Copd Management

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Breathing new life into

COPD management

16 Nursing made Incredibly Easy! July/August 2011

www.NursingMadeIncrediblyEasy.com

Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) promotes awareness, education, and care for patients with chronic obstructive pulmonary disease (COPD). The committee annually reviews evidence-based guidelines for prevention, diagnosis, and treatment of COPD. We give you an overview of these guidelines. By Brenda L. Smith, MSN, RN, CMSRN Nursing Instructor • UPMC Shadyside School of Nursing • Pittsburgh, Pa. Frederick J. Tasota, MSN, RN Critical Care Clinical Specialist • UPMC Presbyterian Hospital • Pittsburgh, Pa. The authors have disclosed that they have no significant relationships with or financial interest in any commercial companies that pertain to this educational activity.

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GOLD is a consortium of international experts whose objective is to improve worldwide awareness, education, and care for COPD patients. Formed in 1997 in collaboration with the World Health Organization (WHO) and the National Heart, Lung and Blood Institute, the consortium published its initial report in 2001, following a comprehensive review of existing guidelines for COPD. After reviewing the world’s literature each year, committee members continue to develop evidence-based guidelines for preventing, diagnosing, and treating COPD. Annual updates are available online at http://www.goldcopd.org. In this article, we give you an overview of these important guidelines to promote their use in the clinical setting.

Coming to terms
The term COPD doesn’t describe one disease process; rather, it encompasses pathology from different disease states that ultimately produce chronic and irreversible limitations in airflow. The GOLD report www.NursingMadeIncrediblyEasy.com

defines COPD as a preventable and treatable disease characterized by airflow limitation that also has some extrapulmonary (outside of the lung) effects that may contribute to other comorbidities in certain patients. The airflow limitation is progressive in nature and is associated with an abnormal lung inflammatory response. Chronic bronchitis and emphysema have long been identified as the two categories beneath the umbrella term COPD. Interestingly, the 2010 GOLD report includes neither of these disease entities in its definition of COPD. Bronchitis isn’t always associated with airflow obstruction, and the alveolar destruction that’s indicative of emphysema is only one of multiple lung abnormalities present in COPD. However, the 2010 report does describe the characteristic airflow limitation of COPD developing from small airway disease (obstructive bronchiolitis) and lung tissue destruction (emphysema). Chronic bronchitis is diagnosed by the presence of a cough with sputum production for 3 months a year for 2 consecutive July/August 2011 Nursing made Incredibly Easy! 17

Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

years. Although this is a disease of the small airways, its definition doesn’t include reference to airflow limitation, and many patients who don’t have a chronic cough and sputum production may develop airflow limitation. However, the presence of a cough and sputum production doesn’t exclude a diagnosis of COPD. Obstructive bronchiolitis involves narrowing of the small airways that may result from various pathologic states. This broader term better reflects the airflow limitation of COPD as defined by the GOLD report. Emphysema is associated with alveolar destruction, which reduces the surface area available for gas exchange. This structural change decreases elastic recoil— the ease with which the lung

relaxes during expiration—and results in alveolar hyperinflation and air trapping. There are two commonly recognized...
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