Nursing Diagnoses

Five Key Nursing Diagnoses:

1) Ineffective Airway Clearance: Possibly evidenced by statement of difficulty breathing, changes in depth/rate of respirations, use of accessory muscles, abnormal breath sounds, persistent cough and sputum. More info in table below!

2) Impaired Gas Exchange: May be related to altered O2 supply, Alveoli destruction, and alveolar-capillary membrane changes. Evidenced by dyspnea, abnormal breathing, confusion, restlessness, inability to move secretions, hypoxia, hypercapnia, changes in vital signs, and activity intolerance.

3) Imbalanced Nutrition: May be related to dyspnea, sputum production, medication side effects, fatigue. Possibly evidenced by weight loss, loss of muscle mass, poor muscle tone, reported altered taste sensation, aversion to eating, and lack of interest in food.

4) Risk for Infection: Risk factors include inadequate primary defenses, inadequate acquired immunity, chronic disease process, and malnutrition.

5) Knowledge Deficit: May be related to lack of information/unfamilarity with resources, misinterpretation and lack of recall cognition. Evidenced by patient requesting information, statement of concerns/misconceptions, inaccurate follow-through of instructions, and development of preventable complications. 

Nursing Diagnosis	Ineffective Airway Clearance
Actual or Potential	-Potential
Related to	-Broncospasm -Increased production of secretions; retained secretions; thick, viscous secretions -Allergic airways -Hyperplasia of bronchial walls -Decreased energy/fatigue
Plan and Outcome	-Maintain airway patency with breath sound clear/clearing -Demonstrate behaviors to improve airway clearance (cough effectively, expectorate secretions)
Nursing Intervention	-Auscultate, assess, and monitor breath sounds; note rate, i/e ratio, and adventitious sounds -Evaluate degree of dyspnea -Comfort; elevate HOB, lean over on table, sit on edge of bed -Minimize exposure to dust, smoke, feathers -Observe cough -Increase fluid intake within cardiac tolerance (3000mL). Warm or tepid liquid.

This website is my favorite and is the most clear about the different nursing care diagnosess and interventions. It is longer and in-depth, however very organized and extremely easy to read!
NurseLabs.com

HEY NURSES! Ways to care for patients COPD.

Nursing Diagnosis	Rationale
Ineffective Airway Clearance	-Auscultate, assess, and monitor breath sounds; note rate, i/e ratio, and adventitious sounds -Evaluate degree of dyspnea -Comfort; elevate HOB, lean over on table, sit on edge of bed -Minimize exposure to dust, smoke, feathers -Observe cough -Increase fluid intake within cardiac tolerance (3000mL). Warm or tepid liquid.
Impaired Gas Exchange	-Asses RR; note accessory muscle use, purse-lip breathing, inability to speak -Elevate HOB; encourage deep, slow, purse-lip breathing -Monitor skin/mucus membrane color -Encourage sputum; suction as needed -Auscultate breath sounds -Palpate for fremitus -Evaluate level of activity intolerance and sleep patterns -Vitals and cardia rhythm
Imbalanced Nutrition	-Assess dietary habits -Auscultate bowel sounds -Frequent Oral care -Avoid gas-producing, carbonated, very-hot, and very-cold beverages/foods -Weigh -Administer O2 with meals as indicated
Risk of Infection	-Monitor temp -Observe sputum odor, color, character; obtain specimen by deep cough/suction -Stress hygiene and proper tissue disposal -Monitor visitors -Encourage balance b/t activity and rest -Discuss adequate nutrition intake -Administer antimicrobials as indicated
Knowledge Deficit	-Explain disease process -Stress oral and dental hygiene! -Discuss avoiding people with Resp. Infections. Discuss individual aggravating factors. Avoidance of smoking/harmful pollutants. Activity limitations. Need for follow-up appointments. -Discuss medications, O2 needs, inhaler usage and technique

Below are some helpful links that go more in depth in nursing care for individuals with COPD:

1) This website is my favorite and is the most clear about the different nursing care interventions to give. It is longer and in-depth, however very organized and extremely easy to read! Because of it's informative and simple format, this is important for nurses to read through because it touches on all key interventions, while not presenting it like a paper or essay!
NurseLabs.com for COPD

2) This website gives interventions/care and rationales for that care in two VERY BRIEF lists: one for chronic bronchitis, and one for emphysema. I recommend this website to the nurse who simply needs a brief list for COPD patients on a case-by-case basis.
NursingFile.com for COPD

3) Also here is a great resource from The Asthma Foundation to send your patients home with for management guidance!!

Treating for COPD

Because COPD is a progressive disease, the key is managing and preventing (as best we can) any further complications for whatever stage we are in. The most important complications for COPD are coughing, changes in sputum (color/amount), and fever (and need to be reported to your provider). The most important side effects are those for Streroid therapy; these may include weight gain, diabetes, osteoporosis, cataracts and an increased risk of infection.

1) Lifestyle Changes

-Quit Smoking and Avoid Lung Irritants

Quitting smoking is the most important step you can take to treat COPD. Talk with your doctor about programs and products that can help you quit. If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking. Ask your family members and friends to support you in your efforts to quit. Try to avoid secondhand smoke and places with dust, fumes, or other toxic substances that you may inhale.

-Other Lifestyle Changes

If you have COPD, you may have trouble eating enough because of your symptoms, such as shortness of breath and fatigue. (This issue is more common with severe disease.) As a result, you may not get all of the calories and nutrients you need, which can worsen your symptoms and raise your risk for infections. Talk with your doctor about following an eating plan that will meet your nutritional needs. 

2) Medicines

-Bronchodilators

Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Depending on the severity of your COPD, your doctor may prescribe short-acting or long-acting bronchodilators. Short-acting bronchodilators last about 4–6 hours and should be used only when needed. Long-acting bronchodilators last about 12 hours or more and are used every day. Most bronchodilators are taken using a device called an inhaler. This device allows the medicine to go straight to your lungs. Not all inhalers are used the same way. 

-Combination Bronchodilators Plus Inhaled Glucocorticosteroids (Steroids)

If your COPD is more severe, or if your symptoms flare up often, your doctor may prescribe a combination of medicines that includes a bronchodilator and an inhaled steroid. Steroids help reduce airway inflammation.  In general, using inhaled steroids alone is not a preferred treatment. 

3) Vaccines

-Flu Shots

The flu (influenza) can cause serious problems for people who have COPD. Flu shots can reduce your risk of getting the flu.

-Pneumococcal Vaccine

This vaccine lowers your risk for pneumococcal pneumonia and its complications. People who have COPD are at higher risk for pneumonia than people who don't have COPD. 

4) Pulmonary Rehabilitation

Pulmonary rehabilitation is a broad program that helps improve the well-being of people who have ongoing breathing problems. Rehab may include an exercise program, disease management training, and nutritional and psychological counseling. The program's goal is to help you stay active and carry out your daily activities.

5) Oxygen Therapy

If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can help you breathe better. For this treatment, you're given oxygen through nasal prongs or a mask. You may need extra oxygen all the time or only at certain times. For some people who have severe COPD, using extra oxygen for most of the day can help them:

• Do tasks or activities, while having fewer symptoms
• Protect their hearts and other organs from damage
• Sleep more during the night and improve alertness during the day
• Live longer

6) Surgery

Surgery may benefit some people who have COPD. Surgery usually is a last resort for people who have severe symptoms that have not improved from taking medicines.

Surgeries for people who have COPD that's mainly related to emphysema include bullectomy (bul-EK-toe-me) and lung volume reduction surgery (LVRS). A lung transplant might be an option for people who have very severe COPD.

-Bullectomy

When the walls of the air sacs are destroyed, larger air spaces called bullae (BUL-e) form. These air spaces can become so large that they interfere with breathing. In a bullectomy, doctors remove one or more very large bullae from the lungs.

-Lung Volume Reduction Surgery

In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work better. In carefully selected patients, LVRS can improve breathing and quality of life.

-Lung Transplant

During a lung transplant, your damaged lung is removed and replaced with a healthy lung from a deceased donor. A lung transplant can improve your lung function and quality of life. However, lung transplants have many risks, such as infections. The surgery can cause death if the body rejects the transplanted lung.

Learning Objective:  Analyze the treatment guidelines of your disease from current resources. Identify key article that will be part of your blog in this area. What are the current treatment recommendations during various stages of your disease? Describe the treatment progression. Which side effects are most important? Which side effects are most common? When does the treatment need to be stopped because of side effects?

Learning Activity 1. Find treatment information on websites, textbooks and journals. If possible create a chart with the two most frequently used treatment guidelines and compare them for their information. 2. Find information related to side effects on websites, textbooks and journals. If possible create a chart with the five most frequent side effects and what to do about them. 3. Post references that explain most comprehensively the treatments of the disease on your blog.

Key Articles: 
National Heart Lung and Blood Institute 

American Lung Association.

Anderson B, Conner Anderson B, Conner K, Dunn C, et al. Institute for Clinical Systems Improvement. Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD). https://www.icsi.org/_asset/yw83gh/COPD.pdf. Accessed May 5, 2014.

Balkissoon R, Lommatzsch S, Carolan B, Make B. Chronic obstructive pulmonary disease: a concise review. Med Clin N Am. 2011;95:1125-1141

WHAT SHOULD I EXPECT TO LOOK AND FEEL LIKE WHEN I HAVE COPD?

Chronic obstructive pulmonary disease (COPD) can cause shortness of breath, tiredness, production of mucus, and cough. 

COPD patients and their disease progression are staged based on lung function, that sadly typically decreases over time. Below is table giving what you might experience as lung function declines.

 Decreasing lung function and the discomfort and declining quality of life calls for great healthcare. Below are FAQs and general recommendations about how to cope, treat, and when to seek care for your symptoms. 

Many people with COPD develop most, if not all, of these signs and symptoms.

Why is shortness of breath a symptom of COPD?
Shortness of breath (or breathlessness) is a common symptom of COPD because the obstruction in the breathing tubes makes it difficult to move air in and out of your lungs. This produces a feeling of difficulty breathing. Unfortunately, people try to avoid this feeling by becoming less and less active. This plan may work at first, but in time it leads to a vicious cycle: avoiding activities leads to getting out of shape or becoming deconditioned, and this can result in even more shortness of breath with activity.

What can I do to treat shortness of breath?
If your shortness of breath is a result of COPD, you can do several things:

• Take all of your medications regularly as prescribed.
  If you do not think that your medications are helping your shortness of breath, talk to your healthcare provider, but don’t stop the medication.
  
• Begin a regular exercise program to build-up your strength.
  
• Learn about paced breathing and ways of breathing more efficiently with activities.
  Pulmonary rehabilitation programs offer an exercise program and teach you how to control your shortness of breath. Breathing support groups offer more general information. To locate a rehabilitation program or support group, contact your local American Lung Association. 
  When should I call my healthcare provider about my shortness of breath?
  If your shortness of breath is new, or it worsens for no known reason, call your healthcare provider. Describe to your provider when the shortness of breath started, how long it has lasted, and what makes it better or worse.
  

Is tiredness a symptom of COPD?
Tiredness (or fatigue) is a common symptom in COPD. Tiredness discourages a person from keeping active, which leads to greater loss of energy, which then leads to more tiredness. When this cycle begins it is sometimes hard to break.
What can I do to increase my energy level?
If you and your healthcare provider find that your tiredness is from your COPD, begin a regular program of exercise to build your strength. Learn about paced breathing and ways of breathing with less effort during activities. Consider going to a breathing support groups offered by your Lung Association or enrolling in a pulmonary rehabilitation program.
When should I call my healthcare provider about my tiredness?
Call your healthcare provider when unexpected tiredness does not go away. Describe when the tiredness started, how long it has lasted, and what makes the tiredness better or worse.
Is mucus production a symptom of COPD?
Excess mucus (phlegm or sputum) can be a symptom of COPD. It is normal for the breathing tubes to produce several ounces of mucus a day. Mucus is needed to keep the breathing passages moist. This mucus is normally swallowed without even knowing that you are doing so. However, when the lungs are infected or bothered by irritants, they try to protect themselves by producing more mucus than normal, which often makes you cough.

Should I look at the mucus I cough up?
Mucus needs to be coughed up and you need to look at it. Swallowing small amounts of mucus is not known to cause health problems, but looking at your mucus can give you an idea of what is happening in your lungs. It is best to cough your mucus into a disposable tissue so that you can see the color, thickness, and amount of mucus. Describing your mucus to your healthcare provider is helpful.
How can I lessen the amount of mucus produced in my lungs?
If you smoke, stop smoking. Everyone should avoid smoke and limit exposure to other items that can cause irritation to the lungs, such as pollution and fumes (paints, cleaning products and perfumes). Besides avoiding irritants, medicines like bronchodilators (to open up the breathing tubes), expectorants (to make the mucus easier to cough out), mucolytics (to thin thick mucus) and antibiotics (to treat infection in the lung) can be used.

When should I call my healthcare provider about changes in mucus?

For people with COPD, it is important to contact your healthcare provider soon after noticing a change in your mucus. Generally, a change in the color, thickness, and/or the amount of mucus is a sign that there is something abnormal going on in your lungs. Call your healthcare provider if you cough up blood or mucus that is deep yellow or green.
Is coughing a symptom of COPD?
A cough is common with COPD. Coughing can be a result of the lungs trying to remove extra mucus (phlegm or sputum) or it can be a way for the breathing tubes to protect themselves from inhaled irritants. Coughing is a good thing when it moves mucus out of the lungs because if large amounts of mucus stay in the breathing tubes, it can prevent oxygen from entering into the blood or can result in pneumonia. For this reason, your healthcare provider may not recommend medication to prevent your cough.

When should I call my healthcare provider about my cough?
Most coughing is not dangerous. You should call your healthcare provider if you notice any of the following: unexplained cough; severe cough; or coughing that causes you to black out. 

Key Articles: 
-ATS/ERS Standards for the Diagnosis and Management of Patients with COPD, http://www.thoracic.org/COPD/18/signs.asp 
-O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk DD, Balter M, Ford G, Gervais A, Goldstein R, Hodder R, Kaplan A, Keenan S, Lacasse Y, Maltais F, Road J, Rocker G, Sin D, Sinuff T, Voduc N, Can Respir J. 2007 Sep; 14 Suppl B():5B-32B

DIAGNOSING COPD

Your doctor will diagnose COPD based on your signs and symptoms, your medical and family histories, and test results. Your doctor may ask whether you smoke or have had contact with lung irritants, such as secondhand smoke, air pollution, chemical fumes, or dust.

If you have an ongoing cough, let your doctor know how long you've had it, how much you cough, and how much mucus comes up when you cough. Also, let your doctor know whether you have a family history of COPD.

Your doctor will examine you and use a stethoscope to listen for wheezing or other abnormal chest sounds. He or she also may recommend one or more tests to diagnose COPD.

Lung Function Tests

Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.

The main test for COPD is spirometry (spi-ROM-eh-tre). Other lung function tests, such as a lung diffusion capacity test, also might be used. During this painless test, a technician will ask you to take a deep breath in. Then, you'll blow as hard as you can into a tube connected to a small machine. The machine is called a spirometer.

The machine measures how much air you breathe out. It also measures how fast you can blow air out.

Your doctor may have you inhale medicine that helps open your airways and then blow into the tube again. He or she can then compare your test results before and after taking the medicine.

Spirometry can detect COPD before symptoms develop. Your doctor also might use the test results to find out how severe your COPD is and to help set your treatment goals.

Other Tests

Your doctor may recommend other tests, such as:

• A chest x-ray or chest CT scan. These tests create pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. The pictures can show signs of COPD. They also may show whether another condition, such as heart failure, is causing your symptoms.
• An arterial blood gas test. This blood test measures the oxygen level in your blood using a sample of blood taken from an artery. The results from this test can show how severe your COPD is and whether you need oxygen therapy.

NEWS IN COPD DIAGNOSIS: CDSS

An important problem in healthcare is the significant gap between optimal evidence-based medical practice and the care actually applied. A systematic review of adherence to chronic obstructive pulmonary disease (COPD) guidelines by clinicians found that the assessment of the disease and the therapy applied to patients were suboptimal. This situation exists across all chronic-disease care in general: in a multinational survey of chronically ill adults, 14-23% of cases reported at least one medical error in the previous two years.

Clinical decision support systems (CDSSs) can be defined as "software that is designed to be a direct aid to clinical decision-making in which the characteristics of an individual patient are matched to a computerized clinical knowledge base (KB), and patient-specific assessments or recommendations are then presented to the clinician and/or the patient for a decision". CDSSs have the potential to enhance healthcare and health, and to help close the gap between optimal practice and actual clinical care.

The CDSS operates by receiving and sending standardized messages, and relies on an existing HIS to present its recommendations to the healthcare professional on screen or via the issuance of a report. Two such HISs have successfully implemented the CDSS web services. The CDSS response time for all decision support services was acceptable (within seconds) to the clinical task at hand, and thus allowed a seamless integration into the existing HIS.

The performance of the CDSS diagnosis service was compared with an anonymised database of patients from Primary Care centres participating in forced-spirometry training in a web-based remote support program to enhance quality of forced spirometry done by non-expert professional in the Basque Country region of Spain. Forced-spirometry testing was done using a Sibel 120 SIBELMED spirometer. The spirometry quality and diagnosis evaluation was done by one respiratory specialist. Inclusion criteria to form the validation data set were:

(i) age of the patient greater than or equal to 40;

(ii) forced spirometry taken and recorded as an electronic record before and after the application of bronchodilators;

(iii) respiratory specialist used option menu to select the appropriate diagnosis (rather than entered through the free text field).

After applying the inclusion criteria, the validation set was formed containing 323 cases. The use of the dataset for validation purposes was approved by the Ethical Committee of the Hospital Clinic í Provincial de Barcelona.

References: 

-Velickovski, F., Ceccaroni, L., Roca, J., Burgos, F., Galdiz, J. B., Marina, N., & Lluch-Ariet, M. (2014). Clinical Decision Support Systems (CDSS) for preventive management of COPD patients. Journal of Translational Medicine, 12(Suppl 2), S9. doi:10.1186/1479-5876-12-S2-S9

-http://www.nhlbi.nih.gov/

Additional Question: What contributes to mortality and morbidity from this disease? Once again, COPD is the third leading cause of death in the US. Chronic/acute respiratory failure and has been found to be the primary contributor to deaths in COPD patients (mortality), though in the past researchers have also blamed coexisting/associated lung cancer. However, people can live and have been living long(ish) with this condition. In 2011, 12.7 million U.S. adults (aged 18 and over) were estimated to have COPD. However, close to 24 million U.S. adults have evidence of impaired lung function, indicating an under diagnosis of COPD. An estimated 715,000 hospital discharges were reported in 2010; a discharge rate of 23.2 per 100,000 population. COPD is an important cause of hospitalization in our aged population. Approximately 65% of discharges were in the 65 years and older population in 2010. The cause of these morbidity rates is due to the gradual/ongoing manifestation of COPD.

Etiology: Causes

Long-term exposure to lung irritants that damage the lungs and the airways usually is the cause of COPD. In the US, the most common irritant that causes COPD is cigarette smoke. Pipe, cigar, and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled.

Breathing in secondhand smoke, air pollution, or chemical fumes or dust from the environment or workplace also can contribute to COPD. (Secondhand smoke is smoke in the air from other people smoking.)

Rarely, a genetic condition called alpha trypsin 1 deficiency may play a role in causing COPD. People who have this condition have low levels of alpha-1 antitrypsin (AAT)—a protein made in the liver.

Having a low level of the AAT protein can lead to lung damage and COPD if you're exposed to smoke or other lung irritants. If you have this condition and smoke, COPD can worsen very quickly.

Although uncommon, some people who have asthma can develop COPD. Asthma is a chronic (long-term) lung disease that inflames and narrows the airways. Treatment usually can reverse the inflammation and narrowing. However, if not, COPD can develop.

Pathophysiology: How COPD manifests

Inhaled irritants cause inflammatory cells such as neutrophils, CD8⁺ T-lymphocytes, B cells and macrophages to accumulate.² When activated, these cells initiate an inflammatory cascade that triggers the release of inflammatory mediators such as tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ), matrix-metalloproteinases (MMP-6, MMP-9), C-reactive protein (CRP), interleukins (IL-1, IL-6, IL-8) and fibrinogen. These inflammatory mediators sustain the inflammatory process and lead to tissue damage as well as a range of systemic effects. Chronic inflammation is present from the outset of the disease and leads to structural changes in the lung which further perpetuate airflow limitation. This chronic inflammatory cascade is illustrated at left. 

COPD is characterized by chronic inflammation of the airways, lung tissue and pulmonary blood vessels as a result of exposure to inhaled irritants such as tobacco smoke. 

Airway remodeling in COPD is a direct result of the inflammatory response associated with COPD and leads to narrowing of the airways. Three main factors contribute to this: peribronchial fibrosis, build-up of scar tissue from damage to the airways and over-multiplication of the epithelial cells lining the airways.

Parenchymal destruction is associated with loss of lung tissue elasticity, which occurs as a result of destruction of the structures supporting and feeding the alveoli (emphysema). This means that the small airways collapse during exhalation, impeding airflow, trapping air in the lungs and reducing lung capacity 

Smoking and inflammation enlarge the mucous glands that line airway walls in the lungs, causing goblet cell metaplasia and leading to healthy cells being replaced by more mucus-secreting cells. Additionally, inflammation associated with COPD causes damage to the mucociliary transport system which is responsible for clearing mucus from the airways. Both these factors contribute to excess mucus in the airways which eventually accumulates, blocking them and worsening airflow.

Key References:

-Saqib A. Gowani, Sana S. Memon, and Javaid A. Khan "A Major Cause of Death in COPD and Risk Factors for Lung Cancer—a Dilemma or a Mistake?" American Journal of Respiratory and Critical Care Medicine, Vol. 176, No. 6 (2007), pp. 624-625.
-Centers for Disease Control and Prevention. National Center for Health Statistics. National Hospital Discharge Survey raw data, 2010. Analysis performed by the American Lung Association Research and Health Education Division using SPSS software.
-Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 2011. Analysis performed by the American Lung Association Research and Health Education Division using SPSS and SUDAAN software. 
-Chung KF. The role of airway smooth muscle in the pathogenesis of airway remodelling in COPD. Proc Am Thorac Soc 2005;2:347-54. 
-Laperre TS, Sont JK, van Schadewijk A, et al. Smoking cessation and bronchial epithelial remodelling in COPD: a cross-sectional study. Respir Res 2007;8:85-93.
-Danahay H & Jackson AD. Epithelial mucus-hypersecretion and respiratory disease. Curr Drug Targets Inflamm Allergy 2005;4:651-64
-National Institute of Health: National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/health/health-topics/topics/copd/causes

COPD in the US

Epidemiology:
According to recent statistics, chronic bronchi- tis affects approximately 10 million people in the United States, the majority of which are between 44 and 65 years of age. Among them, 24.3% with chronic bronchitis are older than 65 years, and surprisingly 31.2% are between the ages of 18 and 44 years. The numbers affected by chronic bronchitis dramatically increase with smoking. Pelkonen et al. followed 1711 Finnish men in rural com- munities for 30 years and found the incidence of chronic bronchitis was 42% in continuous smokers, 26% in ex-smokers, and 22% in never-smokers. In a recent cross-sectional study of over 5000 adult current or ex-smokers with over a 10-pack-year history, the prevalence of chronic bronchitis, using the classic definition, was a striking 34.6%. The prevalence of chronic bronchitis is higher in COPD patients, affecting 14 – 74% of all COPD patients.

Are some populations more at risk?: Debatable.
Chronic bronchitis seems to affect whites more than blacks, but the majority of studies have been composed of mostly whites. A recent study of non-Hispanic whites and blacks found that COPD patients were more likely to be white than black, but the differences in racial distribution between those with and without chronic bronchitis were small. Sex has also been a matter of debate. Many studies have found that chronic bronchitis affects men more than women. How- ever, according to the 2013 American Lung Association study, the prevalence rates of chronic bronchitis in women were nearly twice that in men (59.7 vs. 29.6 per 1000 persons). A 10-year study of 21 130 Danish patients showed that the cumulat- ive prevalence of chronic mucus secretion was 10.7% in women vs. 8.7% in men. The reasons for the higher prevalence of chronic bronchitis in women compared to that in men are unclear, but may be due to hormonal influences, sex differences in symptom reporting, and sex diagnostic bias; for example, in the European Respiratory Society Study on Chronic Obstructive Pulmonary Disease (EUROSCOP) study, women reported more dyspnea and cough, but less phlegm symptoms than men

Until next time: here's a great animation just on Emphysema!

Key Articles:
Kim, V. (2015). The chronic bronchitis phenotype in chronic obstructive pulmonary disease: Features and implications. Current Opinion, 21(00), 1-9. Retrieved January 17, 2015.

Searched databases: NIH, WHO, PubMed, Medline.
Search Terms: "COPD", "COPD US", "COPD epidemiology", "US epidemiology COPD" "COPD US prevalence"

Uh, what is COPD?

Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that block airflow and make breathing difficult. Emphysema and chronic bronchitis are the two most common conditions that make up COPD. Chronic bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. Emphysema occurs when the air sacs (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed.

Here's a great animation from Nucleus Medical Media to help introduce the lungs, COPD, and how its different presentations it develop.

COPD Epidemiology & Pathophysiology:

Epidemiology: Chronic obstructive pulmonary disease (COPD) is estimated to affect 32 million persons in the United States and is the fourth leading cause of death in this country. Patients typically have symptoms of chronic bronchitis and emphysema, but the classic triad also includes asthma.

Pathophysiology: COPD is characterized by airflow limitation that is poorly reversible. Cumulative, chronic exposure to cigarette smoking is the number one cause of the disease, but repeated exposure to secondhand smoke, air pollution and occupational exposure (to coal, cotton, grain) are also important risk factors.

Chronic inflammation plays a major role in COPD pathophysiology. Smoking and other airway irritants cause neutrophils, T-lymphocytes, and other inflammatory cells to accumulate in the airways. Once activated, they trigger an inflammatory response in which an influx of molecules, known as inflammatory mediators, navigate to the site in an attempt to destroy and remove inhaled foreign debris.

Under normal circumstances, the inflammatory response is useful and leads to healing. In fact, without it, the body would never recover from injury. In COPD, repeated exposure to airway irritants perpetuates an ongoing inflammatory response that never seems to shut itself off. Over time, this process causes structural and physiological lung changes that get progressively worse.

As inflammation continues, the airways constrict, becoming excessively narrow and swollen. This leads to excess mucus production and poorly functioning cilia, a combination that makes airway clearance especially difficult. When people with COPD can't clear their secretions, they develop the hallmark symptoms of COPD, including a chronic, productive cough, wheezing and dyspnea. Finally, the build-up of mucus attracts a host of bacteria that thrive and multiply in the warm, moist environment of the airway and lungs. The end result is further inflammation, the formation of diverticula (pouch-like sacs) in the bronchial tree, and bacterial lung infection, a common cause of COPD exacerbation.