Ineffective Airway Clearance r/t fatigue, ineffective cough or hypersecretion of mucus.  Imbalanced Nutrition: Less than Body Requirements r/t anorexia or fatigue  Activity Intolerance r/t fatigue, difficulty breathing, O2 imbalance

Goal Relieve symptoms Improve exercise tolerance Prevent disease progression Prevent exacerbations Reduce mortality

Determining Severity of COPD Symptoms- use questionnaires like the COPD Assessment Test Degree of airflow limitation- Use the GOLD Criteria for mild, moderate, severe, very severe (FEV1 > 80% predicted, 50-50, 50-30, less than 30) Risk of exacerbations- increases with increased airflow limitation & hx of previously treated events Comorbidities- osteoporosis, anxiety, skeletal muscle dysfunction, lung ca

How is COPD Managed? Quit smoking and encourage tobacco-control policies Emphasize primary and secondary prevention Increase physical activity Bronchodilators (prn or regular basis) Inhaled corticosteroids (FEV1 < 60% predicted) Influenza vaccine recommended annually Pneumococcal vaccine recommended for pts over 65 Mucolytic Agents may be helpful

Management  Oxygen Therapy  Indicated for severe hypoxemia in order to prevent Cor Pulmonale (PaO2 , 55 mmHg) or O2 sat