Nursing Management of COPD and Asthma

Chronic Obstructive Pulmonary Disease (COPD)

• Characterized by chronic and progressive expiratory air flow limitations
• Fourth leading cause of death in the U.S. with increasing incidence
• Pathophysiology involves:
  • Air flow restriction due to emphysema and chronic bronchitis
  • Abnormal in ammation-mediated mucosa hypersecretion, mucus plugging, tissue edema, and goblet cells
  • Bronchospasm and airway remodeling
• Emphysema: abnormal enlargement of airspace distal to terminal bronchioles, hyperinflation of the lungs
• Chronic bronchitis: narrowing of airway passage, airway obstruction
• Risk factors include:
  • Tobacco
  • Genetic factors
  • Exposure to particles
  • Biomass cooking in poorly ventilated areas

Clinical Manifestations of COPD

• Dyspnea
• Chronic cough (> 3 months)
• Sputum production
• Fatigue
• Frequent respiratory infections
• Use of accessory muscles
• Barrel chest
• Wheezing
• Pursed lip breathing
• Prolonged expiratory time
• Bronchitis
• Digital clubbing
• Thin in appearance
• Cor pulmonale (late in disease)

Medical Management of COPD

• Medications:
  • Bronchodilators
  • Inhaled corticosteroids
  • Diuretics
  • Phosphodiesterase-4 inhibitors
  • Alpha-1 replacement therapy
  • Antibiotics
  • Oxygen therapy
• Self-management:
  • Smoking cessation
  • Exercise
  • Nutrition
  • Education
  • Vaccinations

Exacerbations and Complications of COPD

• Acute event characterized by a worsening of symptoms
• Causes include:
  • Acute infection
  • Heart failure
  • Response to allergens and/or pollutants
• Often requires hospitalization and may be life-threatening

Nursing Management of COPD

• Education:
  • Disease process
  • Management of common problems
  • Medications
  • Self-care
• Acute management:
  • Respiratory status
  • Airway
  • Cardiac status
• Pulmonary rehabilitation

Nursing Diagnosis related to COPD

• Impaired Gas Exchange
• Cough and Ineffective Airway Clearance
• Decreased Exercise Tolerance
• Nutrition
• Enhancing Self-Care Strategies
• Enhancing Individual Coping Strategies

Asthma

• Common disease characterized by obstruction of small airways
• Inflammation is a key underlying feature
• 18.7 million Americans have asthma
• Types of asthma:
  • Allergic
  • Non-allergic
  • Late-onset
  • Asthma with fixed air flow limitation
  • Asthma with obesity

Pathophysiology of Asthma

• Common causes of asthma:
  • Pollens
  • Mold
  • Animal dander
  • Occupational exposure
  • Smoking
  • Dry, cold air
  • Air pollution
  • GERD
  • High fatty or spicy foods
  • Nasal polyps
• Symptoms typically occur at night or suddenly over several hours

Clinical Manifestations of Asthma

• Dyspnea
• Cough
• Wheezing (high-pitched)
• Chest tightness
• Tachycardia
• Worsen with:
  • Exercise
  • Exposure to allergens, irritants, or occupational irritants
  • Weather changes
  • Stress
  • Menstrual cycle
  • Strong emotions
• Between attacks, most people are symptom-free

Asthma Attack

• Mild attack:
  • Feeling of chest tightness
  • Slight increase in respiratory rate
  • Mild wheezing
  • Cough
  • Able to talk
• Severe attack:
  • Use of accessory muscles
  • Gasping for breath
  • Loud wheezing
  • Very stressed or anxious
  • Fatigue
  • Skin – pale and clammy
• Status asthmaticus:
  • Severe form of asthma refractory to initial therapy
  • Can occur with little warning

Management of Asthma

• Overall goal of treatment:
  • Reduce impairment
  • Reduce risk of adverse outcomes
• Non-pharmacologic:
  • Patient education
    • Identifying and managing triggers
    • Early warning signs
    • Medications
  • Monitoring for and treating exacerbations/complications
• Pharmacologic therapy (6-step process)

Pharmacologic Measures for Asthma

• Bronchodilators (anti-asthmatics):
  • Dilate the airway
  • Types: Xanthines, Sympathomimetics, and anti-cholinergics
  • Administered as an inhaler or nebulizer
  • Side effects: tachycardia
• Inhaled corticosteroids:
  • Decrease inflammation in the airway
  • Takes 2-3 weeks to respond