CHRONIC OBSTRUCTIVE PULMONARY
DISEASE (COPD) AND ASTHMA
a. Chronic obstructive pulmonary disease (COPD): chronic
obstructive bronchitis and emphysema
i. Chronic airflow limitations (CAL): caused by a mixture
of small airway disease (obstructive bonchiolitis) and
parenchymal destruction (emphysema)
ii. Airway inflammation: causes structural changes, narrowing
of lumina, and loss of elastic recoil in parenchyma
b. Asthma (also called chronic reactive airway disease)
i. Chronic inflammatory disorder—episodic exacerbations
of reversible inflammation and hyperreactivity and
variable constriction of bronchial smooth muscle,
hypersecretion of mucus, and edema
II. Spirometric Classification of Severity of COPD—2007
Global Initiative for Chronic Obstructive Lung Disease
a. Stage I (mild COPD)—mild airflow limitation (FEV1/FVC
0.70; FEV1 to 80% predicted)
b. Stage II (moderate COPD)—worsening airflow limitation
(FEV1/FVC 0.70; 50% to FEV1 80% predicted);
shortness of breath on exertion, and cough and sputum
production may be present
c. Stage III (severe COPD)—continued worsening of airflow
limitation (FEV1/FVC 0.70; 30% to FEV1 50%
predicted); increasing shortness of breath, reduced exercise
capacity, fatigue, and repeated exacerbations
d. Stage IV (very severe COPD)—severe airflow limitation
(FEV1/FVC 0.70; FEV1 30% predicted or FEV1
50% predicted plus presence of chronic respiratory
i. Risk factors: smoking (primary irritant), air pollution,
secondhand smoke, history of childhood respiratory
infections, heredity—1-antitrypsin deficiency
ii. Acute exacerbations usually due to pulmonary infections
i. Tends to be acute and intermittent or episodic
ii. Genetic and environmental: household substances (such
as dust mites, pets, cockroaches, mold), pollen, foods,
latex, emotional upheaval, air pollution, cold weather,
exercise, chemicals, medications, viral infections
IV. Statistics (American Lung Association, 2006, 2007a;
National Heart, Lung and Blood Institute [NHLBI], 2008b)
i. Morbidity: COPD affects more than 12 million people.
ii. Mortality: It is the fourth leading cause of death in the
United States with 122,000 deaths in 2003; women’s
deaths exceed that of men (63,000 females to 59,000
iii. Cost: $37.2 billion is spent each year.
i. Morbidity: Asthma is most common chronic disorder in
children, affecting 6.8 million under age 18; affects
15.4 million adults.
ii. Cost: $14.7 billion is spent each year.
Primarily community level; however, severe exacerbations
may necessitate emergency or inpatient hospital stay.
Heart failure: chronic
Psychosocial aspects of care
Ventilatory assistance (mechanical)
1. Maintain airway patency.
2. Assist with measures to facilitate gas exchange.
3. Enhance nutritional intake.
4. Prevent complications and slow progression of condition.
5. Provide information about disease process, prognosis,
and treatment regimen.
1. Ventilation/oxygenation adequate to meet self-care needs.
2. Nutritional intake meeting caloric needs.
3. Infection treated or prevented.
4. Disease process, prognosis, and therapeutic regimen
5. Plan in place to meet needs after discharge.