Chronic Obstructive Pulmonary Disease (COPD) in older people comprises emphysema, chronic bronchitis, and asthma. COPD is resistance to expiratory airflow, that is, resistance to air leaving the lungs.
Emphysema
Emphysema is characterized by progressive changes in the lung tissue. The alveolar sacs become distended and break down, destroying the capillary bed. The loss of elasticity in the alveoli prevents normal expiration. Fibrous tissue replaces much of the capillary bed and interferes with normal exchange of oxygen and carbon dioxide during respiration.
Chronic Bronchitis
Chronic bronchitis is inflammation of the bronchi with excessive mucous secretion and a persistent cough. Smoking and air pollutans are among the factors causing this condition.
Asthma
Asthma is airflow obstruction caused by spasm of the smooth muscle of the bronchial tubes, swelling of the mucous membrane, and thick bronchial secretions. The classic wheezing occurs as the air tries to move out through narrowed bronchi and bronchioles. Causes of asthma include allergy, infection, and emotional stress.
The signs and symptoms of COPD are shortness of breath and cough. The expiration of air is prolonged. In advanced COPD, a “barrel chest” is apparent.
The treatment of COPD involves long-term planning with the patient, family, physician, nurse, and respiratory therapist. Education is aimed at slowing progression of the disease. The patient should be taught to avoid respiratory irritants and respiratory infection. Depending on the patient`s status, pulmonary ventilation is improved by a number of measures :
- Bronchodilating drugs
- Humidification of the air in the patient`s immediate environment to loosen secretions
- Intermittent positive-pressure breathing
- Breathing exercises
- Chest percussion and postural drainage
- Oxygen therapy
- Adequate rest
- Extra fluids
- A well-balanced diet
Emotional support is a critical part of the treatment.
Reference :
Farrell J : Nursing Care of the Older Person, J.B. Lippincott Company, Philadelphia, 1990.
