In airspaces within the lung, destruction of the alveolar

In
conclusion COPD is an irreversible condition which has drastic effects on
patient’s respiratory system.  The
umbrella term of COPD describes both bronchitis and emphysema. Emphysema is the
permanent destructive enlargement of the airspaces within the lung, destruction
of the alveolar walls, loss of natural lung elasticity and reduction in lungs
surface area. In order to effectively manage and treat the disease a holistic
approach to care is needed. Psychological, social, intellectual and physical
needs must all be met in order to achieve this. Continued research into the
condition and treatments available such as endobronchial valve insertion
demonstrates that active improvements to treat the disease are undergoing.
However, as it is an irreversible condition the aim of this research is to
improve quality of life of patients rather than cure the disease itself.

Although
the majority of physiological and social effects of COPD mentioned within this
assignment are negative, advances in treatment helps provide positive frame of
mind for patients. The National Institute for Health and Care Excellence (NICE)
have recently published interventional procedures guidance for endobronchial
valve insertion to reduce lung volume in emphysema. This procedure essentially
consists of placing small one-way valves in certain airways in the lungs
leading to the damaged areas. These areas are found by a bronchoscope moving
through either to nose or move and then into the lungs. The aim of the
procedure is to allow more air to travel to the healthier areas of the lungs
and reduce airflow to the damaged parts. (NICE 2017)

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Like
all chronic disorders COPD has many sociological effects on patients. Each
individual experience of emphysema is different and unique to the patient and
so are the effects on their social well-being. The pathophysiology of the
condition is generalised and predicted as already been discussed, however
sociologist emphasise that social experiences cannot be understood or predicted
in the same way. (Taylor and Field 2008) The British lung foundation is an
example of an organisation which run support groups which encourages patients to
socialise. The groups also provide patients with an opportunity to discuss
their worries, fears and issues they face living with the chronic condition
(British Lung Foundation 2018) Another great opportunity for socialising is
exercising. Patients suffering from COPD can often enter a negative
psychological cycle of feelings of inability due to breathlessness, which leads
to inactivity which then leads to social isolation. This may lead to
development of depression or deterioration of the condition if already
developed (Page and McKinney 2012)

Like
all chronic diseases COPD not only has a range of implications on the patients’
physical health but also their psychological and social health. As previously
mentioned within this assignment, holistic care is vital for the patient’s
well-being therefore all needs must be met. Emphysema is a type of a chronic
disorder. Even when the condition is well managed and stable the patient will
still struggle for breath. Subsequently altering the ability to perform a range
of activities of daily life. Minor activities that are effected such as
brushing their hair, cleaning their teeth and eating are often overlooked with
the focus being on mobilising. (Alexander et al 2006) Two very common
psychological conditions associated with COPD are anxiety and depression (Smith
et al 2017) There are numerous reasons for this including the increasing number
of periods that patients have to spend in hospital, the progressive disabling
nature of the disease alongside the daily restriction it burdens the patients
with. ( Willgoss and Yohannes 2013) Anxiety is dominated by fear and in the
case of sufferers of COPD they are dominated by the fear of breathlessness.
This symptom dominates their life and prevents them from living life to the
fullest. Depression is a psychological disorder that focusses on low mood. This
low mood is triggered in patients with COPD by the daily struggles of the
disease that have already been discussed. 896 deaths registered in Northern in
2016 were as a result of COPD.  In
comparison to all respiratory deaths that year it accounts for 45% (Chest Heart
Stroke) The worry of the inevitable end of life for many emphysema suffers
contributes to the deterioration of their psychological health and well-being.
Often patients become dependent on others for help and support with basic every
day responsibilities such as house hold chores. Furthermore this leads to them
feeling like a burden on their family and friends, unescapably having a
negative effect on the psychological health. (European Lung Foundation 2018)

Salbutamol
has a range of side effects, both common and uncommon. As with a range of drugs
salbutamol can be prescribed at different dosages for different patients
depending on the severity of their COPD. With high dosages of the drug a common
side effect is lactic acidosis. This is caused from a build-up of lactate
within the body causing low blood PH. As already discussed patients suffering
from emphysema experience low levels of blood PH anyway, therefore lactic
acidosis can be extremely harmful.  A few
other common side effects are nausea and vomiting. (BNF 2017) There are a few
nursing implications of the drug. These include the risk of hypertension;
therefore, clinical observations should be carried out whilst in hospital under
the nurses’ care at regularly intervals e.g. four hourly. Another common side
effect is dryness and irritation around the move when salbutamol is inhaled.
This nursing implication can be addressed by regular mouth care and encouraging
fluid intake.

There
are a range of medications used to treat COPD but for the purpose of this
assignment the focus will be on salbutamol. Salbutamol is a short-acting betta
two antagonist. This category of drugs increases the level of cyclic adenosine
monophosphate through the stimulation of beta two receptors in the smooth
muscle, resulting in bronchodilation. This allows the smooth muscle to relax,
open the airways, resulting in more capacity for air to move in and out. This
helps relives the patient’s symptoms of dyspnoea. It is a short acting drug
that takes effect over four hours. It can be administrated through an inhaler,
a nebuliser, in tablet form or in syrup form if the patient is not able to
effectively use an inhaler. The most common way to administer the drug is
through an inhaler (Scott and Mc Grath 2009)

Peak
flow is also an essential measurement obtained via a spirometer. This is the
maximum flow rate that the patient can expel from their lungs during one forced
exhalation. (Barbara K et al 2012) A basic description of the test is that the
patient blows into a mouth piece that is attached to a spirometer and the
healthcare provider tells the patients simply breathing commands to obey. The
test plays an essential part in diagnosing COPD as it can measure the degree of
air flow limitation. (The Royal Marsden 2015)

The
main investigation used is spirometry. Spirometry is a pulmonary function test
that measures a range of volumes and capacities within the respiratory system.
These include; tidal volume, residual volume, expiratory reserve volume, total
long capacity and vital capacity. This essentially demonstrates how much air
the patient can exhale and at what speed they can perform this. The three main
measurements used for the diagnosis of COPD are forced expiratory volume
(FEV1), forced vital capacity and the ratio of the two. Forced expiratory
volume is the volume of air that the patient is able to exhale in the first
second of forced expiration and forced vital capacity is the total volume of
air the patient is able to exhale in one breath. With the spirometry test the
degree and severity of air flow obstruction can be measured. Where mild airflow
obstruction occurs a FEV1 score between 50–80%, where moderate airflow
obstruction a FEV1 score between 30–49% and where there is severe airflow
obstruction a FEV1 score<30% predicted. (NICE 2010) Another essential investigation is a set of clinical observations. These should also be carried out to discover the patients baseline. Patients who suffer from COPD have a target oxygen saturation of 88-92%, therefore this measurement would aid a diagnosis of the condition. (Page and Mc Kinney 2012) Other possible investigations include chest x-ray, sputum and atrial blood gas. In order to support a diagnosis of COPD there are a few main investigations that should be carried out. Firstly, a brief history must be taken in order to gain a background knowledge of the patient's individual experience of their condition. This allows healthcare professionals to carry out a holistic approach to their care. Holistic care is based on treating every aspect of the patient's needs including emotional, physical, intellectual and social. Furthermore, it is essential to explore if the patient is a smoker or has ever smoked in their lifetime, their occupation and relevant family medical history (NICE 2010). This is carried out as smoking is a huge contributing factor for COPD. Occupation is important as the exposure to dust particles and toxins is also a contributing factor to the development of COPD. Family history is also important due to the possibility of genetic deposition of the enzyme alpha-antitrypsin. When a patient presents with emphysema the three main signs and symptoms they will display are; chronic productive cough, progressive reduction in the ability to exhale and dyspnea. Chronic cough is often as a result of obstructive airflow over many years. ( Chong, Leung, Poole 2017) The pathophysiology of emphysema explains why patients present with these symptoms. Elastic recoil is vital in the alveoli. In emphysema this is lost and the alveoli can no longer contract and move air back out of the body. When the alveolar wall collapses the airspace becomes enlarged and ineffective. This decreases the effect of gas exchanged, especially the release of carbon dioxide. When a person takes a deep breath and releases half of the air, hyperinflation occurs. This is the chronic cough that the patients present with. As this symptom persists the alveoli become stretched even further, continue to lose elasticity and as a result carbon dioxide is retained and the Ph level of the blood is reduced. Patients suffering from emphysema commonly perform pursed lip breathing to increase the pressure in the airways, to prevent alveolar wall collapse, and to allow the air to escape the alveoli. They may often be referred to as Pink puffers ( Braun and Anderson 2011) Furthermore, as well as the loos of elastic recoil the enzyme alpha-antitrypsin is very important in the explanation of the pathophysiology of emphysema. This particular enzyme protects the lungs. When the walls of alveoli are breaking down as already described, then other components that make up the alveoli are also broke down and released. (Porth 2015) These include elastin which is broke down by protease. Protease, especially elastase, are released from polymorphonuclear leukocytes, e.g neutrophils, alveolar macrophages and other inflammatory cells. As already discussed some patients have a genetic deficiency of the alpha-antitrypsin enzyme as well. This leads to airflow obstruction and explains why patients present with these common signs and symptoms. ( Eden 2010)  Another possible cause of a patient developing emphysema is environmental factors. These include exposure to both indoor and outdoor air pollution such as dust and chemicals. If exposure to these irritants are prolonged and intense it could have a negative effect on the respiratory system and lead to the development of emphysema. Other than the causes already discussed there is a genetic factor that may also lead to the development of emphysema. The enzyme alpha-antitrypsin protects the lung parenchyma from injury, when patients suffer from a deficiency of this enzyme then emphysema develops. It is crucial that their deficiency is discovered at an early stage of life as they are highly susceptible to the environmental factors e.g. smoking. (Smeltzer et al 2010). The main aetiology of emphysema is obstruction of airflow within the body. This is caused by the normal function of the respiratory system being altered. In early stages of the disease the primary source of obstruction, is the development of inflammation in the small airways distal to the respiratory bronchioles. In moderate to severe disease, the loss of elastic recoil in the alveoli is the primary mechanism for airway obstruction. Simultaneously, vascular changes in the lungs develop. The inner lining of the arteries and arterioles that perfuse the lungs become thicker and fibrotic. The main risk factor for the body to respond in this way is cigarette smoking ( Braun and Anderson 2011). Everyone who smokes cigarettes show inflammatory changes within their lungs, but those who develop COPD demonstrate an enhanced or abnormal inflammatory response to the toxic agents in cigarette smoke (Kaufman G 2013) Passive smoking also compromises the respiratory system and contributes towards emphysema. Smoking irritates the goblet cells and mucus glands, which causes an increase gathering of mucus, leading to irritation and over all infection within the lungs. Furthermore, the by-product of smoking called carbon monoxide, which is extremely toxic and poisonous, combines with haemoglobin to form carboxyhaemoglobin. Haemoglobin that is bound by carboxyhaemoglobin cannot carry oxygen effectively which causes serious effects on the body as oxygen is an essential element of the body and is needed for all functions, most importantly gas exchange. This paper will discuss Chronic Obstructive Pulmonary disease (COPD) and in particular five main areas of the condition; aetiology, signs and symptoms patients will demonstrate, main investigations used to diagnosis the condition, a main drug used in the treatment and the psychological and sociological effects of the condition. COPD is currently ranked the fifth most deadly disease within the U.K and is suspected to rise to the third by 2030 (D.H 2010) COPD is an umbrella term used to describe all chronic obstruction airflow that interferes with normal breathing and is not fully reversible. It is used to describe all chronic obstructive lung problems however the two main types are emphysema and chronic bronchitis. (World Health Organisation 2017) This paper will focus on emphysema. Emphysema is an irreversible enlargement of the air spaces beyond the terminal bronchioles, most notably in the alveoli, resulting in the destruction of the alveolar walls and obstruction of air flow. (Braun and Anderson 2011)

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