Nursing management of COPD

Effective COPD management plan includes four components: (1) assess and monitor disease; (2) reduce risk factors; (3) manage stable COPD; (4) manage exacerbations.

The objectives of effective COPD management are to:

• Prevent disease progression
• Relieve symptoms
• Increase exercise tolerance
• Improving the health status
• Prevent and treat complications
• Preventing and treating exacerbations
• Reduce mortality

These objectives should be achieved with minimal side effects from treatment, a particular challenge in COPD patients where comorbidities are common. the extent to which these goals can be realized varies with each individual, and some treatments will produce benefits in more than one area.

In selecting a treatment plan, the benefits and risks to individuals and the cost, direct and indirect, to the community must be considered. Patients should be identified before the end stage of the disease, when the defect is substantial. However, the benefits of screening spirometry, either public or smokers, are still unclear. Educating patients and physicians to recognize that cough, sputum production, and especially breathlessness are not trivial symptoms is an important aspect of public health care of this disease.

Reduction of therapy once symptom control has been achieved is usually not possible in COPD. further deterioration of lung function usually requires the progressive introduction of more treatments, both pharmacological and non-pharmacological, to try to limit the impact of these changes. Acute exacerbations of signs and symptoms, a hallmark of COPD, patient quality of life and lower Destructive their health status. treatment and measures to prevent further exacerbation of the right must be implemented as soon as possible.

Component 1: Assess and monitor disease

• Diagnosis of COPD is based on a history of exposure to risk factors and their airflow limitation that is not fully reversible, with or without symptoms.
• Patients who have chronic cough and sputum production with a history of exposure to risk factors should be tested for airflow limitation, even if they do not have dyspnoea.
• For the diagnosis and assessment of COPD, spirometry is the gold standard because it is the most reproducible, standardized, and the purpose of measuring airflow limitation. FEV1 / FVC
• Reduction of total personal exposure to tobacco smoke, dust labor and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and development of COPD.
• health care workers involved in the diagnosis and management of patients with COPD should have access to spirometry.

Component 2: Reduce risk factors

• Reduction of total personal exposure to tobacco smoke, dust labor and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and development of COPD.
• Quitting smoking is the most single effective and cost-effective to reduce the risk of developing COPD and stop its development. Brief tobacco dependence treatments are effective and every tobacco user should be offered at least this treatment at every visit to a health care provider.
• Three types of counseling are very effective: practical counseling, social support as part of treatment, and social support arranged outside of treatment.
• Some effective pharmacotherapies for tobacco dependence are available, and at least one of these medications should be added to counseling if necessary and in the absence of contraindications.
• The development of many occupationally induced respiratory disorders can be reduced or controlled through a variety of strategies aimed at reducing the burden of inhaled particles and gases.

Component 3: Manage stable COPD

• The overall approach to managing stable COPD should be characterized by a gradual increase in treatment, depending on the severity of the disease.
• For patients with COPD, health education can play a role in improving skills, ability to cope with illness, and health status. It is effective in achieving certain goals, including smoking cessation.
• None of the existing medications for COPD has been shown to modify the long-term decline in lung function that is the hallmark of this disease. Therefore, pharmacotherapy for COPD is used to decrease symptoms and complications.
• bronchodilator medications are central to symptom management of COPD. They were given the needed basis or on a regular basis to prevent or reduce symptoms.
• The main bronchodilator treatment is 2-agonists, anticholinergics, theophylline, and a combination of one or more of these drugs.
• routine treatment with inhaled glucocorticosteroids should only be prescribed to patients with symptoms of COPD with documented spirometric response to glucocorticosteroids or for those with FEV1 <50%
• Chronic treatment with systemic glucocorticosteroids should be avoided because the ratio of the benefit-to-risk unfavorable.
• All patients with COPD benefit from exercise training programs, improving with respect to both exercise tolerance and symptoms of breathlessness and fatigue.
• Long-term administration of oxygen (> 15 h per day) to patients with chronic respiratory failure has been shown to improve survival.

Component 4: Manage exacerbations

• Exacerbation of respiratory symptoms requiring medical intervention are important clinical events in COPD.
• The most common cause of exacerbations is an infection of the air pollution and tracheobronchial tree, but the cause of about one-third of severe exacerbations can not be identified.
• Inhaled bronchodilators (particularly inhaled 2-agonists or anticholinergics), theophylline, and systemic, preferably oral, glucocorticosteroids effective for the treatment of acute exacerbations of COPD.
• Patients experiencing COPD exacerbations with clinical signs of respiratory tract infection (eg, increased volume and change of color of sputum, or fever) may benefit from antibiotic treatment.
• Noninvasive positive pressure ventilation (NIPPV) in acute exacerbations increase blood gases and pH, reduces mortality in hospitals, reducing the need for invasive mechanical ventilation and intubation, and reduces the length of hospital stay.