Good Example Of Essay On Chronic Obstructive Pulmonary Disease

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Introduction

Chronic obstructive pulmonary (COPD) disease refers to a group of chronic lung diseases that lead to limitations in lung airflow. Some of the common manifestations of the disease include excessive production of sputum, breathlessness, and chronic cough. There were 64 million people with the disease in the year 2004, with 3 million deaths recorded (World Health Organization, ‘Facts’ para. 1.). The World Health Organization also predicts that COPD will be the third cause of deaths by the year 2030. The discussion below will center on the causes, management, prognosis, and diagnosis of COPD.

Causes of Chronic obstructive pulmonary disease

Several causes of COPD have been identified in various studies. For convenience, these causes can be grouped as environmental and genetic. Some of the environmental factors include tobacco smoking, air pollution, occupational exposure, respiratory infections, and dietary factors.

Smoking

Research has revealed that smoking us the leading cause of OCPD (Cho et al. 2015), though some OCPD patients are non-smokers. Among the smokers, the rates of OCPD are higher in cigarette smokers as compared to cigar and pipe smokers. Non-smokers, on the other hand, have the lowest risk of developing OCPD. Moreover, exposure of fetus to smoking affects lung growth hence increasing the chances of contracting OCPD (Kun, Hansel, & Barnes, 2008, p.4).

Air pollution

Polluted air, both indoor and outdoor, containing poisonous gases such as Sulphur (IV) oxide and particulates have been associated with both bronchitis and OCPD. In addition, burning of biomass fuels for cooking and heating especially in poorly ventilated houses release poisonous gases (Kun, Hansel, & Barnes, 2008, p.4). This explains the high rates of OCPD seen amongst women in developing countries. Similarly, a study by Hung, Zhong, and Ran (2015) revealed that reductions in biomass smoke exposure were correlated with a reduction in the decline of FEV1 and consequently a decrease in COPD risk.

Occupational exposure

Individuals working in mining sectors have a high rates of OCPD as a result of exposure to dusts containing coal, silica, and quartz (Carlveley et al. 2003, p.76). Apart from dust, isocyanate fumes and solvents in mines interacts with smoke to cause the disease. Other occupational factors include cadmium, organic dusts, and fumes from welding (Cho et al.2015)

Respiratory infections

The respiratory tract of a healthy individual is kept sterile by bronchial mucus, mucociliary escalator, and epithelium. These primary host defenses help to ensure that air tract infections does not occur despite exposure to air containing pathogenic microorganisms and particulate matter (Carlveley et al. 2003, p.76). They are able to clear bacterial loads amounting to 200000 colony units per ml. When these loads are exceeded, secondary defenses are activated.
On the other hand, patients with COPD show alteration to their primary defenses. Some of these include inflammation of respiratory tract, over secretion of mucus, increased production of goblet cells, and increased production of acidic mucus. The impact of all these changes is impairment of mucociliary clearance hence exposing the host to bacterial colonization. Studies have also found that bacterial and viral chest infections in infancy has been reported to lead to OCPD later on in adult life.
In another study, Hosseni et al (2015) investigating the relationship between respiratory virus and severity of OCPD found out that 81% of exacerbations had viral infections as compared to 25% presence in stable patients. Moreover, adenovirus were more common in patients with severity than stable ones. Other types of virus that contributed to exacerbation included influenza, enterovirus, and respiratory syncytial virus.

Dietary factors

A number of studies have found out that dietary factors lead to COPD. For instance, Hirayama, Lee, and Binns (2008) found out that excessive meat consumption leads to a high risk of COPD, respiratory symptoms, and furthermore a deterioration in lung function. In the same study, fruit intake was established to improve lung function, reduces mortality and respiratory symptoms in COPD.

Chronic obstructive pulmonary disease management

Assessing and monitoring the disease
The basis for OCPD diagnosis is the history of contact with the potential risk factors and the existence of airflow limitation that is not easily irreversible. Similarly, patients exposed to risk factors and showing prolonged cough and excessive sputum production ought to undergo airflow limitation testing even if they do not have difficulty in breathing (dyspnoea).
The test that is used to diagnose and assess OCPD is referred to as spirometry. The test comes with the advantage of being standardized, objective, and reproducible approach of assessing airflow limitation. Forced expiratory volume 1(FEV1)/ forced vital capacity (FVC) ratio of less than 70% and post-bronchodilator forced expiratory volume 1 of less than 80% predicted is a confirmatory test for the existence of airflow limitation that cannot be fully reversed. Other measurements for COPD patients include arterial blood partial pressure. This should be mandatory patients with forced expiratory volume 1 of less than 40% predicted and for those with showing signs of respiratory failure.

Reducing risk factors

The risk factors that include tobacco smoke, dusts, chemicals, and coal pollutants are important in combating the start and advancement of OCPD. Of all the risk factors, the most cost-effective in curbing the development and advancement of OCPD is smoke cessation. Therefore, tobacco smoke dependence treatment should regularly be provided by health care providers every time the patient visits the health institutions. Apart from this, patients should be provided with counselling services including practical counselling and social support both within and outside the treatment. Moreover, medications can be used to reduce dependency on smoke.

Managing stable COPD

Management of stable COPD involves progressive increase in treatment based on the severity of the condition. It also involves health education that aids in coping with illness, equipping skills, smoking cessation, and improving health status. As medication has not shown any help in reversing the deterioration in lung function for the disease, pharmacotherapy is only meant to lessen symptoms and complications. Some of common medications include bronchodilator such as 2-agonists, anticholinergics, and theophylline. Other ways of managing the disease include physical exercise programs and administration of oxygen for at least fifteen hours a day.

Managing exacerbations

Severity of respiratory symptoms in COPD are caused by infection of the respiratory tree and pollution of air. Some of the common treatments of exacerbations of COPD include the use of inhaled bronchodilators and systemic glucocorticosteroids (Siafakas, 2008, p.260). Other treatment options are antibiotics and for patients with airway infection.

Prognosis

Gold system
Stage 1: characterized by extremely mild COPD with a forced expiratory volume 1 of about 80% or more of the normal.
Stage 2: characterized by moderate COPD having a forced expiratory volume 1 of between 50 and 80% of normal.
Stage 3: characterized by severe emphysema, having a forced expiratory volume 1 between 30 and 50 percent of normal.
Stage 4: characterized by very severe COPD, with a lowest a forced expiratory volume 1
In general, the higher the stage of chronic obstructive pulmonary disease, the worse the prognosis is.
Use of spirometry in diagnosis of COPD
Spirometry is a process of evaluating lung function by determining the volume of air that the patient can breathe out after a maximal inspiration. The indices obtained from this forced exhalation are the most precise and consistent ways of supporting a diagnosis of COPD. Comparison of these data with normal values obtained on the basis of height, age, sex, and ethnicity provide a measure of the degree of airway obstruction that is used to categorize the disease as either mild, moderate, or severe.

Spirometry procedure

Preparing the patient
The patient is first informed of the purpose of the test and its procedure. Thereafter, the individual’s age, sex, and height need to be obtained and entered into the device so as to aid in calculation of predicted curves and values.

Measuring forced expiratory volume, FVC, and Flow–Volume Curves

This is done by first attaching a sterilized, disposable, one-way mouthpiece to the spirometer. The patient is then instructed to fully inhale till the lungs are filled. At the same time, the patient ought to hold their breath so as to seal their lips firmly around the mouthpiece. Thereafter, the patient should force the air out as forcibly until there is no more air left to expel. The procedure should be repeated until three consistent blows are obtained. The obtained readings should be 150 mL of each other.

Differential Diagnosis

If the procedure above confirms the presence of airway obstruction, either COPD or asthma diagnosis is carried out. The difference between the two conditions can be done by careful examination of clinical history, smoking, or other risk factors.

Summary

COPD is the leading causes of deaths in the world today. The disease is caused by genetic factors and environmental factors such as smoking, dietary factors, pollution, and occupational exposure. Management of the disease involves assessing and monitoring of the disease, reducing of risk factors, managing stable OCPD, and management of exacerbations. To diagnose the disease, a process known as spirometry is carried out.

References

Hirayama, F, Lee, A, & Binns, C 2008, ‘Dietary factors for chronic obstructive pulmonary disease: epidemiological evidence’, Journal of Expert Review of Respiratory Medicine, vol. 2, pp. 645-653, viewed 30 march 2015 PubMed database
Cho, Y, Lee, J, Choi, M, Choi, W, Myong, J, Kim, H, & Koo, J 2015, ‘Work-related COPD after years of occupational exposure’, Journal of Annals of Occupational and Environmental Medicine, vol. 27, pp. 2-5, viewed 30 March 2015 PubMed database
Hu, G, Zhong, N, & Ran, P 2015 ‘Air pollution and COPD in China.’ Journal of thoracic disease, vol 7, pp. 59-66, viewed 30 March 2015 PubMed database
Hosseini, S, Ghasemian, E, Jamaati, H, Tabaraie, B, Amini, Z & Cox, K 2015 ‘Association between respiratory viruses and exacerbation of COPD: a case-control study.’ Journal of infectious diseases, vol. 24, 1-7, viewed 30 March 2015 PubMed database
Carlvaley, PM, McNee, W, Pride, NB, & Rennard, SI 2003, Chronic Obstructive Pulmonary Disease, 2nd edn, Taylor & Francis Group, Boca Ratton FL.
Kon, OM, Hansel, TT, & Barnes, BJ 2008, Chronic Obstructive Pulmonary Disease (COPD), 2nd edn, Oxford University Press, New York, NY
Siafakas, NM 2006, European Respiratory Monograph 38: Management of Chronic Obstructive pulmonary disease, European respiratory society journals limited, Wakefield, UK
World Health Organization 2015, Chronic respiratory diseases, World Health Organization, viewed 30 March 2015, http://www.who.int/respiratory/copd/management/en/
World Health Organization 2015, Chronic respiratory diseases, World Health Organization, viewed 30 March 2015, http://www.who.int/respiratory/copd/en/