NM3041 Chronic Obstructive Pulmonary Disease

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NM3041 Chronic Obstructive Pulmonary Disease

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NM3041 Chronic Obstructive Pulmonary Disease

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Course Code: NM3041
University: City, University Of London

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The report topic must be Chronic Obstructive Pulmonary Disease. Please use the headings and provide relevant points according to the headings. 

Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease is an infection of the lungs that results to dyspnea. At the moment, the condition does not have any cure but there are only options that enables management of the condition. It is an umbrella of different conditions such as emphysema, chronic bronchitis and finally chronic asthma is irreversible .The condition is characterized by shortness of breath (Dyspnea), repetitive cough that has phlegm or mucus in most days.
According to statistics, 14.4% of Australians who are above 40 years’ experience difficulties in airflow of lungs. The figures increase to 29.2% in Australians who are above 75 years old. Out of this figures, 7.5% of those that have COPD in Australia experience advanced signs and symptoms that affect their daily lives (Barnes, 2016). Several studies have also found out that among avoidable hospital admission diseases, COPD is ranked second. Recently, there has been reduced death rates from COPD. However, the condition still contributes largely to the mortality rates in Australia after cardiovascular disease, stroke and then cancer. There is no current cure for the condition but is avoidable. In this assignment, the overview of anatomy and physiology of systems involved in COPD, etiology, signs and symptoms, investigations and tests, the treatment and management of COPD and potential complications will be discussed.
Overview of Anatomy and Physiology
The respiratory system is made up of different structures .They include the nasal cavity, the larynx, pharynx, trachea, bronchioles, lungs and alveoli. All these structures have different functions. However, they both work in synchrony to ensure that there is effective gaseous exchange.
The respiratory system facilitates the exchange of gases between the air and the blood and between the blood and the cells of the body as well. The system assists in pulmonary ventilation where the air is inhaled through the nasal as well as the oral cavities (Barrecheguren, Esquinas, & Miravitlles, 2015). The air then moves through the pharynx, larynx, the trachea and finally to the lungs. Air then flows out in the opposite route. What facilitates this is the difference in air pressure and the volume of the lungs.
Oxygen is usually delivered to the body through the blood. The red blood cells carry oxygen from the lungs and when it reaches the capillaries, it is released from the RBC and diffuse into tissues .Carbon dioxide on the other hand diffuse from the tissues into the red blood cells and plasma. Carbon dioxide is then carried to the lungs so that it can be released.
Chronic Obstructive Pulmonary Disease is a condition in which the functions of the lungs are altered. This is due to different irritants such as smoke from cigarettes that cause inflammation of the airways and secretion of mucus. The obstructed airways makes it difficult for the patients to breath and that is why patients with the condition experience dyspnea.
Summary of Terms Pertaining the Disease
Dyspnea is a term that is used to describe shortness or difficulties in breathing. COPD is an abbreviation of Chronic Obstructive Pulmonary Disease which is a condition in which there is impairment in gaseous exchange in the lungs .Exacerbations is a term that is used to describe the worsening of the signs and symptoms or the disease. Wheezing is a term that is used to describe the sound produced by patients suffering from COPD when they are breathing (Chen, Thomas, Sadatsafavi, & FitzGerald, 2015). Bronchodilators is a term that is used to describe a group of drugs that are used in the treatment of COPD. Cor pulmonale is a condition in which the right ventricles swell as they work hard to pump out blood to the rest of the body.
According to studies, the leading cause of COPD in developed countries like United States of America and Australia is smoking. Studies have also established that 90% of the people who are suffering from COPD are either smokers or they are former smokers. Out of those who smoke, 20-30% end up developing COPD. Majority of the people with COPD are also above 40 years with a history of smoking .This therefore means that the more an individual smokes, the higher the risks of COPD. Besides the cigarette smoke, others such as cigar smoke, pipe smoke and the second hand smoke also cause COPD.
One can develop COPD if he/she is exposed to certain chemicals and fumes in the workplace .Studies have found out that there is a link between long exposure to chemicals, continuous inhaling of dust and COPD. It has also been established that in developed countries like Australia, the houses are poorly ventilated and as a result, people inhale fumes from cooking as well as heating fuel and this increases the risk of COPD(Christenson et al., 2015).COPD has also been attributed to genetics .Studies have shown that 5% of patients suffering from COPD have a deficiency in a certain protein known as alpha-1-antitrypsin.This causes the lung to deteriorate and can also alter the functions of the liver.
Signs and Symptoms
There are different signs and symptoms of COPD. One of the most notable sign and symptom is shortness of breath .This is due to emphysema which is a condition in which there is destruction of the delicate walls as well as the elastic fibers of the alveoli .The small airways then collapse when the patient breaths out(Divo et al., 2015). This makes it difficult for the air to flow into the lungs .Excess mucus in the lungs is another symptom. Patients suffering from COPD always remove excess mucus especially in the morning. The excess mucus are produced due to the inflammation of the bronchiole tubules when they are affected by chemical irritants like smoke from cigarettes.
Patients with COPD always experience fatigue. Since the airways are usually narrowed and full of secretions like the mucus, the patient’s heart and lungs have to work extra hard to ensure that the patients is able to undergo gaseous exchange. This aspect of the heart and the lungs working hard is what makes the patient experience fatigue.
Wheezing is another significant sign of COPD. People suffering from COPD will always produce some whistling sounds whenever they force out air through the airways that are obstructed by excess mucus. This symptom is therefore due to excess mucus that block the airways as well as the tightening of the muscles of the chest.
Frequent respiratory infections is a clear sign and symptom of COPD. Studies have shown that patients suffering from COPD have impaired immune systems. The condition also makes it difficult for the lungs to get rid of different pollutants like dust. The buildup of excess pollutants and dust makes the patients susceptible to different respiratory infections. The most common infections include colds, flu and finally pneumonia.
Weight loss is common among patients with COPD. This is because they need more energy to breathe effectively and this uses a lot of calories in the body .In most cases, the calories used are not proportional to the ones being used up and this leads to weight loss. Swollen feet and ankles is also a common sign and symptom of COPD.COPD causes severe damage to the lungs and this means that the heart has to work extra hard to supply blood to the damaged lungs (Lange et al., 2015). This eventually leads to congestive heart failure that is shown by the swollen feet and ankles. Headaches and fever are also common. This is due to the high level of carbon dioxide in the blood. This signs and symptoms can also occur when the level of oxygen is low since there is impaired gaseous exchange.
Investigations and Tests 
There are different investigative procedures, clinical tests and laboratory tests that are used to investigate COPD. There are cases where the condition has been misdiagnosed. Some patients who quit smoking are often told that they are suffering from COPD when they are just experiencing deconditioning or another condition of the lungs. Other people who have the disease might also not be diagnosed until the symptoms gets worse and this hampers the interventions. For effective diagnosis, the doctor needs to review the signs and symptoms and then make an inquiry of history of health and exposure to lung irritants more so smoking. There are several tests that can be done.
The lung (pulmonary) function test is one of them. The aim of this test is to determine the quantity of air that the patient can inhale and exhale .It also checks if the lungs are taking enough oxygen to the blood r]of the patient .The most common lung function test is spirometry (McCarthy et al., 2015). The doctor usually instruct the patient to blow into a tube that is connected to an equipment known as spirometer. The spirometer could then indicate the quantity of air that the lungs can sustain and the speed at which the patient can blow air out of the lungs .The advantage with the lung function test using a spirometer is that it has the ability to detect COPD even before the signs and symptoms can be experienced. The test can also be used to track on how the disease progress and it can also be used to evaluate if the medication is working or not .It also measures the effects of the bronchodilators. Other tests under the lung function tests include measurement of the lung volumes, diffusing capacity and finally the pulse oximetry.
Laboratory tests are also investigative tests that can be used in COPD. However, the laboratory tests are not used to diagnose COPD .It is only used to establish the cause of the symptoms or rule out the disease. An example of a laboratory test is the one that tests for the genetic disorder alpha-1-antitrypsin (AAt) deficiency which is known to be one of the conditions that contribute to COPD .The test is done when an individual has a family history of COPD and developed the condition below 45 years.
Treatment and Management
There are different options that can be used to treat COPD. The most common group of drugs used however the bronchodilators are. The bronchodilators are a broad group which can be divided further into the long acting and the short acting bronchodilators .The difference between the two is that the short acting bronchodilators provide a swift or quick response to relieve acute bronchoconstriction while the long acting bronchodilators assist in preventing the symptoms.
The indications or the uses of the bronchodilators generally depend on the extent or the severity of the disease .In case the disease is still at its acute stage, then the short acting bronchodilators are prescribed. Examples of the short acting bronchodilators include albuterol, levalbuterol and ipratropium. The long acting bronchodilators are on the other hand used when the condition is very severe and they are used to control the symptoms (Pascoe, Locantore, Dransfield, Barnes, & Pavord, 2015). They are also used to prevent bronchoconstriction. They also take long before they start acting. They are also used to relieve airways constriction for a period of up to 12 hours. They are administered two times a day together with another anti-inflammatory medication so that they can open the airways thus preventing the symptoms of asthma especially at night. Examples of the long acting bronchodilators are salmeterol and the formoterol.
Mechanism of action
The mechanism of action of these drugs is that they dilate the bronchi of the patient as well as the bronchioles and therefore reduce resistance of the respiratory airways and this increases the amount of air that flows into the lungs. These group of drugs maybe endogenous which means they can originate from the body or they can be administered in the form of medications.
There are different contraindications that should be considered when using the bronchodilators .Patients who are hypersensitive, have cardiac arrhythmias that is associated with tachycardia, organic brain damage, cerebral arteriosclerosis and narrow angle glaucoma are usually contraindicated against the sympathomimetic bronchodilators (Postma, Bush, & Van den Berge, 2015). During acute bronchospasm, salmeterol is usually contraindicated .The sympathomimetic drugs should not be used with oxytocic drugs concurrently since they lead to hypotension .In patients who are pregnant, have hypertension, cardiac dysfunction, hyperthyroidism, glaucoma, diabetes and history of seizures, the sympathomimetic bronchodilators should not be used .If they are used, the doctor ought to be very cautious. Sympathomimetic should also not be administered together with adrenergic blockers since they can inhibit cardiac Broncho dilating as well as the vasodilating action of the sympathomimetic drug. There would also be an increased cardio toxicity if sympathomimetic drugs are used with theophylline and the doctor should therefore be very careful.
Adverse reaction/side effects
These drugs are associated with many adverse reactions or the side effects. The side effects of the beta-2-agonists such as the salbutamol include trembling especially the hands, nervous tension ,headaches and sudden palpitations. It is also associated with muscle cramps. These side effects however improve and can disappear after using the drugs for some days or weeks. Serious side effects include paradoxical bronchospasm or the constrictions of the airways. High doses of the drugs can also lead to heart attacks and low level of potassium otherwise described as hypokalemia (Woodruff, Agusti, Roche, Singh, & Martinez, 2015). The side effects of using anticholinergics on the other hand include dry mouth, constipation, headaches. Other minor side effects include nausea, heartburns and dysphagia .When a patient is using an inhaler, glaucoma may get worse especially if the drugs get into the eyes. Finally, theophylline can lead to severe side effects if it builds up in the body. Old people are the ones at risk since their livers might fail to clear the drug in the blood. The main side effects include tachycardia, arrhythmia, headaches and insomnia.
 Potential Complications
Chronic obstructive pulmonary Disease is associated with different complications .Cor Pulmonale is an example of the complications. This is a condition in which there is edema or swelling of the lower extremities. Since there is poor exchange in COPD, there is less oxygen in blood and this leads to constriction of blood vessels .Majority of the capillaries that surround the alveoli are in return destroyed and this therefore makes the heart to work hard to pump blood in the few and constricted blood vessels .Due to this effort, the right hand side of the heart enlarge and the walls thicken and finally the chamber loses its ability to contract efficiently. This is what brings about pulmonary hypertension and right sided heart failure that is known as cor pulmonale.
End stage lung disease is a serious complication of COPD. Chronic Obstructive Pulmonary Disease is characterized by the slow decline in the lung function as well as increased levels of carbon dioxide in blood. The elevated levels of carbon dioxide leads to a narcotic effect in the patient who end up losing consciousness and eventually stops breathing.
Pneumonia, polycythemia and pneumothorax are other complications that are associated with COPD. Since patients with COPD have impaired immune systems, it makes the patient susceptible to bacterial infection especially the streptococcus pneumoniae that leads to pneumonia .Since there is impaired lung function in patients with COPD, the level of oxygen in blood reduce. This therefore needs the body to adjust and produce more oxygen carrying red blood cells. This condition is known as polycythemia. COPD leads to a weakened lung structure. This therefore makes the lungs to develop holes as air tries to escape into the chest wall. This condition in which there are holes in the lungs is known as pneumothorax.
Chronic Obstructive Pulmonary Disease is a condition in which patients experience difficulties in breathing .It is caused by substances that can irritate the lungs such as smoke from cigarettes and the dust as well as some chemicals. This chemicals cause inflammation of the airways and increased production of mucus that block the airways and that is why patients suffering from COPD experience difficulties in breathing.14.4% of Australians who are above 40 years are suffering from COPD .Some of the signs and symptoms for the condition include wheezing sounds, shortness of breath and fatigue. Diagnosis of COPD involve the lung function test that is done using a spirometer and different laboratory tests. The treatment includes the use of bronchodilators that cause dilation of airways and improves the breathing pattern of the patient. COPD is the third leading cause of mortalities in Australia and therefore should be strategies to reduce its prevalence.
Barnes, P. J. (2016). Inflammatory mechanisms in patients with chronic obstructive pulmonary disease. Journal of Allergy and Clinical Immunology, 138(1), 16-27. doi:10.1016/j.jaci.2016.05.011
Barrecheguren, M., Esquinas, C., & Miravitlles, M. (2015). The asthma–chronic obstructive pulmonary disease overlap syndrome (ACOS). Current Opinion in Pulmonary Medicine, 21(1), 74-79. doi:10.1097/mcp.0000000000000118
Chen, W., Thomas, J., Sadatsafavi, M., & FitzGerald, J. M. (2015). Risk of cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. The Lancet Respiratory Medicine, 3(8), 631-639. doi:10.1016/s2213-2600(15)00241-6
Christenson, S. A., Steiling, K., Van den Berge, M., Hijazi, K., Hiemstra, P. S., Postma, D. S., … Woodruff, P. G. (2015). Asthma–COPD Overlap. Clinical Relevance of Genomic Signatures of Type 2 Inflammation in Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 191(7), 758-766. doi:10.1164/rccm.201408-1458oc
Divo, M. J., Casanova, C., Marin, J. M., Pinto-Plata, V. M., De-Torres, J. P., Zulueta, J. J., … Celli, B. R. (2015). COPD comorbidities network. European Respiratory Journal, 46(3), 640-650. doi:10.1183/09031936.00171614
Lange, P., Celli, B., Agustí, A., Boje Jensen, G., Divo, M., Faner, R., … Vestbo, J. (2015). Lung-Function Trajectories Leading to Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 373(2), 111-122. doi:10.1056/nejmoa1411532
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003793.pub3
Pascoe, S., Locantore, N., Dransfield, M. T., Barnes, N. C., & Pavord, I. D. (2015). Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. The Lancet Respiratory Medicine, 3(6), 435-442. doi:10.1016/s2213-2600(15)00106-x
Postma, D. S., Bush, A., & Van den Berge, M. (2015). Risk factors and early origins of chronic obstructive pulmonary disease. The Lancet, 385(9971), 899-909. doi:10.1016/s0140-6736(14)60446-3
Woodruff, P. G., Agusti, A., Roche, N., Singh, D., & Martinez, F. J. (2015). Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. The Lancet, 385(9979), 1789-1798. doi:10.1016/s0140-6736(15)60693-6

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