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Chronic Obstructive Pulmonary Disease (COPD)



Research Paper Introduction

The research paper discusses chronic obstructive pulmonary disease (COPD), its causes, symptoms, at-risk groups and impact. Nowadays, there are many cases of the disease being reported around the world. Thus, it is crucial for nurses to recognize chronic obstructive pulmonary disease by assessing symptoms and risk factors associated with it. The ability of a nurse to conduct an early diagnosis of COPD helps to reduce the mortality and morbidity rate, thus improving the quality of life of people suffering from the disease. Therefore, nurses should receive good training on how to accurately and successfully conduct and interpret spirometry as outlined in the diagnostic process of the COPD. The aim of the research paper is to discuss factors associated with chronic obstructive pulmonary disease.

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Background Information on COPD

According to the World Health Organization report on COPD, there are approximately 60 million people suffering from chronic obstructive pulmonary disease across the world. From the report, it is evident that nurses must have a good preparation knowledge about COPD to help people manage their health conditions (Rennard, Rodriguez-Roisin, Huchon, & Roche, 2007). Nurses should have realistic aims for managing COPD by halting or slowing the disease progression, relieving patients of symptoms with an aim to reduce disability and decreasing the severity and frequency of exacerbations. Nurses should be trained on how to use a wide range of medications and how to review patients on a regular basis to manage their condition well. Chronic obstructive pulmonary disorder is a devastating disease characterized by slow progression.

Therefore, nurses should help address the issue of under-diagnosis of COPD cases around the world. They should detect pathological changes occurring in the airways and lungs to ensure that cases of chronic obstructive pulmonary lung disease are properly examined, explain its consequences to the patients and recommend medications to manage the condition (Rennard et al., 2007).

Chronic obstructive pulmonary disease, commonly abbreviated as COPD, refers to a group of conditions or diseases that affect the lungs, making it difficult for them to empty out the air. The signs and symptoms of the chronic obstructive pulmonary disease include breathing difficulties, wheezing, chest pain when attempting to breathe, coughing up mucus, shortness of breath when performing simple activities and inability to perform some basic tasks. This kind of difficulty in emptying air out of the lungs may cause shortness of breath or breathlessness. It may also make the patient feel physically tired. COPD is an umbrella term that can be used to describe people suffering from emphysema, chronic bronchitis or a combination of the two (Rennard et al., 2007).

COPD is a totally different disease from asthma, but it may be hard to differentiate between chronic asthma and chronic obstructive pulmonary disease. Thus, two people may be suffering from chronic obstructive pulmonary disease, but one may show symptoms of emphysema, whereas the other may exhibit more symptoms of chronic bronchitis (Rennard et al., 2007).

COPD is characterized by airflow limitation that is not completely reversible. The progressive airflow limitation is linked to the lungs’ abnormal inflammatory response to some toxic gasses or particles (Rennard et al., 2007). The disease is mostly caused by smoking. Moreover, people may develop COPD by inhaling noxious gases. It makes the walls of the bronchial tubes swell and thicken, thus causing inflammation of the area. The increase of mucus makes individuals with the infection cough more frequently, hence causing phlegm or raising mucus. Chronic obstructive pulmonary disorder may develop when an individual inhales small amounts of irritants for a very long period. Similarly, it can be caused by exposure to large amounts of irritants in a very short time frame. Chronic obstructive pulmonary disorder may also be caused by genetics and environmental factors.

For instance, individuals may get COPD when they are heavily exposed to certain dust and chemicals at their workplaces as well as outdoor or indoor air pollution. People suffering from COPD are advised to quit smoking in order to lessen its severity. The improvements in the disease’s symptoms depend on the degree of damage occurring to the individual’s lungs. Chronic obstructive pulmonary disease can help in learning about the efficient use of lung power that an individual has. The recommendation is that an individual learns as much information as possible about his or her condition (Lee, 2008).

Types of Chronic Obstructive Pulmonary Disorder

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Chronic Bronchitis

This refers to a type of chronic obstructive pulmonary disease that causes constant irritability and swelling of the bronchi or the bronchioles, also known as the breathing tubes, leading to increased production of mucus or phlegm. Medical personnel can diagnose patients with chronic bronchitis if they complain of persistent coughs and mucus for at least 2 years. Excessive production of mucus may cause airway obstruction leading to chronic bronchitis. Excessive mucus and swelling of blood vessels block all the airways, hence causing breathing difficulty (Ceylan, 2006).

Emphysema

It is one of the types of COPD in the alveoli in the lungs. There are about 300 million alveoli in the lungs. The alveoli have the stretching and springing characteristics as witnessed in balloons. Alveoli need effort and time for them to be successfully filled with air. However, energy is not required to release air from the alveoli. In emphysema, some of the alveoli’s walls are damaged, and the air sacs become stretchy and behave like paper bags. It is easy to blow a paper bag, but one needs to squeeze it to get the air out. Lungs need energy as well as an effort to expel air out in a process called hyperinflation. The hyperinflation phenomenon can also be described as air trapping. A patient suffering from emphysema may experience obstruction of the airway.

The airway is obstructed when there is a total collapse of the breathing tubes while the patient is exhaling. Therefore, the patient is unable to remove the air out of the lungs. Therefore, due to the loss of stable walls of the alveoli, the breathing tubes stay open as an individual exhales. There exists a breathing test known as spirometry to measure airway obstruction. Moreover, there are several other tests that a health care provider can use to tell if an individual has got emphysema that is causing chronic obstructive pulmonary disease (Ceylan, 2006).

Epidemiological Data

Risk Factors

According to the CDC, chronic obstructive pulmonary disorder is most common in former or current tobacco smokers. Smoking accounts for nine out of 10 COPD-related deaths around the world. It is evident that smoking is an unhealthy habit that is extremely harmful to people’s lungs. Smoking not only destroys bronchioles but also causes inflammation of the lungs. An individual who smokes for a long time increases his or her risk of developing COPD. People who already have COPD are advised to stop smoking as it can increase the risk of dying prematurely. It is misleading to argue that everyone suffering from COPD was once a cigarette smoker or is currently a cigarette smoker. It is evident that even non-smokers can develop COPD. At least one person out of six people suffering from COPD has never smoked cigarettes in his or her entire life.

People who are suffering from the disease but have never smoked may have acquired the disease through other means. For instance, an employee can develop COPD after being exposed to irritants at his or her workplace. People can also develop COPD when exposed to secondhand smoke as well as polluted air. Therefore, non-smokers must be aware of dust, chemicals, and other irritants and work to reduce the risk of developing COPD. Asthmatic individuals may also be at risk of developing chronic obstructive pulmonary disorder if exposed to other COPD-related risk factors. Individuals who are significantly exposed to irritants causing COPD are advised to minimize such exposure as much as possible (Bayer & Stubber, 2006).

Age

Age is another risk factor that may predispose an individual to chronic obstructive pulmonary disease. Thus, the disease is most prevalent in older adults as well as in middle-aged adults. Clinical studies argue that COPD is rare in younger adults because the lungs are still very healthy in younger years. Therefore, it is unlikely for young adults to develop COPD. It takes many years for an individual to develop chronic obstructive pulmonary disease. Thus, people develop the first signs of COPD when they are between 35 and 40 years old. It is evident that old age is a risk factor to develop chronic obstructive pulmonary disease.

However, it is not simply a disease of older people and not part of an individual’s natural aging process. The WHO’s health statistics reveal that 50-60 million people worldwide are suffering from COPD (MacNee & Rennard, 2009). However, there is a possibility that there are many people suffering from the disease who did not address health professionals to conduct diagnostic tests. Therefore, COPD is more prevalent in older people than among youth (MacNee & Rennard, 2009).

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Gender

The World Health Organization also notes that there is an increase in COPD prevalence among women in low-income countries due to higher exposure to indoor pollutants (MacNee & Rennard, 2009). Therefore, the incidence of COPD is almost becoming equal in both men and women. Previously, men were at higher risk of contracting chronic obstructive pulmonary disease than women. However, the World Health Organization health report shows that the tendency is changing because the number of women smoking tobacco is increasing across the world, especially in high-income countries. It means that smoking tobacco is putting both women and men at the risk of getting chronic obstructive pulmonary disease. The data for such people have not been included in the WHO report (MacNee & Rennard, 2009).

According to CDC reports, there has been a notable decline in the number of men dying of COPD between 1999 and 2000. During that period of time, men’s death rate dropped by 9.4% from 57% to 7.6%. The CDC report further reveals that the U.S. has witnessed no significant change in death rates among women between the years 1999 and 2010. For instance, in 1999, the death rate for COPD among American women was 35.3 per 100000 people, and in 2010, it rose to 36.4 per 100000 people in the American population. Every year, it is estimated that 12000 people die of COPD in America. Research shows that there is no cure that can be used to reverse COPD. However, an individual who develops it early can survive for the long term. Therefore, people should improve their chances of survival by preventing risk factors irrespective of age.

The Center for Disease Control and Prevention reports that COPD is incurable and can be deadly without treatment. CPD does not discriminate against any gender since it affects everyone irrespective of their sexes. It mostly affects older people due to their weak immune system and a long period of time during which they have been exposed to the risk factors. However, scientific research shows that it is riskier for women to develop COPD than it is for men. The prevalent rate in women aged 75-84 years old is recorded at 9.7%. The prevalent rate in women aged 65-74 years old is recorded at 10.4%.

To compare, the prevalence rate in men aged 75-84 years old is recorded at 11.2%. Only 2% of all chronic obstructive pulmonary disease cases affect men between the age of 18 and 24 years; whereas 3% of COPD cases affect women of a similar age group. There is a slight increase in individuals aged between 25 and 44 years, with 2% of such cases involving men and 4.1% of the cases involving women. Further, the CDC notes that the higher percentage of all COPD diagnoses involves women in all the age groups except those aged between age 75 and 84 years. It is also obvious that chronic obstructive pulmonary disorder is most prevalent among individuals from low-income families irrespective of all the ethnicities studied by the Center for Disease Control and Prevention (Lee, 2008).

Race and Ethnicity

There was a sharp rise in the number of COPD-related deaths among African Americans between 1980 and 2000. It is noted that the mortality rate of COPD is higher among African-Americans than the Whites. In that period of time, the death rate for African-Americans stood at 87% whereas the death rates for the Whites stood at 67%. The research further reveals that the number of African-Americans affected by COPD equals the number of Whites suffering from COPR-related complications. However, it is outlined that African-Americans are more susceptible to tobacco smoke than whites, a situation that puts them at a higher risk of developing COPD (Bayer & Stubber, 2006).

Income Level

In the U.S., the chronic obstructive pulmonary disorder is common among people with lower income and educational levels. Similarly, approximately 90% of deaths caused by COPD occur in developing and middle-income countries. It is evident that the total number of people suffering from COPD may surpass the official figures released by the WHO. Most hospitals across the world are overwhelmed by financial constraints, hence they are unable to roll out programs for testing and diagnosing people.

As COPD prevalence is increasing, the burden of health care costs is also increasing. In the year 2007, total health care expenditures spent on dealing with chronic obstructive pulmonary diseases estimated $42 billion in the United States of America alone. The WHO reveals that there will be a 30% increase in COPD in relation to deaths if significant measures to prevent tobacco use, as well as other risk factors, will not be taken in the next decade. Chronic obstructive pulmonary disease is predicted to cause approximately 6 million deaths every year (MacNee & Rennard, 2009). COPD mostly affects low-income families because they lack financial resources to seek medical care. Lack of adequate income negatively affects the health-seeking behavior of poor families.

Thus, even though they may be experiencing serious health problems, the lack of funds hinders them from seeking quality health care. They are also unable to pay consultation fees required to establish their state of health. People living in low-income countries cannot afford to pay for health care bills like people from more prosperous nations do. The high number of deaths is attributed to ineffective prevention and control strategies used in developing and middle-income countries. Developing countries lack financial resources to implement prevention and control strategies. Low income makes it difficult for low-income families to access medical services to help them manage COPD.

Environment

Moreover, people in low-income countries are exposed to indoor air pollution. It is estimated that over 3 billion people from low-income countries are exposed to poor environmental conditions that make it easy for them to develop COPD. In low-income regions such as the Middle East, Africa, and Asia, biomass fuels that women use are putting non-smoking women at risk of developing chronic obstructive pulmonary disease. People living in low-income countries are also likely to develop chronic obstructive pulmonary disorder due to occupational exposure to vapors, fumes, and irritants. They develop lower respiratory infections at a young age. However, in high and middle-income countries, tobacco smoking is considered the main risk factor for COPD. People in high-income areas have the disposable income to maintain their smoking habit. They end up tobacco smoking for many years. It is exposure to tobacco smoke that puts them at risk of contracting chronic obstructive pulmonary disorder (Lee, 2008).

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Healthy People 2020

Healthy People refer to a specific set of goals and objectives having ten-year targets, which are designed to guide disease prevention and national health promotion efforts aimed at improving the health of all individuals in America. The US Department of Health and Human Services releases goals at the beginning of every year that must be achieved after a certain period of time, usually in ten years. It involves setting goals and providing benchmarks to monitor progress made in the health sector in a decade. Healthy People 2020 build on the gains made in the last three decades of involvement with setting and implementing goals for the health department. The main vision of Healthy-People 2020 is to ensure people live longer without being affected by numerous health problems. It promotes healthy living in society.

One of the goals of Healthy People 2020 is to attain longer and higher-quality lives that are free from disability, injury, preventable disease and premature death. It is a goal that can be used to tackle COPD. For instance, the implementation of the goal is to prolong the lives of people with COPD. The implementation of the goal can involve the provision of quality health care to ensure proper diagnosis and management of the disease. Young and old people can also have education on the risk factors of COPD to enable them to prevent exposure to those factors. Another goal of the initiative is to eliminate disparities by achieving health equity and improving the health of people regardless of their groups, goals also diagnosis, management, and prevention of COPD.

Health equity will ensure that people from low-income families can access affordable and quality health care to enable people with COPD to manage their health conditions as well. It will ensure that everyone suffering from COPD receives good care irrespective of their social status. Another goal stipulation in Healthy People 2020 regards creating physical and social environments that promote good health. It will ensure that the living environment is available for low-income people to prevent exposure to irritants that cause COPD.

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Ethical Issues

The guarded prognosis when dealing with COPD presents an ethical dilemma because patients may fail to benefit from mechanical ventilation and intubation if they have the development of a far-advancement of the disease. Moreover, patients with the slow probability of being weaned from the ventilator support, or patients with poor baseline life quality may not be considered for mechanical ventilation or intubation.

Therefore, the withdrawal of life-supportive care can be considered for patients who are dependent on ventilators, but there is no improvement in their health status despite aggressive respiratory care. There are no clinical factors that can be used to identify patients who are likely to fail in order to benefit from life-supportive care when it is admitted. Therefore, caregivers and patients should consider possible burdens and benefits when deciding to start life supportive care (MacNee & Rennard, 2009).

Pressing Nursing Implications

The three pressing nursing implications in COPD include ineffective clearance of the airway, impaired gas exchange, and imbalanced nutrition. Ineffective airway conditioning can cause difficulty in breathing, persistent cough, abnormal breath sounds, among others. Impaired gas exchange is evident in abnormal breathing, dyspnea, confusion and abnormal ABG values among others. Imbalance in nutrition is evident by the weight loss, version of eating among other signs.

Role of the DNP

The DNP equips nurses with knowledge and skills to fully implement developmental science and to prevent and manage COPD. It offers research-focused nursing doctorates to enable nurses to tackle COPD cases in society. Research-focused doctoral programs on the COPD equip nurses with significant and reliable know-how to enable them to address issues related to the disease.

Need for Future Research

Since chronic obstructive pulmonary disease is a condition of great public health concern, there is an urgent need for research progress to establish potential directions to use for future investigations of the disease. Future research on COPD is a requirement to address early detection, impact, and management of the chronic obstructive pulmonary disease. Additionally, future research should be done to ensure the effective prevention and treatment of COPD (Lee, 2008).

Research Paper Conclusion

It is evident that COPD poses a significant public health concern worldwide. The World Health Organization report reveals that at least 60 million people suffer from this chronic disease. It mostly affects older people from 40 years and above, although young adults may also get the disease if exposed to the risk factors associated with the COPD. Research shows that tobacco smoking is a risk factor for developing COPD. It is common in low-income countries due to exposure to biomass fuels and other forms of irritants. On the other hand, most cases of COPD in high and middle-income countries are caused by tobacco smoking. Finally, there is a demand for training and equipping nurses with knowledge and skills to help in diagnosing and management of the disease.

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