This document provides information on chronic obstructive pulmonary disease (COPD). It begins with an introduction stating that COPD is a progressive and partially reversible disease comprising chronic bronchitis and emphysema. It then discusses the incidence and prevalence of COPD in the United States. Next, it describes the signs and symptoms of chronic bronchitis and emphysema. It concludes by outlining the diagnostic tests, complications, medical management including medications and lifestyle changes, and nursing management of COPD.

2. INTRODUCTION
 COPD is the progressive and partially reversible
disease of the airway
 Comprises primarily of two related disease-
chronic bronchitis and Emphysema
 Chronic obstruction of the flow of air through
the airway and out of the lungs permanent and
progressive obstruction over time

3. INCIDENCE
 COPD is the 5th leading cause of death in the
United States for all ages and both genders; fifth
for men and fourth for women
 Men were found to have a prevalence of 11.8% and
women 8.5%. The numbers vary in different
regions of the world
 more than 12,000 persons died of COPD. The
middle adult years, and the incidence of COPD
increases with age Chronic bronchitis

4. CONTD
 Chronic bronchitis is defined clinically as a daily
cough with production of sputum at least 3 month
per year for 2 or more consecutive year.
 It involves inflammation and swelling of the lining
of the air way that leads to narrowing and
obstruction of the air way.
 The inflammation also stimulate production of
mucus which can cause further obstruction of the
airway.


5. EMPHYSEMA
 It is permanent enlargement of the alveoli due to
destruction of the wall between alveoli which
leads to reduce the elasticity of the lungs over all.
 Loss of elasticity leads to collapse of the
bronchioles, obstructing air flow out of the
alveoli. Air become trapped to the alveoli and
reduce the ability of the lungs to shrink during
exhalation .

6. CONTD
 Reduce the expansion of the lungs during the next
breath reduce the amount of air that is inhaled
 As a result, less air for the exchange of gasses
gets in to the lungs .
 This trapped air also can compress adjacent less
damage lung tissue.

7. ETIOLOGY AND RISK
FACTORS
 The specific causes of COPD are not clearly
understood. Some risk factors are tissue.
1.Cigarette smoking. The primary cause is exposure
to tobacco smoke. cigarette smoking will develops
COPD in 15% .Overall, tobacco smoking accounts
for as much as 90% of the risk of COPD .
 Secondhand smoke

8. contd
 Secondhand smoke, or environmental tobacco
smoke, increases the risk of respiratory
infections.
2.Air Pollution
 outdoor air pollution contributes to the
development of COPD.
 most common cause is indoor stoves for cooking
 Some occupational pollutants such as cadmium and
silica-

9. contd
3.Alpha-1 Antitrypsin (AAT) deficiency-
 AAT enzyme is produced by liver and present in
normal lungs. Normal1.5-3.5 g/l. Block the
damaging effects of elastase on elastin.
4. Chronic Respiratory Infections
5. Alcohol Ingestion

10. PATHOPHYSIOLOGYChronic inflammation
Increase number of goblet cell and
mucus secreation
Increase size and number of
submucus gland in bronchi and
mucus production
Decrease cillary function reduce mucus
clearance (deposit )mucus
Allergic reaction
IgE stimulation
IgE attached to the
mast cell
Mast cell release histamine
and prostagladin
Mucus secretion and
bronchospasm
Bronchi constriction
Obstructive air
way

11. SIGN AND SYMPTOMS
 Cough, with or without mucus
 Chronic cough and sputum production (in chronic bronchitis
 Shortness of breath (dyspnea) that gets worse with mild
activity
 Trouble catching one's breath
 Fatigue
 Wheezing
 Rhonchi, decreased intensity of breath sounds, and
prolonged expiration on physical examination
 chest tightness and tiredness
 People with advanced COPD sometimes develop respiratory
failure

12. Common signs are:
 Tachypnea a rapid breathing rate
 Wheezing sounds or crackles in the lungs heard
through a stethoscope
 Breathing out taking a longer time than breathing
in
 Enlargement of the chest, particularly the front-
to-back distance (hyperaeration)
 breathing through pursed lips
 Increased anteroposterior to lateral ratio of the
chest (i.e. barrel chest)

13. INVESTIGATION
 Medical History
 Physical examination finds enlarged chest cavity
and wheezing.
Blood Test
 A hematocrit value of more than 52% in males and
more than 47% in female indicates disease.
 Measure the alpha1-antitrypsin (AAT),the AAT
level is low

14. contd Sputum for culture and microscopic examination
mucoid sputum .
 The pathogens Streptococcus pneumoniae and
Haemophilus influenzae

15. CONTD
Chest X-ray-
 Hyper inflated lung
 Flat diaphragm
 Tubular heart
 Increase broncho vascular markings

18. severe bullous

19. contd
 High Resolution CT scanning(HRCT): is highly specific
for diagnosing emphysema, and the outlined bullae
are not always visible on a radiograph.
 CT scan (COPD)
 Two-dimensional echocardiography may be helpful as
a screening tool to estimate pulmonary arterial
systolic pressure and right ventricular systolic
function.

20. CONT
Pulmonary Function Test
 Forced expiratory volume in 1 second (FEV1) is a
reproducible test and is the most commonly
used index of airflow obstruction.
 Mild= FEV1 >80% predicted
 Moderate= FEV1 80-50% predicted
 Sever= FEV1 50-30% predicted
 Very sever = FEV1 <30% predicted

21. contd
 Arterial blood gas analysis:
 As the disease progresses, severe hypoxemia and
hypercapnia.

22. contd
 Hypercapnia commonly is observed as the FEV1
falls below 1 L/s or 30% of the predicted value
 Lung volume measurements often show an
increase in total lung capacity, functional residual
capacity, and residual volume.
 The vital capacity often decreases

23. contd
Tidal Volume (TV):
 volume of air inhaled or exhaled with each breath during
quiet breathing
Total Lung Capacity (TLC):
 Sum of all volume compartments after maximum
inspiration

24. contd
Inspiratory Reserve Volume :
 maximum volume of air inhaled from the end-
inspiratory tidal position
Expiratory Reserve Volume :
 maximum volume of air that can be exhaled from
resting end-expiratory tidal position

25. COMPLICATIONS OF COPD
 Respiratory Infections
 Acute Respiratory Failure
 Spontaneous Pneumothorax due to rupture of
emphysematous bleb.
 Ventilation Perfusion Mismatch
 Hypoxemia
 Corpulmonale

26. Medical management
The treatment goal for the client with COPD is
 To improve ventilation
 To facilitate the removal of bronchial secretions
 To prevent complications
 To slow the progression of clinical manifestations
 To promote health maintenance and client
management of disease.

27. Treatment strategies include
 Quitting cigarette smoking
 Taking medications to dilate airways(
bronchodilators)
 Vaccinating against flu influenza and pneumonia
 Regular oxygen supplementation
 Pulmonary rehabilitation

28. MEDICAL MANAGEMENT
 Quitting cigarette smoking: most important
treatments for COPD.
 Patients who continue to smoke have a more rapid
deterioration in lung function when compared to
others who quit.
 If one stops smoking, the decline in lung function
eventually reverts to that of a non- smoker

29. contd
 Bronchodilators: Beta2 agonists are the most
frequently prescribed. (albuterol or salbutamol,
metaproterenol) have minimal adverse effects, rapid
onset of action
 Anticholinergic : bronchodilators work by blocking the
cholinergic receptors resulting in bronchodilatation.(
Atrovent) is the most commonly used drug in this
category.
 Methylxanthines(theophylline, aminophylline) are also
used to treat acute exacerbations.

30. contd It is helpful for the patient with COPD who have
heart failure and pulmonary hypertension.
 Corticosteroids are used in the acute management of
clients with COPD exacerbations
 Inhaled corticosteroids like Beclomethasone
diproprionate, salmeterol and fluticasone are used.

31. contd
 Regular oxygen therapy: Regular oxygen therapy
is required when the client has severe exertion or
resting hypoxemia (pao2 < 40mm of Hg). Oxygen
(1-3L) by nasal canula may be required to raise the
pao2 to no less than 60mm of Hg. (normal 80-100
mm of Hg)

32. CONTD
 Postural drainage and chest physiotherapy they
can be help expelled secretion.
 Control complications: Edema and corpulmonale
are treated with diuretics and digitalis.
 Phlebotomy also reduces cardiac workload.
 Antibiotic- Treat with antibiotic therapy for
recurrent bacterial infection.

33. CONTD
 Promote exercise- Aerobic exercise :Exercise
does not improve lung function more effectively
but strengthen the respiratory muscles even the
lungs are diseased.
 Progressively increased walking is the most
common form of exercise.
 Encourage diaphragmatic breathing and pursed-lip
breathing.

34. contd
Improve general health- The most effective way to slow disease
progression is for the client
 to stop smoking
 avoid exposure to known allergens
 avoid high altitudes
 Use supplemental O2 for air travel.
 Adequate nutrition is essential to maintain respiratory muscle
strength.
 Regular O2 therapy should be maintained.

35. NURSING MANAGEMENT
Assessment
Assessment :
 history of smoking, family history, occupational
history
 ABG analysis
 respiratory rate, depth and characteristics
 sputum amount and type
 anxiety level of the patient

36. contd
1.Nursing Diagnosis: Impaired gas exchange
related to dyspnoea, mucus plug and decreased
ventilation
Goal: Client will be demonstrated improved
ventilation and adequate oxygenation .
Nursing intervention
 Assess respiratory rate, depth, note use of
accessory muscles, pursed lip breathing, inability
to speak.

37. CONTD
 Elevate head of bed, assist patient to assume
position to ease work of breathing.
 Encourage deep slow or pursed lip breathing as
individually tolerated.
 Administer low- flow oxygen therapy (1-2lit/min)
as needed via nasal prongs.
 Administer bronchodilators if ordered
 Regularly monitor the client's respiratory rate
and pattern, pulse oximetry, ABG results.

38. contd
2.Nursing Diagnosis: Activity intolerance related to
inadequate oxygenation and dyspnea
 Nursing Goals: The client will have improved
activity tolerance within hospitalization period

39. CONTD
Nursing Intervention
 Monitor the severity of dyspnea and oxygen
saturation with and following activity
 Keep the patient in semi- flower position.
 Maintain supplemental oxygen therapy (2lit/min)
 Assist the client in scheduling a gradual increase
in daily activity and exercise

40. contd
 Advise the client to avoid conditions that increase
oxygen demand such as temperature extremes,
excess weight and stress.
 Instruct the client energy conservation
techniques such as pacing activities throughout
day.
 Teach the client to use pursed-lip and
diaphragmatic breathing techniques

41. CONTD
3.Nursing Diagnosis: Ineffective airway clearance
related to excessive production of secretions,
retained secretions and ineffective coughing
Goal: The client will be maintain patent airway with
breath sounds clear within hospitalization
Nursing Intervention
 Monitor respiratory rate and auscultate breath
sounds eg. wheeze, crackles, rhonchi
 Assist the patient to assume position of comfort eg
elevate head of bed, sitting on edge of bed.

42. contd
 Keep environmental pollution to minimum eg dust,
smoke and feather pillows according to individual
situation
 Encourage/ assist with abdominal or pursed lip
breathing exercises
 Administer medications as indicated such as
bronchodilators
 Perform chest physiotherapy.

43. contd
4.Nursing Diagnosis: Anxiety related to disease
prognosis
Nursing goal: Patient will not have any more anxiety
after nursing intervention

44. contdNursing Intervention
 Provide care in a calm and quiet environment.
 Encourage the use of breathing retraining and
relaxation techniques.
 Explain the patient about disease including
cause, signs and symptoms, medication,
procedures, prevention and follow up care
 Give the opportunity to talk the patient with
similar problem who admitted in the same
ward and almost in recovery phase.

45. contd
5.Nursing Diagnosis: Risk for infection related to
ineffective pulmonary clearance
Goal: Client will have a decreased risk of infection
related to ineffective pulmonary clearance after
intervention
Nursing Intervention
 Teach the client to wash his or her hands after
contact with potentially infectious material.
 Teach the client and family how to care for and clean
respiratory equipment used at home.

46. CONTD
 Assess vital signs including temperature and sputum
color, odor and character.
 Teach the client and family the manifestations of
pulmonary infections like change in color or volume of
sputum, fever, chills, malaise, productive cough,
confusion, increased dyspnea etc
 Discuss need for adequate nutritional intake
 Explain client about the importance of self care
 Notify the physician if any sign of infections occurs.

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