Chronic Obstructive Pulmonary Disease

• COPD

  also known as Chronic Airflow Limitation
• COPD


  Chronic obstruction of the lungs resulting in decreased gas exchange, leading to chronic air trapping and high CO2 in the body
• Most significant risk factor: Smoking
• Chronic Bronchitis


  Bronchial tubes become inflamed and excessive mucus production occurs
• Persistent cough due to hypersecretion of mucus

  Most characteristic manifestation of Chronic Bronchitis
• Emphysema


  Air sacs in the lungs are damaged and enlarged
• Chronic Bronchitis


  (+) cough at least 3 months per year for consecutive 2 years
• Chronic bronchitis - Blue bloaters: Emphysema - Pink puffers
• Emphysema: Chest

  Barrel
• Chronic Bronchitis: Normal 02

  88 to 93 %
• Safest amount of O2: 2L/min
• Position: Tripod (upright, leaning forward) - facilitates breathing
• Breathing: Pursed-lip (prevent airway collapsed and air trapping)
• Diet: High Calorie, High Protein, Low Carbohydrates
• High CHON - enhances absorption of bronchodilators
• Low CHO - prevent excessive formation of CO2
• CO2 - natural end product of carbohydrates
• CHO slow down excretion og bronchodilators
• Fluid intake: Increase, avoid drinking while eating
• Avoid smoking and alcohol drinking - enhance mucociliary function and prevent acute exacerbation of COPD
• Pharmacotherapy: Expectorants, mucolytics


  Expectoration of mucus
• Pharmacotherapy: Expectorants, mucolytics


  Examples: Mucomyst (Acetylcysteine), Robitussin (Guaifenesin)
• Pharmacotherapy: Antitussives

  best given during night to prevent sleep pattern disturbance due to persistent coughing during night
• Pharmacotherapy: Antitussives

  Examples: Codeine (Narcotic); Dextromethorphan (Non-narcotic)
• Pharmacotherapy: Antitussives

  Codeine causes drowsiness and constipation
• Pharmacotherapy: Bronchodilators

  Expected therapeutic effect is relief of dyspnea
• Pharmacotherapy: Bronchodilators

  Most common side effects: Tachycardia and palpitations
• Pharmacotherapy: Bronchodilators

  Should be given before steroid inhalation (To open airways and promote adequate absorption of steroid)
• Pharmacotherapy: Bronchodilators


  Examples: Aminophylline (Theophylline); Ventolin (Albuterol)
• Pharmacotherapy: Antihistamines


  Used specifically for asthma
• Pharmacotherapy: Antihistamines


  Examples: Benadryl (Diphenhydramine); Intal (Cromolyn Na)
• Pharmacotherapy: Antihistamines

  May cause drowsiness and dizziness. Advise patient to avoid driving and operating electrical machines to prevent accidents.
• Pharmacotherapy: Steroids


  Administered to relieve inflammation of airways
• Pharmacotherapy: Steroids


  Examples: Dexamethasone; Beclomethasone
• Pharmacotherapy: Steroids

  Advise patient to rinse mouth after administration to prevent oral candidiasis (Thrush)
• Pharmacotherapy: Leukotriene Antagonists


  Prevent broncho-constriction, decrease mucosal edema, and mucus production.
• Pharmacotherapy: Leukotriene Antagonists


  Examples: Montelukast; Zafirlukast
• Pharmacotherapy: Antimicrobials


  To treat infections which commonly occur among clients with COPD