A 78-year-old patient is scheduled for transition to home after treatment for heart disease.
The patient's spouse, who has chronic obstructive pulmonary disease, plans to care for the patient at home.
The spouse says that their grown children, who live nearby, will help. The best approach to discharge planning is to:
1- arrange nursing home placement for the couple.
2- consult the spouse's healthcare provider about the spouse's ability to care for the patient.
3- contact the children to ascertain their commitment to help.
4- discuss community resources with the spouse and offer to make referrals.
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Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the lungs that obstructs the flow of air from the lungs. Symptoms include difficulty breathing, cough, mucus production (sputum) and wheezing. It is caused by long-term exposure to gases or irritating particles, in most cases of cigarette smoke. People with COPD have a higher risk of heart disease, lung cancer and a variety of other conditions.
Emphysema and chronic bronchitis are the two most common conditions that contribute to developing COPD. Chronic bronchitis is the inflammation of the lining of the bronchi, which carry air to and from the air sacs (alveoli) of the lung. It is characterized by daily cough and mucus production (sputum).
Emphysema is a condition in which the alveoli that are at the ends of the smaller airways (bronchioles) of the lungs are destroyed as a result of harmful exposure to cigarette smoke and other irritating gases and particles.
COPD can be treated. With proper treatment, most people with COPD can achieve good control of symptoms and quality of life, in addition to reducing the risk of other related conditions.
Symptom:
Symptoms of COPD do not usually appear until significant damage has already occurred and usually gets worse over time, particularly if the patient is still exposed to tobacco smoke. Patients with chronic bronchitis have a daily cough and mucus production (sputum) as the main symptom for at least three months a year in two consecutive years.
Other signs and symptoms of COPD may include the following:
- Difficulty breathing, especially during physical activity.
- Whistle when breathing.
- Chest pressure.
- Having to clear your throat early in the morning, due to excess mucus in the lungs.
- A chronic cough that can produce mucus (sputum), which can be transparent, white, yellow or greenish.
- Blue color on the lips or nail beds (cyanosis).
- Frequent respiratory infections
- Lack of energy.
- Involuntary weight loss (in the most advanced stages).
- Swelling in the ankles, feet or legs.
It is also likely that people with COPD have episodes called exacerbations, during which the symptoms worsen more than the usual daily variation and last at least several days.
Causes:
The main cause of chronic obstructive pulmonary disease (COPD) in developed countries is smoking. In developing countries, COPD often occurs in people who are exposed to combustible gases used for cooking or heating in homes with poor ventilation.
Only about 20 to 30 percent of chronic smokers can have clinically apparent COPD, although many smokers with a history of long-standing smoking may have reduced lung function. In some smokers, less frequent lung conditions manifest themselves. They can be misdiagnosed as COPD until a more thorough evaluation is performed.
How the lungs are affected:
The air travels through the trachea and enters the lungs through two long tubes (bronchi). Inside the lungs, these tubes are divided many times, like the branches of a tree, into smaller tubes (bronchioles) that have tiny air sacs (alveoli) at their ends.
The air sacs have very thin walls full of blood vessels (capillaries). The oxygen present in the air you inhale crosses these blood vessels and enters the bloodstream. At the same time, carbon dioxide (a gas that is a waste product of metabolism) is exhaled.
The lungs depend on the natural elasticity of the bronchial tubes and air sacs so that the air leaves the body. Because of COPD, they lose their elasticity and stretch excessively, so air is trapped in them when exhaled.
Causes of airway obstruction:
Causes of airway obstruction include the following:
- Emphysema. This disease of the lungs destroys the fragile walls and elastic fibers of the alveoli. The small airways collapse when you exhale, which prevents the flow of air outward from the lungs.
- Chronic bronchitis. If you suffer from this disease, the bronchial tubes become inflamed and narrow, and the lungs produce more mucus, which can further block the bronchial tubes that are narrow. The patient may have a chronic cough by trying to clean the airways.
Cigarette smoke and other irritants:
In the vast majority of cases, the lung damage caused by COPD is due to smoking for a long time. However, there are probably also other factors that play a role in the onset of COPD, such as a genetic susceptibility to the disease, because only about 20 to 30 percent of smokers could have COPD.
Other irritants can cause COPD, including cigarette smoke, secondhand smoke, pipe smoke, environmental pollution and exposure in the workplace to dust, smoke or vapors.
Alpha-1 antitrypsin deficiency:
Approximately, in 1 percent of people with COPD, the disease occurs because of a genetic disorder that causes low levels of a protein called alpha-1 antitrypsin. Alpha-1 antitrypsin is produced in the liver and secreted into the bloodstream to help protect the lungs. Alpha-1 antitrypsin deficiency can affect the liver as well as the lungs. Lung damage can occur in infants and children, not only in adults with a history of long-standing smokers.
For adults with COPD related to alpha-1 antitrypsin deficiency, treatment options are the same as for people who have more frequent types of COPD. In addition, the treatment of some people may consist of replacing the missing alpha-1 antitrypsin protein, which can prevent further damage to the lungs.
Risk factor's:
Risk factors for COPD include the following:
- Exposure to tobacco smoke. The most significant risk factor for COPD is cigarette smoking for a long time. The more years and more cigarettes you smoke, the greater the risk. Pipe, cigar and marijuana smokers can also present a risk, as can people exposed to heavy amounts of secondhand smoke.
- People with asthma who smoke. The combination of asthma, a chronic inflammatory disease of the respiratory tract and cigarettes further increases the risk of COPD.
- Occupational exposure to dusts and chemicals. Long-term exposure to gases, steam and dust from chemicals in the workplace can irritate and inflame the lungs.
- Exposure to combustion gases. In the developing world, people exposed to combustion gases for cooking and heating in homes with poor ventilation have a higher risk of having COPD.
- Age. COPD appears slowly over a period of years, so most people are at least 40 years old when symptoms begin.
- Genetics The rare genetic disorder called alpha-1 antitrypsin deficiency is the cause of some cases of COPD. Other genetic factors probably make some smokers more prone to the disease.
Complications:
COPD can cause many complications, including the following:
- Respiratory infections. People with COPD are more likely to get colds, flu or pneumonia. Any respiratory infection can make breathing very difficult and cause further damage to lung tissue. Annual flu vaccination and regular vaccinations against pneumococcal pneumonia can prevent some infections.
- Heart problems. For reasons that are not fully understood, COPD may increase the risk of heart disease, including heart attack. Quitting smoking can reduce this risk.
- Lung cancer. People with COPD have a higher risk of lung cancer. Quitting smoking can reduce this risk.
- High blood pressure in the pulmonary arteries. COPD can cause high blood pressure in the arteries that circulate blood to the lungs (pulmonary hypertension).
- depression. Difficulty breathing can prevent you from doing activities that you enjoy. In addition, living with this serious disease can contribute to the patient's depression. Talk to your doctor if you feel sad or helpless, or if you think you may have depression.
Prevention:
Unlike other diseases, COPD has a clear cause and a clear way of prevention. Most cases are directly related to smoking, and the best way to prevent COPD is to not smoke or quit smoking right now.
If you have been a smoker for a long time, these simple statements may not seem so simple, especially if you have tried to quit once, twice or many times. However, you should keep trying to quit. It is very important to find a smoking cessation program that can help you quit forever. It is your best chance to prevent damage to your lungs.
The exposure generated by certain jobs to vapors and chemical dust is another risk factor for COPD. If you work with this type of lung irritants, talk to your supervisor about the best ways to protect yourself, for example, wear respiratory protection.
