Introduction
William is a 55 year old retired policeman who was constantly having cough during the last 2 weeks before he was brought to the hospital by his youngest daughter. Lately, he has been experiencing troubles in breathing. He described it as a difficulty in expiration during breathing. For this reason, he asked his youngest daughter who is living just two blocks away from him to take him to the hospital.
William admits to be a chronic smoker, consuming two packs per day and drinks alcoholic beverages regularly with his friends. After undergoing a thorough examination, his physician ordered a series of sputum tests and other lung tests. Chronic infection was detected in the lungs most probably due to smoking which irritates the bronchi and bronchioles. There was also obstruction of the airways which is responsible for William’s difficulty in expiration. He was diagnosed to have chronic obstructive pulmonary disease (COPD).
Problem Description
Chronic obstructive pulmonary disease (COPD) is a disease state characterized by the progressive development of airflow limitation that is not fully reversible. The airflow limitation is associated with an abnormal inflammatory response of the lungs to noxious particles or gases (Daryanani, 2004).
COPD is an umbrella term for two diseases, chronic bronchitis and emphysema, both of which are characterized by irreversible obstruction to air flow on exhalation. Asthma is another obstructive lung disease; however, it is classified separately from COPD because the person with asthma usually has periods during which air flow returns to normal.
While many persons with COPD also have some degree of airway reactivity (or bronchospasm) and are thus said to have an asthmatic component to their disease, their air flow never returns to normal. Both COPD and asthma are also inflammatory processes; however, inflammation in COPD differs markedly from that seen in asthma, with different cells, mediators, and responses to treatment (Locke, 2004).
The chronic infection as is seen in William’s case is caused by his excessive smoking or other substances which irritate the bronchi and the bronchioles. The principal reason for the chronic infection is that the irritant seriously deranges the normal protective mechanisms of the airways, including partial paralysis of the cilia of the respiratory epithelium by the effects of nicotine; as a result, mucus cannot be moved easily out of the passageways (Guyton & Hall, 2000).
The obstructive process is frequently much worse in some parts of the lungs than in other parts, so that some portions of the lungs are well ventilated, whereas other portions are poorly ventilated. This often causes extremely abnormal ventilation-perfusion ratios (Ganong, 2001).
Possible Solutions
The first step in diagnosing emphysema and chronic bronchitis is a good evaluation. Following the evaluation may be a number of tests to evaluate your breathing or other aspects of your health.
In COPD, definite diagnosis depends on (1) demonstration of physiologic evidence of airways obstruction which persists despite intensive and maximum medical management, and (2) exclusion of any specific disease as a cause of this physiologic abnormality.
Individuals with a family history of lung disease and those with an early onset of emphysema should be tested for α1-antitrypsin deficiency to determine the serum levels. Phenotyping should be done if the level is low. The normal phenotype is constituted by the MM genetic pattern. The most common abnormal phenotype associated with α1-antitrypsin deficiency is the ZZ pattern. Persons with the MZ phenotype are carriers of the disease, but do not appear to have an increased risk of developing COPD (Locke, 2004).
β-2 agonists, corticosteroids, anticholinergics, and methylxanthines have been the mainstay of COPD therapy. New agents, classes, and combinations of drugs are being developed for the treatment of COPD. In February 2004, tiotropium, a long-acting anticholinergic bronchodilator, was approved by FDA. Three combination products are available: ipratropium/albuterol as a metered-dose inhaler (MDI); ipratropium/albuterol as a solution for inhalation via a nebulizer; and fluticasone/salmeterol, in the 250/50 mcg strength for the treatment of COPD associated with chronic bronchitis (Daryanani, 2004).
Phosphodiesterase-4 (PDE4) inhibitors are a newer class of drugs under investigation for the treatment of COPD that may also be available in the near future. With the growing number of pharmacologic options for the treatment of COPD, it is important to use evidence-based clinical data to determine which agents are most beneficial.
William has to undergo COPD therapy. He also has to quit smoking and drinking for it will be futile to undergo therapy and still continue with his health damaging habits. He should be constantly monitored by the nurses and by his daughter as well so that his therapy will be effective.
Conclusion
William’s case is not a hopeless one. Chronic obstructive pulmonary diseases are experiences by many individuals worldwide. There are already many drugs that can help patients who have COPD. But of course, these drugs alone cannot cure the ailment.
William in his case has to stop his smoking and drinking habits as this may only worsen his condition. Smoking continually will eventually destroy his lungs even if he will be taking drugs that are used in COPD therapy.
References
Daryanani, A.A. 2004, Treatment Options for the Management of Chronic
Obstructive Pulmonary Disease, Formulary.
Doenges, M. and Moorhouse, A. 2004, Nurse’s Pocket Guide: Diagnoses,
Interventions, and Rationales 9th Edition. F.S. Davis Publishing.
Ganong, W. 2001, Review of Medical Physiology 20th Edition. McGraw-Hill.
Guyton, A. and Hall, J. 2000, Textbook of Medical Physiology 10th Edition.
Harcourt Asia Pte Ltd.
Kozier, B. and Erb, G. 2004, Fundamentals of Nursing: Concepts, Process, and
Practice 7th Edition. Pearson Education Inc.
Locke, D.L. 2004, Update on Chronic Obstructive Pulmonary Disease, MedSurg
Nursing.
Potter, P. and Perry, A. 2004, Fundamentals of Nursing. Mosby.
0 comments:
Post a Comment