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COPD, References Agarwal, A., Raja, A., & Brown, B. (2021). Chronic…

- - - - Affects airways, alveoli, and pulmonary vasculature.
      - Triggered by irritants, a major one being smoking, or genetic factors like AATD.
      - Involves oxidative stress and protease-antiprotease imbalances.
    - - Emphysema
        
        Alveolar destruction and loss of elastic recoil impair exhalation.
        
        Overdistention of alveoli leads to air trapping and CO2 retention.
        
        Caused by protease-mediated elastin breakdown.
        
        AATD emphysema affects lower lobes and is associated with liver damage.
      - Chronic Bronchitis
        (Capriotti, 2020)
        
        Mucus hypersecretion in large and small airways obstructs airflow.
        
        Diagnosed with chronic cough lasting 3 months per year for 2 consecutive years.
        
        Results in hypoxia and cyanosis.
    - - Fibrosis, narrowing of bronchioles, and smooth muscle hypertrophy.
      - Chronic inflammation thickens airway walls and constricts lumens.
      - Leukotrienes, interleukins, and TNF contribute to lung damage.
    - - Episodes of bronchoconstriction in response to irritants
    - - Decreased FEV1 and airflow limitation.
      - Poor ventilation and hypoxia in severe cases.
      - CO2 retention due to impaired exhalation and hyperinflation.
  - - - Pulmonary function tests
        
        Spirometry is the gold standard for diagnosis. Key indicators include a reduced FEV1/FVC ratio (<70% post-bronchodilator).
      - Chest x-ray
        
        May reveal hyperinflation or flattened diaphragms in emphysema
      - CT scan
        
        Provides more detailed lung imaging, detecting emphysema or other structural changes.
      - Pulse oximetry
        
        Monitors oxygen saturation.
      - COPD assessment test
        
        A questionnaire assessing symptoms like breathlessness, cough, and activity limitations
      - BODE Index
        
        Evaluates COPD severity based on body mass index, airflow obstruction, dyspnea, and exercise capacity
    - - Arterial blood gas
        
        Evaluates oxygenation and carbon dioxide levels in severe cases
      - Alpha-1 antitrypsin testing
        
        Screens for genetic risk in younger patients without smoking history
  - - - Chronic cough
      - Sputum production
      - Dyspnea
      - Wheezing
      - Chest tightness
    - - Fatigue
      - Unintentional weight loss
      - Edema
      - Cyanosis
      - Barrel chest
    - - Hypoxemia
      - Hypercapnia
      - Increased use of accessory muscles
      - Pursed lip breathing
      - Confusion
      - Tachypnea
- - - - Expand telehealth services, provide transportation assistance, or refer patients to clinics offering free or low-cost pulmonary services
  - - - Connect patients to medication assistance programs, financial counseling, or insurance resources to cover COPD treatments and inhalers.
  - - - Improve health literacy by offering tailored patient education on COPD, inhaler techniques, symptom management, and the importance of follow-ups through one-on-one sessions or group classes
- - - - Stimulate beta-2 receptors in bronchiole smooth muscles, causing relaxation and bronchodilation to improve airflow.
      - Short acting & long acting
    - - Block acetylcholine receptors to reduce bronchoconstriction and improve airflow.
    - - Provide bronchodilation and reduce airway inflammation.
    - - Reduce inflammation during acute exacerbations.
    - - Decrease mucus viscosity, making it easier to clear airways
  - - - High Fowler's facilitates lung expansion
    - - Counseling & nicotine replacement therapy
    - - Pursed lip breathing and diaphragmatic breathing to encourage oxygenation
    - - To prevent flu and pneumonia
    - - Improve physical fitness and reduce symptoms