Introduction to COPD

Chronic obstructive pulmonary disease (COPD) is a progressive disease that makes it difficult for clients to breathe effectively. It is characterized by long-term inflammation and scarring in the airways, which lead to difficulty breathing and shortness of breath. COPD is a progressive and chronic lung disease that has no cure but can be treated.

There are two types of COPD: emphysema and chronic bronchitis. Symptoms can be similar between the two types, such as shortness of breath and wheezing, but they are two different conditions.

Emphysema is the most common type of COPD. It occurs when the walls separating the air sacs (alveoli) become damaged and stretched out, so they cannot expand enough to fill with air when clients breathe.

Chronic bronchitis (a form of COPD) is a lung condition where the cilia in the airway of the lungs are destroyed. This manifests with shortness of breath, wheezing, and a cough that produces phlegm (sputum). 

COPD Pathophysiology

COPD refers to structural lung changes due to prolonged exposure to noxious particles or gasses, most commonly cigarette smoke. If COPD isn’t treated early on, it will worsen over time.

Emphysema is a condition in which the walls of the alveoli (the air sacs in the lungs) become damaged, so that they cannot support the bronchial tubes. As a result, the tubes collapse and cause an obstruction, trapping air inside the lungs.

Clients with emphysema can have a barrel-chested appearance. This is because the lungs become hyperinflated, keeping the rib cage expanded more often creating a more barrel chest appearance. In emphysema, the inner walls of the lungs’ air sacs (alveoli) are damaged, causing them to eventually rupture. 

This creates one larger air space instead of many small ones and reduces the surface area available for gas exchange. Loss of lung elasticity and surfactant decrease the ability of lung tissue to recoil and result in air trapping.

Chronic bronchitis is caused by goblet cells overproducing and secreting mucus. As a result, the epithelial lining of the airways responds to toxic, infectious stimuli by releasing inflammatory mediators. As a result, this leads to airflow impediment due to the obstruction of the small airways

The airways are clogged with debris and irritation, which further increases coughing. The cough characteristic of bronchitis is due to the abundant mucus secretion in chronic bronchitis.

Memory Trick

Think, “Chronic Obstruction from Chronic Destruction,” resulting in decreased gas exchange and double Cs:

• Chronic air trapping results in reduced gas exchange due to inflammatory damage to the lungs.
• CO2 High = Clients can’t breathe out due to limited airflow and inability to exhale fully.

Causes & Risk Factors

• Smoking
• Family history
• Smoking
• Exposure to chemicals, dusts, or fumes
• Air pollution
• Secondhand tobacco smoke

Complications 

Respiratory Failure:

• Hypoxemic respiratory failure = Low O2
• Hypercapnic respiratory failure = HIGH CO2, Priority = BiPap

Advanced emphysema:

•  Frequent infections
•  Risk for pneumothorax due to rupture of blebs

COPD Signs and Symptoms

• Clubbing fingers (round fingernail beds from long-term chronic hypoxia)
• Coughing 
• Chest tightness
• Wheezing or whistling sound (when clients breathe out)
• Coughing up phlegm 
• Shortness of breath
• Frequent chest and lung infections
• Night sweats and/or fever
• Inflammation of the bronchi 
• Excessive mucus production

Memory Trick – Emphysema “Pink puffer”

• Pink skin & Pursed-Lip breathing 
• Increased chest “Barrel Chest”
• No chronic cough (minimal) 
• Keep Tripoding

Memory Trick – Chronic bronchitis “Blue bloater”

• Big & Blue skin “Cyanosis” (hypoxia)
• Long-term “chronic” COUGH & Sputum
• Unusual lung sounds: Crackles & Wheezes
• Edema peripherally (due to cor pulmonale)

Nursing Interventions for COPD

Many nursing interventions can help clients deal with their condition and live as full a life as possible. The first step is an assessment to differentiate which type of COPD the client is experiencing. Nursing interventions should include:

Administer

• Oxygen, as prescribed
• Fluid management

Perform

• A history and physical exam to assess the client’s respiratory status
• Respiratory management

Provide

• Instructions on how to use supplemental oxygen at home
• Oxygen therapy
• Resources and support for smoking cessation if needed

Monitor

• Oxygen saturation levels
• Breathing patterns
• Pulse rate
• Chest sounds
• Respiratory rate (and depth)
• Lung function

Encourage

• The use of supplemental oxygen 
• Proper use of supplemental oxygen equipment

Avoid

• Using oxygen masks on clients with COPD if they are not having difficulty breathing
• Administering any analgesic medications

Goals and Outcomes

• Maintain a normal respiratory rate and depth
• Maintain a normal oxygen saturation level 
• Ability to maintain activities of daily living (ADLs)
• Maintain normal pulmonary function as measured by spirometry

COPD Lab Values

Arterial blood gas (ABG) key numbers:

• Low PaO2 32 = Hypoxemia – Below 80 (Normal 80 – 100)
• High PaCO2 = HyperCapnic – pH less than 7.35 = Acidosis, PaCO2 – Over 45 = Acidosis

COPD Medications

There are three main categories of COPD medications: bronchodilators, anticholinergics, and corticosteroids. 

Bronchodilators are used to open up the lung airways for better breathing. 

Anticholinergics reduce inflammation in the airways and make it easier to breathe. 

Corticosteroids reduce inflammation in the airways and make it easier to breathe.

COPD Conclusion

The term COPD describes structural lung alterations brought on by extended exposure to toxic substances, most often cigarette smoke. 

If COPD is not treated at an early stage, it will continue to worsen. The two types of COPD are chronic bronchitis and emphysema. Numerous treatments and interventions are available to help clients manage their disease and lead as full a life as they can.

As a form of COPD, emphysema is the most prevalent. It happens when the walls separating the air sacs (alveoli), which typically extend to fill with air when people breathe normally, become harmed and stretched out. Chronic bronchitis is characterized by recurrent episodes of coughing up mucus (sputum). Both types have some of the same signs and symptoms.

Sources

https://www.healthline.com/health/copd/pathophysiology 

https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679