Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
DISEASE
Introduction
The lungs are a vital part of the respiratory system that enable oxygen from the
air to be taken into the body by inhalation while also enabling the body to eliminate
carbon dioxide, a waste gas produced by the cells, through the air that is breathed out
by exhalation. Respiration is the technical term used to describe this exchange of
gasses. In the average person, the process of respiration occurs automatically at a rate
of about 25,000 times each day.
The respiratory system consists of the nose, throat, larynx, trachea, and the
lungs. The lungs are divided into segments called lobes. The right lung has three lobes
while the left lung, which is smaller, has only two lobes. There are two major blood
vessels that service the lung, the pulmonary artery brings blood rich in carbon dioxide to
the lungs and the pulmonary vein brings oxygen-rich blood from the lungs to the heart
for distribution to the body. When air is inhaled through the nostrils or the mouth, the
trachea moves the air down into the lungs. The upper portion of the trachea is located in
the neck while the bottom portion extends down into the chest cavity where it divides
into two tubes called the right and left bronchi. The right bronchus brings air into the
right lung and the left bronchus brings air into the left lung. Within the lungs, the bronchi
divide into smaller branches called bronchioles. At the end of the bronchioles are tiny air
sacs called alveoli. The alveoli are encased in a mesh of tiny capillaries smallest blood
vessels where blood cells pass through just a few at a time that connect to larger blood
vessels and eventually connect to the pulmonary artery and pulmonary vein. The
process of respiration, the exchange of oxygen and carbon dioxide, actually takes place
in these tiny capillaries. Oxygen-rich air is inhaled and when it reaches the alveoli, the
oxygen moves into the capillaries and attaches to the red blood cells while the carbon
dioxide moves from the capillaries into the alveoli from where it is expelled when we
exhale.
For this reason, any impairment in the breathing process or obstructions alters
this delicate exchange of gasses. Lung function slowly declines with age, beginning
around age 30. There are also several muscles that are involved in respiration that help
the lungs expand with inhalation and contract with exhalation. A few of the muscles
involved includes,
• Diaphragm - a half moon shaped muscle below the lung that is the main muscle used
in breathing
• Intercostal muscles - muscles between the ribs that enable the expansion and
contraction of the chest cavity with each breath
• Abdominal muscles - beneath the diaphragm
• Muscles in the neck and collarbone - these muscles help with breathing when the
other muscles are not working properly or if lung disease impairs breathing
What is Chronic Obstructive Pulmonary Disease?
Chronic obstructive pulmonary disease, or COPD for short, is the medical term
used to describe diseases of the lung that are associated with airway obstruction.
COPD is a progressive condition but partially reversible through treatment, especially
when diagnosed early in its clinical course. With early diagnosis, lifestyle changes for
example smoking cessation, and appropriate treatment, many people can lead normal
and productive lives. In most cases COPD is preventable. It is a major burden on the
health care system, the economy, and has a profound effect on the quality of life of
patients who suffer from the condition.
The two major diseases that are included in the category of COPD are:
• Chronic bronchitis - a chronic, inflammatory condition of the bronchi characterized by
coughing and expectoration of sputum mucous coughed-up from the lungs
occurring on most days and lasting 3 months or longer for at least two
consecutive years.
• Emphysema - a respiratory disorder that is characterized by enlargement and eventual
destruction of the air sacs or the alveoli in the lungs, through which
oxygen passes from the lungs into the bloodstream.
Although asthma is also a condition that is associated with airway obstruction,
and many people with COPD also suffer with asthma, as a general rule, asthma is not
included under the category of COPD.
In general, COPD is characterized by:
• Chronic airflow limitation
• Airway inflammation
• Structural changes to the airways and lung tissue
• Systemic effects such as pulmonary hypertension or cardiovascular disease
COPD is an insidious disease and there are usually no symptoms in the early
stages when diagnosis and treatment are effective in slowing its progression. However,
even in later stages,
with aggressive treatment and good patient compliance, COPD is partially reversible
and the decline of quality of life may be significantly slowed.
• Pursed-lip breathing
• Clubbing
• Cyanosis
• Morning cough
• Chronic cough
• Usually thick, grey, and mucoid until chronic infections develop. Then becomes
mucopurulent.
All of these problems are more prevalent in women. Presently, there are no differences
cited in any guidelines regarding diagnosis, treatment, and management of COPD in
women. It is important for health care professionals to recognize these differences when
monitoring the disease in women.
Nursing tips:
• Titrate oxygen to keep O2 sat 90%
Managing COPD
Acute Exacerbations:
Long-Term maintenance:
Pursed-lip breathing
• Draw your lips together as if you were going to whistle and blow out through
• Try to make the time blowing out longer than when you took a breath in.
(inhale 2 sec/exhale 4 sec)