The refined ABCD grading system utilizes respiratory symptoms and exacerbations alone to assign ABCD categories. These groups are now derived only from patient symptoms and their history of exacerbation. The role of spirometry in overall management of COPD has also been updated. Airflow limitation (obstruction on spirometry) is not a component of the ABCD severity system. Spirometry remains important mainly for diagnosis, prognosis, and consideration of therapies, but NOT for severity grading systems
COPD Treatment
Long-acting bronchodilators. Almost all patients with COPD who experience more than occasional dyspnea should be prescribed long acting bronchodilator therapy. This could be a long-acting beta agonist (LABA), a long acting muscarinic
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Combination agents containing inhaled corticosteroids along with long-acting beta agonists are considered appropriate step-up therapy for patients experiencing COPD exacerbations while taking long-acting bronchodilators.
Oral PDE4 inhibitors are considered an add-on therapy only for patients with COPD with chronic bronchitis and severe airflow restriction who experience COPD exacerbations despite use of a combination bronchodilator with inhaled corticosteroid.
Drugs for secondary pulmonary hypertension due to COPD are not advised.
Oxygen NOT recommended for most COPD Patients
The 2017 GOLD guidelines generally advise against the routine practice of prescribing supplemental oxygen to stable COPD patients without severe resting hypoxemia. In a randomized trial in >700 stable COPD patients with moderate hypoxemia, supplemental oxygen did not improve clinical outcomes or quality of life during the follow-up period.
Grading
The 2017 GOLD guidelines go further in advising what class of medication to use, in COPD patients according to where they fall in the ABCD grading scheme:
• COPD GOLD Grade A: A bronchodilator (short or long acting), titrating or switching to another as
R.S. has been using the recommended treatment for his condition, which inlcude inhaled short-acting Beta-2 agonist and Theophylline, a bronchodilator, to control his respiratory disease.
Asthma is a chronic inflammatory disease of the airways. It is a reversible airway obstruction, occurring 8 to 10% of the population worldwide. According to a study in 2005, asthma affects over 15 million Americans, with more than 2 million annual emergency room visits. Asthma patients have a hyper-responsiveness in their airways and generally and increase in their airway smooth muscle cell mass. This hyperplasia is due to the normal response to the injury and repair to the airway caused by exacerbations. The main choice of therapy for asthma patients is β2- adrenergic agonists. Racemic albuterol has been the drug of choice for a short acting bronchodilator for a long time, but since the development of levalbuterol, there is the question of which drug is a better choice for therapy. Efficacy and cost of treatment must both be taken into consideration in each study of these therapies to determine which is best for the treatment of asthma.
There are two forms of bronchodilators, a short acting and a long acting form. Short acting relieves or stops asthma symptoms and is very helpful during an attack. They are also called ‘rescue’ medications because they are best for treating sudden or severe asthma symptoms. Long acting bronchodilators are used to control asthma, they take longer to work but they also last longer, up to 12 hours, whereas a short acting would only last for about 4-5 hours. Ventolin is a short acting form, it is the recommended medication to use 15-20 mins before exercising.
Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
Introduction BiPAP is a form of noninvasive mechanical ventilation used in patients with acute respiratory failure. Many of these patients go on noninvasive ventilation due to COPD exacerbations that are infectious, with congestive heart failure, and ventilator parameters based on their clinical assessment and changes in arterial blood gases. Two different studies were conducted on COPD patients, using a BiPAP machine to improve exacerbations and their activities of daily living. There are many positive outcomes for using these noninvasive ventilators, however when used incorrectly, negative outcomes or no changes at all are always possible. Positive Use for COPD Exacerbations
Chronic obstructive pulmonary disease, better known as COPD, is a disease that affects a person’s ability to breathe normal. COPD is a combination of two major lung diseases: emphysema and chronic bronchitis. Bronchitis affects the bronchioles and emphysema affects the alveoli.
Oxygen, inhaled bronchodilators, inhaled steroids, combination inhalers, oral steroids, phosphodiesterase-4 inhibitors and theophylline are effective medications for COPD (Mayo Clinic, 2016). “Patients with COPD have persistent high levels of CO2, their respiratory centers no longer respond to increased levels of CO2 by stimulating breathing. Therefore, COPD patients with more severe hypoxemia are at higher risk of CO2 retention from uncontrolled CO2 administration” (Van Houten, p. 13). For nurses, “It is important to administer the lowest amount of O2 necessary to patients” (Van Houten, p. 13). Some COPD medicines are used with inhaler and nebulizer devices. It is important to teach patients how to use these devices correctly. (Potter & Perry,
Carone M, D. C. ( 2007). Clinical Challenges In COPD[e-book]. (Oxford: Clinical Pub) Retrieved March 24, 2014, from (EBSCOhost).
The ability to carry out and document a full respiratory and cardiovascular assessment is an essential skill. The severity of illness can be initially evaluated by inspection, palpation, percussion, and auscultation. During analysis, specific locations of symptoms can be identified using landmarks such as the midaxiallary, midclavicular, and, the midsternal line. Indicate anterior or posterior thorax, and use the midaxillary line location when applicable (Bickley & Szilagyi, 2013).
Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that affects breathing. This disease is one that blocks or obstructs air flow which then affects the way that one breathes. It diminishes the capability of airflow in and out of the lungs. COPD is the term used for a group of different diseases that affect the lungs. The two most common types of COPD are emphysema and chronic bronchitis. Emphysema is a destruction of the small bronchioles in the lungs and chronic bronchitis is an inflammation of the lining of the bronchial tubes. Both emphysema and chronic bronchitis are obstructive diseases that impact breathing in a negative manner. (COPD, 2014)
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
Vijayan, V. K. (2013). Chronic obstructive pulmonary disease. Indian Journal Of Medical Research, 137(2), 251-269.
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Oxygen is widely used in both chronic and acute cases, in emergency medicine, at hospital or by emergency medical services (Nicholson, 2004 ). Just like any other form of medication oxygen is a drug that if used incorrectly could cause potential harm, even death (Luettel, 2010 ). Oxygen is admitted to the patient with chest pain for two main rationales. The first is by increasing arterial oxygen tension, which in opposing causes a decrease to the acute ischemic injury, and thus over time the entire infarct area (Moradk...
The roles of the circulatory and respiratory system both carry important responsibilities and are essential in their jobs to the human body. The circulatory system is one, if not the, most important system in the human body. The circulatory system is made up of the heart, blood, and blood vessels. Within the blood vessels, there are three types: arteries, veins, and capillaries. The heart is an organ made up of cardiac muscle that has a role similar to a pump. When the muscles in the heart contract, it pumps fresh blood away from the heart, through a main artery called the aorta, and to the organs and cells of the body. Nutrients and oxygen then enter the cells through diffusion of the tissues. The respiratory system transports oxygen to the circulatory system. When transporting oxygen to the circulatory system, this will in turn transport oxygen to the rest of the cells in the body. Aside from transporting oxygen to the body, the respiratory system also plays a role in the removal of carbon dioxide and other contaminants in the body. These two systems effectively and efficiently work together in order to supply the body with oxygen and remove carbon dioxide and any other