Chronic Obstructive Pulmonary Disease: 80-Year-Old Female Patient Case Study

Introduction

Chronic obstructive pulmonary disease (COPD) is a lung infection in which the patient’s airways become narrow, thereby causing breathing complications (Wells, Washko, & Han, 2012, pp. 913-921). Most COPD patients normally experience shortness of breath. The two main forms of COPD are chronic bronchitis and emphysema (Wells, Washko, & Han, 2012, pp. 913-921). Noxious particles or toxic fumes are the main causes of COPD (McDonough, Yuan, & Suzuki, 2011, pp. 1567-1575). These fumes can be inhaled due to air pollution, smoking and occupational exposure.

Scenario Analysis

My patient is a female called Mrs. Mary. She is eighty years old. Mary was admitted to the hospital with the following symptoms. Her exercise tolerance level had gradually decreased over time. Furthermore, she had experienced a feeling of shortness of breath for approximately two weeks. She also experienced anxiety. These symptoms are often observed in individuals who are suffering from respiratory diseases (Burney, 2011, pp. 1246-1247). Consequently, the process of diagnosing her condition focused on investigating the presence of respiratory infections. The infections that were considered in the investigation included pleural effusion, chronic obstructive pulmonary disease, non-small-cell lung carcinoma and psoriatic arthritis.

Literature Review

COPD with Dyspnea

Dyspnea is the most commonly noticed symptom in people suffering from COPD (Albert, Connett, & Bailey, 2011, pp. 689-698). It is common to find COPD patients complaining of being unable to get adequate air. At the early stages of COPD, dyspnea is normally experienced when a person engages in vigorous exercise or any activity that increases the demand for air in the lungs (Chowdhury, Seymour, & Michele, 2011, pp. 2247-2249). At this stage, most people often ignore dyspnea since it is common to feel out of breath when performing strenuous activity. Dyspnea tends to get worse with time if a person is suffering from COPD (Kenealy, Adair, & Robinson, 2011, pp. 527-532). In this case, the person tends to feel out of breath even if he or she engages in mild or less strenuous activities such as cleaning the house. At the advanced stage, COPD patients usually experience dyspnea even during rest. Moreover, shortness of breath is constantly present at the advanced stage of the disease.

Dyspnea normally causes respiratory failure if the patient fails to seek medical attention in time. Respiratory failure leads to an “increase in the amount of carbon dioxide in the blood” (Froner, 2011, pp. 605-614). When the concentration of carbon dioxide exceeds the normal levels, the patient is likely to experience a feeling of drowsiness and headache.

Interventions

Medical Interventions

COPD with dyspnea can be managed effectively through interventions that focus on slowing or stopping lung damage and improving airflow (Johnston, Young, & Grimmer, 2011, pp. 659-667). These interventions can be applied in the short term and the long term. Short-term interventions are often applied immediately in order to prevent death due to breathing difficulties. In this regard, the following interventions can be used to manage dyspnea.

In their review of the efficiency and safety of various medical interventions, Bleecker, Siler and Owen (2011) found that bronchodilators can significantly enhance breathing. A bronchodilator is a medicine that relaxes the muscles that support airways (Bleecker, Siler, & Owen, 2011, pp. 431-438). It also increases the capacity of the airways. Thus, it helps in improving airflow in order to reduce shortness of breath and wheezing. The medicine is often administered with the aid of a nebulizer or an inhaler. The main types of bronchodilators are β₂ agonists and anti-cholinergic. β₂ agonists are mainly used to relax the smooth muscles that support airways by stimulating β₂ receptors (Beier & Beeh, 2011, pp. 237-243). The most common types of β₂ agonists include salbutamol and terbutaline. The effectiveness of β₂ agonists depends on the type used by the patient. In general, β₂ agonists help in improving airflow and the patient’s exercise capacity. According to Vogelmeier, Hederer and Glaab (2011), anti-cholinergic can also be used to manage dyspnea. Anti-cholinergic is a medical intervention that improves breathing by relaxing the smooth muscles in the airway. It enhances the relaxation by stopping the stimulation which emanates from cholinergic nerves (Vogelmeier, Hederer, & Glaab, 2011, pp. 1093-1103). Anti-cholinergic drugs can cause both short-term and long-term relief of dyspnea.

β₂ agonists and anticholinergic drugs can be used separately to manage shortness of breath. Anticholinergic drugs can be administered first since they have a long-term effect. Besides, empirical studies reveal that anticholinergic drugs are more effective in reducing shortness of breath than β₂ agonists (Mitzner, 2011, pp. 1637-1639). Anti-cholinergic drugs have been used successfully to reduce cases of death in COPD patients. However, little evidence has been found concerning β₂ agonists’ ability to reduce respiratory deaths. Thus, it is important to prescribe anticholinergic drugs when the patient has advanced dyspnea. β₂ agonists can be used as a short-term intervention. Research evidence shows that β₂ agonists can enhance breathing for a period of about 12 hours (Burney, 2011, pp. 1246-1247). Even though bronchodilators enhance breathing, they do not reduce the rate at which COPD develops in the patient. Thus, they can only be used as a short-term intervention.

Non-medical Interventions

Oxygen Therapy

Oxygen therapy can be used to manage dyspnea. This involves using supplemental oxygen to increase the concentration of oxygen in the blood (Backer, Vos, & Deams, 2011, pp. 615-624). Hence, the patient will be able to maintain his normal mobility, as well as, his ability to perform daily activities including exercise. The rationale of using oxygen therapy is that it can significantly reduce the risk of death in patients with advanced COPD. Additionally, it is convenient since the patient can receive the therapy at home (Backer, Vos, & Deams, 2011, pp. 615-624).

Oga, Tsukino and Ikeda (2011) found little evidence to support the use of supplementary oxygen to manage dyspnea. Their findings indicate that patients with advanced COPD tend to develop high carbon dioxide concentrations in their blood after using large amounts of supplemental oxygen. However, some patients usually do not experience this side effect (Oga, Tsukino, & Ikeda, 2011, pp. 621-526). Generally, a low oxygen flow is safe for people who are likely to develop high carbon dioxide concentrations after using supplemental oxygen.

Oxygen therapy can be administered in two forms namely, in acute settings (within a hospital) or at home (short-burst oxygen therapy). The rationale of administering oxygen therapy in a hospital setting is that it facilitates close monitoring of the patient (Mapel, Dalal, & Blanchette, 2011, pp. 573-581). Thus, it is suitable for patients who have suffered from COPD for a very long time, as well as, patients who are more than 50 years old (Mapel, Dalal, & Blanchette, 2011, pp. 573-581). These patients require controlled oxygen supply during the therapy. According to Mapel, Dalal and Blanchette (2011), the best outcome can be achieved if oxygen therapy is used in conjunction with medical interventions. In this regard, the therapy should be complemented with bronchodilators. Additionally, antibiotics should be prescribed in order to treat the respiratory infections that usually accompany COPD with dyspnea. Administering oxygen therapy in the hospital is a short-term intervention. Thus, a follow-up on the patient’s condition will be required within six weeks after the patient is discharged from the hospital (Mapel, Dalal, & Blanchette, 2011, pp. 573-581). Long-term oxygen therapy should be used if the patient’s condition fails to improve after the short-term therapy.

Short-burst oxygen therapy involves regular use of supplemental oxygen to manage dyspnea. In their study of the variations in the forced expiratory volume, Vestbo, Edwards and Scanlon (2011) found strong evidence to support the use of short-burst oxygen therapy to manage severe cases of breathlessness. However, the use of short-burst oxygen therapy should only be continued if the patient is showing signs of improvement (Vestbo, Edwards, & Scanlon, 2011, pp. 1184-1192). Thus, the patient will have to be assessed by a physician before starting to use short-burst oxygen therapy. Furthermore, the patient will require regular check-ups by a physician. The rationale of using short-term oxygen bursts is that it is economical, especially, if the patient will require oxygen supply for more than 10 hours in a day (Ranst, Otten, & Meijer, 2011, pp. 647-657). It can also be administered at home, thereby reducing the costs.

Physical Therapy and Prohibiting Smoking

Long-term interventions can help the patient to manage the rate at which dyspnea develops in them. In this regard, the following interventions can be used. First, physical therapy can be used to manage dyspnea (Wenzel, Fowler, & Edmond, 2012, pp. 340-347). The main objective of physical therapy is to improve the patient’s ability to breathe. For instance, the patient can engage in regular walking exercises in order to build up strength. The patient should seek advice from a physician or a therapist concerning the distance that should be covered per day (Vestbo, Edwards, & Scanlon, 2011, pp. 1184-1192). The patient can slowly increase the distance to be covered on a daily basis in order to avoid straining the heart or worsening dyspnea. It is also important to avoid talking while walking in order to avoid losing breath. The weakness of physical therapy is that the patient might not be strong enough to engage in physical activities.

Wells, Washko and Han (2012) recommend the use of breathing training methods rather than walking to enhance breathing among patients with severe dyspnea. Some of the breathing training approaches include pursed-lip breathing and diaphragmatic breathing. The rationale of using breathing training approaches is that they require little energy (Obase, Mouri, & Ohue, 2011, pp. 679-683). Thus, they are not likely to exacerbate dyspnea (Froner, 2011, pp. 605-614). Generally, the patient’s condition will determine the physical therapy that she should use. Research indicates that physical therapy is effective in enabling patients to achieve optimum activity level.

Finally, dyspnea can be managed by improving the air quality in the patient’s home (Ternesten, Larsson, & Millgvist, 2011, pp. 685-691). In this case, there should be no smoking in the patient’s home. According to Ternesten, Larsson and Millgvist (2011), the patient must stop smoking in order to improve her condition. Quitting smoking can be achieved through smoking cessation programs such as behavioral therapy, as well as, medication. The physician will have to monitor the patient on a regular basis and assess her progress with the smoking cessation program. Apart from quitting smoking, fireplace smoke or any other irritant should be eliminated (Backer, Vos, & Deams, 2011, pp. 615-624). The patient can opt to live in a house with no fireplace. If her condition improves, then she should continue to live in such a house.

Conclusion

COPD with dyspnea is a chronic disease that affects the lungs, thereby causing breathing difficulties. It mainly occurs in the form of chronic bronchitis, as well as, emphysema. The most common symptoms of the disease include dyspnea and coughing (Johnston, Young, & Grimmer, 2011, pp. 659-667). COPD can be diagnosed through tests that help in measuring the level of oxygen in the patient’s blood and lung capacity. Multiple interventions are often used to manage the disease. These interventions focus on minimizing the effects of the exacerbations (Beier & Beeh, 2011, pp. 237-243). Interventions that improve airflow should be administered first in order to avoid death. Such interventions include oxygen therapy and using bronchodilators. Physical therapy can be used to help the patient buildup strength over time. This can be achieved through activities such as walking. Furthermore, breathing training approaches can also be used to manage dyspnea.

References

Albert, K., Connett, J., & Bailey, W. (2011). Azithromycin for Prevention of Exacerbations of COPD. New England Journal of Medicine, 365(3), 689-698.

Backer, D., Vos, W., & Deams, B. (2011). The Effects of Long-Term Noninvasive Ventilation in Hypercapnic COPD Patients. International Journal of Chronic Obstructive Pulmonary Disease, 6(2), 615-624.

Beier, J., & Beeh, M. (2011). Long-Acting B-Adrenoceptor Agonits in the Management of COPD. International Journal of Chronic Obstructive Pulmonary Disease, 6(1), 237-243.

Bleecker, E., Siler, T., & Owen, R. (2011). Bronchodilator Efficiency and Safety of Indacaterol in Patients with COPD. International Journal of Obstructive Pulmonary Disease, 5(2), 431-438.

Burney, P. (2011). Variable Loss of Lung Function in COPD. New England Journal of Medicine, 365(2), 1246-1247.

Chowdhury, B., Seymour, M., & Michele, T. (2011). The Risks and Benefits of Indacaterol. New England Journal of Medicine, 365(2), 2247-2249.

Froner, L. (2011). Implementing Chronic Care for COPD: Planned Visits, Care Coordination and Patient Empowerment Improved Outcomes. International Journal of Chronic Pulmonary Disease, 5(2), 605-614.

Johnston, K., Young, M., & Grimmer, A. (2011). Why are Some Evidence-Based Care Recommendations in Chronic Obstructive Pulmonary Disease Better Implemented than others? International Journal of Chronic Obstructive Pulmonary Disease, 6(1), 659-667.

Kenealy, R., Adair, J., & Robinson, E. (2011). Spirometry for Patients in Hospital and One Month After Admission with an Acute Exacerbation of COPD. International Journal of Chronic Obstructive Pulmonary Disease, 6(1), 527-532.

Mapel, D., Dalal, A., & Blanchette, C. (2011). Severity of COPD at Initial Spirometry-Confirmed Diagnosis. International Journal of Chronic Obstractive Pulmonary Disease, 6(1), 573-581.

McDonough, J., Yuan, R., & Suzuki, M. (2011). Small-Airway Obstruction and Emphysema in Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 365(2), 1567-1575.

Mitzner, W. (2011). Emphysema: A Disease of Small Airways or Lung Parenchyma? New England Journal of Medicine, 265(2), 1637-1639.

Obase, Y., Mouri, K., & Ohue, Y. (2011). Nutritional Deficits in Elderly Smokers with Respiratory Symptoms that do Not Fulfill the Creteria of COPD. International Journal of Chronic Obstructive Pulmonary Disease, 6(1), 679-683.

Oga, T., Tsukino, M., & Ikeda, A. (2011). Predictive Properties of Different Multidimensional Staging Systems in Patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease, 5(2), 521-526.

Ranst, V., Otten, H., & Meijer, W. (2011). Outcome of Pulmonary Rehabilitation in COPD Patients with Severely Impaired health Status. International Journal of Chronic Obstructive Pulmonary Disease, 6(1), 647-657.

Ternesten, E., Larsson, S., & Millgvist, E. (2011). Sensitivity to Environmental Irritants and Quality of Life in COPD. International Journal of Chronic Obstructive Pulmonary Disease, 6(1), 685-691.

Vestbo, J., Edwards, D., & Scanlon, P. (2011). Changes in Forced Expiratory Volume in 1 Second Over Time in COPD. New England Journal of Medicine, 365(1), 1184-1192.

Vogelmeier, C., Hederer, B., & Glaab, T. (2011). Tiotropium Versus Salmeterol for the Prevention of Exacerbations of COPD. New England Journal of Medicine, 364(1), 1093-1103.

Wells, J., Washko, R., & Han, K. (2012). Pulmonary Arterial Enlargement and Acute Exacerbations of COPD. New England Journal of Medicine, 367(1), 913-921.

Wenzel, P., Fowler, A., & Edmond, B. (2012). Antibiotic Prevention of Acute Exacerbations of COPD. New England Journal fo Medicine, 367(3), 340-347.