mangement of COPD

what are risk factors for COPD?

noxious agents: tobacco smoke, air pollution, biomass fuels

genetic lung development

what is the pathology of COPD?

small airway inflammation, alveolar destruction, mucus hypersecretion

small airways narrow, collapse, blocked by secretions

what are symptoms of COPD?

dyspnea, air trapping (barrel chest)

becomes less elastic, making it hard for it to expand and gas exchange to occur

what is spirometry?

measures volume and speed of air inhaled or exhaled as a function of time, assess severity of COPD

what are the different numbers of spirometry?

FEV1: forced expired volume in 1st second

FVC: total volume of air exhaled from maximal inhalation to maximal exhalation

FEV1/FVC%: the ration of FEV1 to FVC, expressed as percent

PEFR: fastest flow of gas from lungs

what numbers indicate severity from spirometry?

there is a prediction and the patients best which is compared

for FVC, less than 65%

FEV1, less than 37%

FEV1/FVC less than 46%

what are patient teaching goals of COPD?

prevent progression: influenza and pneumococcal vaccine

relieve symptoms

improve exercise tolerance

teach self-management skills

what are the five a’s for smoking cessation?

ask about tobacco use

advise all smokers to quit

assess willingness two quit

assist the patient in his or her attempt to quit

arrange followup contact

what does bronchodilators do for COPD?

short acting: immediate relief of dyspnea

long acting: daily relief

block constriction of airway. by relaxing bronchial smooth muscles

what are the steps of bronchodilator prescription?

1: quick acting, SABA or SAMA

2: add long acting, LABA or LAMA

3: add a 2nd long acting

describe inhaled steroids

later choice for COPD management

side effects: affects immune response, risk for oral thrush

what are some inhaler combinations?

LABA and ICS

LABA and LAMA

LABA, LAMA, and ICS

what is the plan for COPD management?

1: emergency relief of SAMA or SABA

2: long term relief of LABA or LAMA

3: if many exacerbations, trial ICS

4: possible combination inhalers

5: still need to get drug to lungs

what are the types of inhalers?

pressurized and dry powder

how does anatomy affect drug effect?

drug needs to reach lower lung area

anatomy prevents unless about 1 micron

need to keep small, inhale deeply, hold breath 10 sec, wait 1 min if 2 doses

how do you use a dry powder inhaler?

open so you see mouthpiece

slide lever until it clicks

gently breath out

do not exhale into device

seal lips around mouthpiece

inhale rapidly and deeply

hold breath 10 sec to deposit

remove device from mouth, exhale

if powder not all gone, repeat

how does a MDI work?

take off cap and shake

breath out

put inhaler to mouth or just in front of mouth, breath in a push down on top of inhaler and keep breathing in slowly

hold breath 10 seconds and then breath out

describe pursed lip breathing

to help pt if SOB

inhale via nose w/ mouth closed

exhale over 4-6 seconds thru pursed lips

prevents air trapping

how does upper arm exercise affect COPD?

respiratory muscles: breathing and arm work increase SOB

brushing teeth, combining hair, shaving

exercise: improves muscle tone and ability to do ADL

what are the steps to have a more productive cough?

sit in chair, feet on floor

3-4 breaths in thru nose and out mouth

grasp pillow with crossed hands

cough while bending forward

assists action of diaphragm, increase airflow

what is the pulse ox goal for a COPD patient?

at least 89, may be a normal that they live with

what are the benefits of pulmonary rehab?

teaches self management

how to use equipment

how to exercise, less dyspnea

stress reduction

keeps pts active

how do you prevent COPD readmission?

pt teaching

inhaler device training

COPD action plan

pharm reconciliation

follow up call after discharge

referral to pulmonary rehab

what are signs of respiratory distress?

pursed lip breathing, use of excessory muscles, SCM retractions, blue lips, JVD, tripod position