Chronic Obstructive Pulmonary Disease (COPD) is a collection of conditions whereby airflow in the lungs is obstructed due to narrowing of air passages. The lungs initiate a response to harmful stimuli such as foreign particles or irritating gases (especially cigarette smoke). COPD may involve both conditions called emphysema and chronic bronchitis. Emphysema involves destruction of lung tissues while chronic bronchitis involves persistent coughing with phlegm and mucus. COPD is the fourth major cause of death in the United States next to heart disease, cancer and stroke. COPD almost always results in hospitalization and death among the elderly in Long Term Care facilities. This is due to the fact that normal lung functions lessen as we age. Thus, both men and women are at risk.

Signs and Symptoms

Signs and symptoms include persistent cough with excessive phlegm, difficulty in breathing that worsens over time, shortness of breath and wheezing. Patients also can not tolerate physical activities such as exercise. Based on the symptoms, COPD can be classified into three stages:

Mild (Stage 1) often presents no clinical symptoms but when chronic bronchitis is present, phlegm that is somewhat pus-like is observed.

Moderate (Stage 2) may still show no symptoms although the phlegm associated with chronic bronchitis appear more purulent. Wheezing is observed and the patient usually needs a long time to exhale.

Severe (Stage 3) involves frequent attacks that may result to lung failure, breathing difficulty even with slight physical activity, weight loss, abnormal heart rhythm and chest x-ray showing enlargement of the right side of heart.

Treatment

COPD is an irreversible condition. Unfortunately, no medication can reverse the damages that have been done to the lungs. Medications can only relieve symptoms. Bronchodilators are the drug of choice. They are a class of drugs that open airflow and dry up mucus secretions. Oxygen may be administered to patients with low oxygen levels in the blood. Antibiotics may also be prescribed for cases of infection. Drugs such as antidepressants or antipsychotics can also be used for drying of respiratory secretions aside from treating depression encountered by some patients.



Care Management



Management of COPD in a Long Term Care setting poses some challenges to caregivers and healthcare providers. Like many other disease, the earlier the condition is detected, the lower is the chance of progression of the disease. However, COPD presents with a variety of symptoms many of which are shared with other respiratory diseases which can make early diagnosis difficult. The most sensitive method for detection is by spirometry but is unavailable in most facilities. Thus, recognition of COPD is under the vigilant watch of caregivers and healthcare providers.

Aside from treating and controlling the symptoms of the patient, strict monitoring is also needed to prevent the spread of infection. Minimize dusts and pollutants in the air. Provide vaccination against influenza and pneumococcal infections to patients as well as staff. Strictly advise patients to quit smoking.

Encourage patients to join activities. Patients with COPD often experience stress, depression and lack of interest in social activities because of the burden of dealing with the symptoms. COPD is a chronic, progressive disease, meaning the disease will increase in severity over time.

Some patients will eventually reach an end-of-stage nature of the disease. Palliative care may be recommended at this stage. It is a form of medical care that includes services ranging from management of symptoms to treatment of depression. This is the most challenging aspect of long term care for COPD patients. Caregivers and healthcare providers are not spared from the emotional strain. Build palliative teams and schedule specialized trainings to better educate team members not only about end-of-life issues but also on ways of managing stress from doing daily caregiving duties.

Prognosis

Prognosis for patients with COPD depends on the severity of the condition. For mild COPD, prognosis is actually good. For moderate and severe cases of COPD, patients survive for an average of ten years. Cigarette smoking also results to worsening of prognosis as symptoms are significantly accelerated.