Learning outcomes 1 and 2
Chronic Obstructive Pulmonary Disease (COPD) is “a term that describes several complex and overlapping respiratory problems, including chronic bronchitis, emphysema and bronchiectasis” (Green 2010, p.21). Green (2010, p.21) posits that from a technical perspective, asthma also falls under the conditions that make up COPD. However, the term is mostly associated with chronic bronchitis and emphysema. COPD, as a condition, is chronic, implying that it develops slowly and persists over a long period. Green (2010, p.21) argues that the condition mostly affects people who have a history of smoking at least one pack of cigarettes per day for twenty or more years. It has also been established that long-term and persistent exposure to noxious substances as well as genetic conditions contributes to the development of COPD. The chronic nature of the disorder means that patients have to cope with adverse symptoms, pain and stress that accompany the illness (Choudhuri 2012, p.6). This paper presents an in-depth discussion of COPD, highlighting its symptoms, implications for patients as well as the ways palliative care is used to manage its symptoms.
The National Heart, Lung and Blood Institute (2016) describe COPD as a progressive disease that makes it difficult for the affected people to breath. The disease is acknowledged as one of the leading causes of morbidity and the number three cause of death in the U.S. It takes time to develop, implying that millions of people may have it but remain unaware (Seamark, Seamark and Halpin 2007, p. 225-233). The worsening symptoms are usually accompanied by patients’ inability to go about routine activities, including walking and taking care of themselves. The prevalence of the disease is higher among the middle-aged and older individuals (NHLBI 2016). Currently, there is no known cure for COPD, but lifestyle changes and treatment therapies make it possible for patients to lead a more comfortable life, slowing down the progression of the disease (NHS 2016).
What occurs in COPD? When a person develops the condition, the amount of air flowing in and out of the airways is restricted. The victims receive less than the normal amount of air due to a combination of factors, including the air sacs and airways losing their elasticity (NHS 2016). The destruction of the walls separating the millions of air sacs as well as the thickening and inflammation of the airway walls are other factors contributing to the lower levels of air flowing into and out of the airways. The last factor limiting the flow of air is the production of abnormal amounts of mucus, which clogs the airways (NHS 2016).
COPD affects not only the lungs, but also other important body organs and systems such as the heart and the circulatory system. Chronic bronchitis and advanced emphysema are often accompanied by a heart disorder known as Cor Pulmonale (Green, 2010, p.22). The disorder is characterised by an abnormal enlargement of the heart’s right ventricle. The liver is another body organ affected as COPD progresses. The body’s toxin cleansing organ may be overwhelmed by the huge amounts of toxins entering the body through cigarette smoke and the pharmaceutical drugs meant to treat the symptoms accompanying COPD (Preedy 2011, p.99).
Symptoms indicating the presence of COPD include dyspnea or shortness of breath, cough, chest pain, coughing of blood, digital clubbing, cyanosis and excessive mucus. Shortness of breath results from reduced elasticity of the lungs. It may occur during exertion as well as when the patients are at rest (Green, 2010, p.22). According to Hanania and Sharafkhaneh (2010, p.26), it correlates with significant disability, poor prognosis and poor quality of life. They argue that explaining the degree of breathlessness for single patients is often hard, but progress has been made towards understanding the mechanism underlying the condition. Dyspnea worsens as the disease progresses, but during the early stages of the disorder, patients are known to modify their behavioural patterns to counter the feeling of breathlessness. The condition is only unavoidable as COPD becomes severe, making it hard for patients to carry out the simplest of tasks.
Coughing is another common symptom in all the respiratory disorders, including COPD. According to Green (2010, p.23), it is a normal protective reflex that may be brought about by inflammatory factors and chemical or mechanical irritation among others. Hanania and Sharafkhaneh (2010, p.26) argue that for COPD patients, coughing usually worsens during the morning hours, but rarely disturbs the patient’s sleep. They reiterate that persistent coughing is disabling due to the embarrassment that patients may feel, especially when the urge to cough in burst comes up during social occasions. In the worst-case scenario, the coughing is often accompanied by blood released from the respiratory tract, often indicating very serious underlying respiratory disorders such as pneumonia, lung cancer and tuberculosis.