Chronic Obstructive Pulmonary Disorder COPD Diagnosis, Management,

Chronic Obstructive Pulmonary Disorder

COPD

COPD Diagnosis, Management, and Exacerbation Prevention

The treatment objectives for chronic obstructive pulmonary disorder (COPD) outlined by the Global Initiative for Chronic Obstructive Lung Disease are two-fold: (1) the immediate relief of symptoms and (2) the long-term management of disease (GICOPD, 2013). Patients will present in the clinic with shortness of breath, a chronic cough, or production of sputum and a complete patient history will often reveal pulmonary exposure to environmental contaminants. A COPD diagnosis is typically made when the FEV1/FVC ratio is less than 0.70 as determined by spirometry. Ratings of disease severity are based on post-bronchodilator FEV1. The patient should also be evaluated and treated for common comorbidities, such as lung cancer, cardiovascular disease, metabolic syndrome, depression, motor impairment, and osteoporosis.

Long-term management of COPD focuses on the relief of symptoms and treatment of comorbidities (GICOPD, 2013). Smokers are encouraged to enter a smoking cessation program, which will likely involve nicotine replacement and pharmacotherapy. Pharmacotherapy is also to reduce symptom severity and frequency, but no drug has been found which can halt or reverse disease progression. The choice of drug typically depends on an individual patient's symptoms, cost considerations, and availability. Other treatment considerations include vaccinations for influenza and pneumonia and rehabilitative services for patients unable to walk without experiencing dyspnea.

Preventing exacerbations is possible for many patients and is accomplished by implementing many of the same therapies used for long-term disease management (GICOPD, 2013). Eliminating environmental contaminants, such as smoking, is essential. Patient education concerning the use of bronchodilators and other medications is also important, because it empowers patients to be more effective in the use of these medications. When indicated, rehabilitation can make a difference by helping patients maintain a regular exercise schedule.

Clinical Implementation

The primary concern from a clinical standpoint is a complete evaluation of the patient's health and implementation of a long-term care program once the patient has stabilized. A long-term care plan is essential for crisis-in-care decision making for both clinicians and patients. A long-term care plan will also help reduce the frequency of emergency room visits and optimize patient health. Once a treatment plan has been created for an individual patient, a discussion between the patient and nurse should occur so that an effective long-term management plan can be formulated. This can begin by educating the patient about what they can expect if the disease worsens, such as being placed on mechanical ventilation support or bilevel or continuous positive airway pressure. A discussion about the impact these interventions may have on quality of life is essential for helping the patient and loved ones make an informed decision about life-sustaining treatments. The patient and family members also contribute to the process of formulating a long-term care plan by helping the nurse understand how they define quality of life, what their values are, and their wishes concerning life-sustaining treatments.