Chronic obstructive pulmonary disease (COPD)

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Chronic obstructive pulmonary disease (COPD) is a significant health problem ranked 12th for worldwide burden of disease and projected to be 5th by the year 2020 (British thoracic society (BTS),1997). The aim of this assignment is to explore the nature of COPD, the lived experience of those with the condition and their special needs. In particular it looks at the measures used to help the patient manage the symptoms of COPD and minimise the damage associated with pulmonary changes to improve a patient’s quality of life “nursing is the use of clinical judgement and the provision of care to enable people to promote, improve, maintain, or recover health and when death is inevitable, to die peacefully” (RCN 2002, p.1). The author will explore the principles of chronicity and relate how COPD fits into these criteria as a chronic illness. A case study will highlight the key clinical manifestations of an acute exacerbation in a COPD patient, provide the framework for diagnosis and will discuss the strategies for acute care management. An exacerbation in a COPD patient is a significant clinical event requiring prompt diagnosis and management (GOLD, 2001). A critical review of principles of chronicity, definitions of the disease, risk factors and nursing interventions for COPD will also be discussed. Chronic illnesses have profound consequences for the individual and psychological well being (Alexander, Fawcett and Runciman, 2000). The patient’s experience and the effects of their condition on family and carers will be looked at in detail. Focus of this assignment is on experiences of living with COPD from the patient and their significant others’ perspectives and as such the pathogenesis of the respiratory disorder will not be explored in detail. The activities of the multidisciplinary team (MDT) in the diagnosis and management of COPD will be identified.

In the United Kingdom, COPD is ranked as the fourth leading cause of death (behind heart disease, cancer and cerebrovascular disease) and may be underestimated due to concomitant co morbid conditions (Fehrenbach, 2002; BTS, 1997). The economic and social impact of this disease is steadily increasing with costs in the UK for the year reaching £500 million. In 2000, the world health organisation (WHO) estimated 2,74 million deaths .The WHO estimates 1,1 billion smokers worldwide increasing to 1,6 billion by 2025 (BTS, 1997; GOLD, 2001).

Chronicity comes from the Greek word "chronos" meaning "time."  Chronicity is the state of being chronic. The Oxford Dictionary (1998, p.) defines chronic as “persisting for a long time (usually of an illness or personal social problem).  This definition is quiet limited and does not give attributes of the condition or its effects on the sufferer.

Chronic can be defined as, pertaining to a health-related condition, disease, state, disorder, or set of symptoms that lasts and/ or frequently reoccurs over a long period of time (Petty, 1999). The U.S. National Centre for Health Statistics ( defines a chronic condition as one that has lasted for three months or more. In some conditions, chronic is defined as six months or longer. Chronic conditions often progress slowly and last for the remainder of a person's life. A chronic condition is differentiated from an acute, which means pertaining to a health-related condition, disease, state, disorder, or set of symptoms that usually begins suddenly, is sharp and/or intense, and lasts for a short period of time.

Chronic illness is generally associated with the presence of a protracted disease process, which is not amenable to treatment, is responsible for impairment or disability with a sustained influence on functioning and lifestyle of an individual. The North American Commission (cited in Alexander, Fawcett and Runciman, p. 945, 2000) defines a chronic illness as ” all impairment or deviations from normal which have one or more of the following characteristics: permanency, leave residual damage, are caused by non-reversible pathology, require specialised training of the patient for rehabilitation and/or require long period of supervision”.

A wealth of literature has been published on COPD and various definitions have come forth regarding this complex disorder. Below is a review of some of these.

The definition of COPD, that is recognised by both the American Thoracic Society and the European Respiratory Society, is a disorder that is characterised by reduced maximal expiratory flow and slow forced emptying of the lungs; features that do not change markedly over several months. This limitation in airflow is only minimally reversible with bronchodilators (Dluhy,1995)

Mosby’s Medical, Nursing and Allied Health Dictionary (2002), describes COPD as a progressive and irreversible respiratory condition characterised by a diminished inspiratory and expiratory capacity of the lungs.

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The BTS describes COPD as a chronic, slowly progressive disorder with airflow obstruction that does not return to normal with treatment. The patient will have a history of cough and/or wheeze, fatigue and/or breathlessness. This results in the loss of support for the airways and early closure on expiration (Fehrenbach, 2002). Most COPD patients have a history of cigarette smoking of at least 20 pack-years (one pack year = one pack of 20 per day for one year (Brewin, 1997).

Current research has revealed that inflammation plays a significant role in the COPD disease process. The premise that tobacco smoking ...

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