Chronic Obstructive Pulmonary Disease (COPD) Causes

ADEBAYO AINA

Contents

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1. Explain the physiological origin of Chronic Obstructive Pulmonary Disease
2. Describe the physical effects of the Chronic Obstructive Pulmonary Disease
3. Explain the contributory factors to the onset of Chronic Obstructive Pulmonary Disease

1. Explain the process of referral to identified specialist services
2. Explain the investigative processes and procedures involved in assessing Chronic Obstructive Pulmonary Disease

3.1 Compare and contrast care services available in relation to Chronic Obstructive Pulmonary Disease

3.2 Explain the roles and responsibilities of the professionals in relation to Chronic Obstructive Pulmonary Disease

3. Explain the ranges of treatment available for patients with Chronic Obstructive Pulmonary Disease
4. Explain the monitoring processes involved for Chronic Obstructive Pulmonary Disease

1. Evaluate the extent to which an individual diagnosed with Chronic Obstructive Pulmonary Disease condition would need to adapt his/her lifestyle
2. Explain a range of strategies that would help individuals cope with lifestyle changes caused by Chronic Obstructive Pulmonary Disease
3. Explain the likely prognosis and potential long term outcomes for Chronic Obstructive Pulmonary Disease patient

Abstract

Each year in the UK, 25 000 people are killed as a result of Chronic Obstructive Pulmonary Disease. The purpose of this project is to explain the physiological origin Chronic Obstructive Pulmonary, it aims to achieve this by discussing the two diseases which makes up the Chronic Obstructive Pulmonary Disorder, the project will consider its physical effect and its impact on its sufferers. It will lay emphasis on the onset contributory factors to the disease, whilst also explaining the series of diagnostic measures of the disorder. In other to avoid serious complications of COPD, as well deterring its progress, the project will analyse the preventive actions against the disorder, the importance of tobacco abstention as an important treatment of the disease.

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Chronic Obstructive pulmonary disease (COPD) is a progressive disease of the heart; it deteriorates overtime causing severe obstructions to breathing. COPD refers to the group of lung diseases which are responsible for difficult breathing caused by obstructions of the airways.

Chronic bronchitis and emphysema makes up chronic obstructive pulmonary disease, while it is possible for a person to suffer from just one of the disease, a patient would likely experience symptoms of both disease. In chronic bronchitis, damages are done to the airways causing its lining to swell and thicken, producing excess mucus; as a result, a sufferer would develop a chronic cough as the body tries to get rid of the extra mucus, as it progresses, the airways become narrower and irreparably obstructive. In emphysema, the flexibility of the airways and the air sacs is lost which makes it harder for them to expand and contract, it also affects the alveoli, where oxygen and carbon dioxide exchanges occur damaging it and, causing severe short breathlessness. (Theasthmacenter.org, 2015)

COPD does not normally become evident until after thirty five years of age. According to the NHS, most people diagnosed with the disease are over 50 years old. Frequent chest infection especially during winter, stubborn cough with phlegm that never goes away, increased breathlessness and wheezing can all represent symptoms of chronic obstructive pulmonary disorder. (NHS, 2015)

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Several of the causes of COPD disease are self inflicted; smoking represents a major factor influencing the causation of the disease. Smoking is known to be responsible for 90% of cases; it causes the inflammatory of the lining of the airways, making it to become permanently damaged. Long term exposure to fumes and dust, such as cadmium, grains, isocyanates and coal has been found to influence development of COPD, although, air pollution has been said to be an additional factor that influences development of COPD, it is however concluded that, that this assertion is not conclusive and there is ongoing research to establish the facts. (NHS, 2015)

In accordance with the National Institute of Health Care Excellence (NICE) guidance, referral to specialist in COPD patients may be appropriate at any stage of the disease, and not necessarily in severe cases. For example, a GP may refer their patient to specialist service in cases where there is diagnostic uncertainty or suspected severe COPD etc. The process usually involves General Practitioner (GP) writing a letter of referral which includes medical history of the patient, and details of any concern which may require greater attention. (Nice.org.uk, 2010)

There are several procedures used in diagnosing COPD, the most important of them is spirometry, it is used to assess the functionality of the lungs, a patient is usually taken through a process of breathing into spirometer , the spirometer takes two measurements, one of which measures the pace and volume of air a suspected COPD patient can breathe out in a second known as FEV1 , and the other is the measurement of the total air a patient can breathe out which is also known as FVC.

In addition to spirometry and as part of further investigative measures, NICE recommendation stipulates that all patients should have a chest radiograph to check for presence of other pathologies, full blood test count to identify anaemia or polycythaemia and a BMI. Electrocardiogram (ECG) similar to ultrasound may also be used to check the condition of the heart; it involves attaching electrodes to the arms, legs and chest of a patient to pick up electrical signals. (NHS, 2014)

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Hospital is the most appropriate service for COPD patients, while GPs may assist with diagnosis and onwards prescription and monitoring procedures, GPs intervention in COPD patients is limited, they are unequipped with specialist equipment to make diagnosis in many cases, whereas these equipments are readily available in hospitals. An observation study was conducted by NICE in Glasgow; this study found that local GPs referred patients directly to respiratory department of the hospital where they were assessed on the same day by specialist nurse. (British Thoracic Society, 2015)

Roles and responsibilities of specialist in COPD patients vary according to their expertise, they include:

Respiratory Physiologist

Highly trained member of the team, with sufficient knowledge and understanding in respiratory and lung function tests.

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Radiographers

Provides a wide range of service for different department within the healthcare setting, they are trained to use different imaging machines, such as X-rays, ultrasound, etcetera, to carry out imaging checks of the heart for disorders, and to monitor any changes in the heart.

Pulmonologist

Classified as an internal medicine subspecialty, possessing specialised knowledge in the diagnosis and treatment of COPD. (Butterfield, 2015)

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There is currently no absolute cure for COPD; however there are ranges of treatment available for patients which may slow progression of the disease and reduce its symptoms. It is not surprising that the most widely recommended treatment for COPD in a smoker is to quit smoking, as smoking is recognised as the major contributor to its causation.

Theophylline relaxes the muscles of the airways to open them up, which enable free flow breathing. Inhalers such as Short-acting bronchodilators and Long acting-bronchodilators and steroid inhalers performing the same function, but not necessarily as aggressive or effective as the Theophylline tablets, they also open and aid the relaxation of the airways.

Mucolytic such as carbocisteine makes it easier to cough up the mucus of phlegm in the throat by making them thinner. Antibiotics and steroid tablets are also used to treat COPD. (Nice.org.uk, 2010)

NICE guidance recommends that follow-up care of patients with COPD is a necessity in severe COPD patients, however it is not necessary in less severe cases, but necessary provisions should still be made available locally to ensure easy access for hospital assessment when necessary. These monitoring processes include twice a yearly review of the patient’s condition, the review should cover, clinical assessment to establish smoking status and desire of patient to quit smoking, breathlessness checks, presence of complications etcetera. In addition to these checks, a FEV1and FVC checks should also be performed to check the performance rate of the heart. (Nice.org.uk, 2010)

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Smoking is generally accepted as the main cause of the disease, a patient who is also a smoker must take steps to quit immediately, to do this, a patient is encouraged to make a quit plan, seek expert assistance and may go on e-cigarette as opposed to real tobacco. A patient must learn to adapt to their new life on medication, COPD treatment is a palliative type of treatment and a sufferer needs to come to terms with reality on the long and timely use of their medications, a patient would need to establish a good relationship with the team responsible for their care even if this is not convenient for the patient, as the more the team knows about the patient, the more help they would be able to offer, regular meetings would also prevent any complications of COPD as they will be spotted early.

A patient would need to adjust to being observant of what they breathe in, while this is not usually a worry for people without COPD and often taking for granted; a COPD patient must be vigilant with regards anything they breathe in, as the consequences of inhaling any inappropriate substance may increased the symptoms of COPD and may cause flare-up. A COPD patient would also need regular respiratory exercise to improve breathing and reduces the symptoms of COPD, according to the NHS; research has shown that pulmonary rehabilitation improves exercise capacity, and breathlessness, these reduce the need to visit Doctors. (Healthcommunities.com, 2015)

Having COPD means being on medication for the rest a person’s life are there is currently no cure for the disease, life expectancy are not particularly favourable for a COPD patient, a patient is highly likely to be living the rest of their lives with an abnormally high pressure in the lungs, as the condition worsens a sufferer will experience more severe form COPD which at that point, they may be experiencing frequent collapse of some part of the lungs (Pheumothorax) due to air leakage from the lung, weight loss and wasting may occur, and an eventual death of a patient cannot be discounted. (University of Maryland Medical Center, 2015)

Conclusion

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COPD is a lethal disease that has no cure, while it is preventable however, the main causation of the disease has been identified as tobacco, it is a self adopted, destructive lifestyle which is so addictive and inviting that the costly implications does not immediately come to mind when a smoker is on course of lighting up his or her cigarette. Increased public awareness is a very important preventive measure against the prevalence of COPD; this is not to ignore the unyielding effort of governments to increase public awareness on the accompanying implications of smoking, it just mean more needs to be done until COPD death rate has been reduced to at least in the hundreds.

References

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Clahrc-sy.nihr.ac.uk, (2015).South Yorkshire Collaboration for Leadership in Applied Health Research and Care – CLAHRC SY. [online] Available at: http://clahrc-sy.nihr.ac.uk/theme-copd-gp-referral.html [Accessed 26 Jan. 2015].

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Nhs.uk, (2015).Chronic obstructive pulmonary disease – Symptoms – NHS Choices. [online] Available at: http://www.nhs.uk/Conditions/Chronic-obstructive-pulmonary-disease/Pages/Symptoms.aspx [Accessed 20 Jan. 2015].

Nhs.uk, (2015).Chronic obstructive pulmonary disease – Diagnosis – NHS Choices. [online] Available at: http://www.nhs.uk/Conditions/Chronic-obstructive-pulmonary-disease/Pages/Diagnosis.aspx [Accessed 18 Jan. 2015].

Nice.org.uk, (2010).Chronic obstructive pulmonary disease | guidance | Guidance and guidelines | NICE. [online] Available at: http://www.nice.org.uk/guidance/cg101/chapter/guidance [Accessed 18 Jan. 2015].

Theasthmacenter.org, (2015).The Asthma Center Education and Research Fund | Disease Information | COPD. [online] Available at: http://www.theasthmacenter.org/index.php/disease_information/copd/ [Accessed 19 Jan. 2015].

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YouTube, (2015).COPD (chronic bronchitis and emphysema). [online] Available at: https://www.youtube.com/watch?v=2nBPqSiLg5E [Accessed 16 Jan. 2015].

Healthcommunities.com, (2015).What Is a Pulmonologist/Pulmonary Specialist? – COPD – HealthCommunities.com. [online] Available at: http://www.healthcommunities.com/copd/what-is-pulmonary-specialist.shtml [Accessed 24 Jan. 2015].

University of Maryland Medical Center, (2015).Chronic obstructive pulmonary disease. [online] Available at: http://umm.edu/health/medical/altmed/condition/chronic-obstructive-pulmonary-disease [Accessed 18 Jan. 2015].

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