APA format 2 pages 3 references 2 from walden university library. As a registered nurse working as a case manager within the home health care setting, I have had the opportunity to provide care to patients diagnosed with various respiratory disorders. A majority of the patients I have worked with were diagnosed with chronic obstructive pulmonary disease (COPD). COPD is defined as a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases (Huether, 2017). Two important facts regarding this respiratory disorder include the following: COPD is the third leading cause of death in the United States accounting for 138,080 deaths in 2010. In 2010, the cost of COPD in the United States was estimated to be nearly $50 billion, including nearly $30 billion in direct health care expenditures. These figures detail the staggering numbers of patients living with COPD and the significant impact on patients, families, communities and the health care system. During the time that I worked with COPD patients, one of the respiratory disorders of particular interest was emphysema. I wanted to make sure I understood the disease process so I could provide the most appropriate care and teaching to my patients, families and caregivers. Emphysema is abnormal permanent enlargement of gas-exchange airways (acini) accompanied by destruction of alveolar walls without obvious fibrosis (Huether, 2017). Furthermore, the American Lung Association defined emphysema as the gradual damage of lung tissue, specifically thinning and destruction of the alveoli or air sacs ( www.lung.org ). I often used this definition with patients to help them understand how this respiratory disorder effects the body. The pathophysiology of emphysema includes the following: Air sacs are destroyed in emphysema, making it progressively difficult to breathe. Emphysema is usually accompanied by chronic bronchitis, with almost-daily or daily cough and phlegm. Cigarette smoking is the major cause of emphysema. People with emphysema experience shortness of breath with activities It is not curable, but there are treatments that can help you manage the disease (www.lung.org). Medication management of emphysema varies depending upon severity of the disease. Initial drug therapy selection depends on COPD severity, symptoms, and exacerbation risk. In addition, medication therapy may be based upon Global Obstructive Lung Disease (GOLD) guidelines which categorized COPD into four groups (A, B, C, D) ranging from low risk, less symptoms to high risk, high symptoms (Arcangelo, 2017). Medications may include the following: Short-acting beta2 agonists, short-acting anticholinergics, combination of short-acting anticholinergic and short-acting beta2-adrenergic agonists, long-acting beta2-agonists, l ...