COPD & Emphysema
Chronic Obstructive Pulmonary Disease (COPD)
- Gradual irreversible disease of the lungs.
- COPD is the umbrella term for both diseases.
- Emphysema is alveolar collapse and chronic bronchitis is inflamed bronchioles/bronchi with lots of mucus.
- Both have “air trapped in lungs”
- Both hyperventilate trying (without success) to blow out excess CO2Â
Chronic bronchitis can lead to pulmonary hypertension and right-sided heart failure.
Risk Factors
- Smoking
- Old age
- Exposure to pollution, chemicals and dust
Diagnosis
- Chest X-ray
- Pulmonary Function tests
- ABG will show chronic compensated respiratory acidosis (pCO2 retained)
- Oxygenation < 90% on room air
Treatment
- No smoking
- Low Oxygen therapy
- Bronchodilators
Venturi Mask has a dial to delivery low flow oxygen (Usually on 28% for COPD clients). Remember that room air is 21% and each liter of oxygen is 4%. So 28% venturi mask is close to 2 L/NC.
Low Oxygen
- Only use 2 L nasal cannula or a venturi mask that delivers low oxygen unless severely hypoxic and ready to be intubated
- It is low oxygen that keeps these clients breathing.
- NCLEX: if you put a COPD client on oxygen, he/she will stop breathing
Medications
- Prednisone: Oral corticosteroid for exacerbations. Watch for bruising, infection, elevated glucose levels.Â
- Pulmocort: “cort” = corticosteroids. Rinse mouth and spit water.
- Spiriva: Long-acting bronchodilator; anticholinergic; tiotropium bromide.
- Take Bronchodilator first then 5 minutes later take corticosteroid. Spiriva then pulmocort.Â
- Symbicort: Both bronchodilator (LABA) and corticosteroid.
- LABA= Long acting beta agonist
- SABA= Short acting beta agonist
- Salmeterol: long-acting bronchodilator. Beta 2 agonist.
- Theophylline: Xanthine bronchodilator. Monitor therapeutic levels 10-20 mcg/ml
- Roflumilast: phosphodiesterase-4 inhibitor for severe chronic bronchitis. Monitor for suicidal ideation.
COPD medications