Chronic Obstructive Pulmonary Disease (COPD)

Comparison of healthy lungs versus COPD-affected lungs showing anatomical differences

Figure 1: Anatomical comparison between healthy lungs and COPD-affected lungs showing structural changes

1. Definition

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, inflammatory lung disease characterized by persistent respiratory symptoms and airflow limitation that is not fully reversible. It is caused by significant exposure to noxious particles or gases, most commonly from tobacco smoke.

Progressive

Worsens over time

Inflammatory

Chronic inflammation

Irreversible

Not fully reversible

2. Types of COPD

Chronic Bronchitis

Productive cough for ≥3 months in 2 consecutive years
Excessive mucus production
Inflamed and thickened bronchial walls
“Blue bloater” appearance

Emphysema

Destruction of alveolar walls
Loss of elastic recoil
Air trapping and hyperinflation
“Pink puffer” appearance

3. Etiological Factors

Primary Risk Factors

Tobacco Smoking (80-90% of cases)

Most significant risk factor for COPD development

Occupational Exposure

Dust, fumes, chemicals in workplace

Air Pollution

Indoor and outdoor pollutants

Secondary Risk Factors

Genetic Factors

Alpha-1 antitrypsin deficiency

Respiratory Infections

Childhood respiratory infections

Age & Gender

Age >40, increasing prevalence in women

Memory Aid: COPD Risk Factors

SMOKING

S – Smoking (tobacco)
M – Manufacturing/occupational exposure
O – Outdoor air pollution
K – Kitchen smoke (indoor pollution)
I – Infections (respiratory)
N – Nature (genetic predisposition)
G – Gender and age factors

4. Pathophysiology

Pathophysiological Process

Noxious Particles/Gases Exposure

Inflammatory Response Activation

Mucus Hypersecretion & Cilia Dysfunction

Airway Remodeling & Alveolar Destruction

Airflow Obstruction & Gas Exchange Impairment

Inflammatory Changes

Neutrophil infiltration
Macrophage activation
Cytokine release (IL-8, TNF-α)
Oxidative stress

Structural Changes

Airway wall thickening
Smooth muscle hypertrophy
Goblet cell hyperplasia
Alveolar wall destruction

5. Signs & Symptoms

Primary Symptoms

Chronic cough
Sputum production
Progressive dyspnea
Wheezing
Chest tightness

Physical Signs

Barrel chest
Use of accessory muscles
Pursed-lip breathing
Decreased breath sounds
Prolonged expiration

Advanced Signs

Cyanosis
Digital clubbing
Pedal edema
JVD (jugular venous distension)
Weight loss/cachexia

COPD Severity Staging (GOLD Classification)

6. Nursing Assessment

Comprehensive Assessment Framework

Respiratory Assessment

• Respiratory rate, rhythm, depth
• Oxygen saturation levels
• Breath sounds auscultation
• Cough characteristics
• Sputum color, consistency, amount

Functional Assessment

• Activities of daily living (ADL)
• Exercise tolerance
• Sleep patterns
• Nutritional status
• Psychological impact

Assessment Tools

CAT Score: COPD Assessment Test for symptom impact
6MWT: Six-minute walk test for functional capacity
mMRC Scale: Modified Medical Research Council dyspnea scale

Priority Assessment Areas

Gas Exchange: ABG analysis, pulse oximetry
Cardiac Status: Signs of right heart failure
Mental Status: Confusion, anxiety, depression

7. Diagnosis

Pulmonary Function Tests (PFTs)

Spirometry (Gold Standard)

FEV1/FVC ratio <0.70 post-bronchodilator

FEV1 (Forced Expiratory Volume)

Determines severity staging

Additional Diagnostic Tests

Chest X-ray
CT scan (high-resolution)
Arterial blood gas analysis
Alpha-1 antitrypsin level
Echocardiogram

8. Medical Management

Pharmacological Management

Bronchodilators

• SABA (Albuterol)
• LABA (Salmeterol)
• SAMA (Ipratropium)
• LAMA (Tiotropium)

Anti-inflammatory

• ICS (Fluticasone)
• Combination therapy
• Systemic corticosteroids

Adjunct Therapy

• Mucolytics
• Antibiotics (exacerbations)
• Vaccines (flu, pneumonia)

Non-pharmacological Management

Smoking cessation
Pulmonary rehabilitation
Oxygen therapy
Nutritional support
Vaccination programs

Advanced Interventions

Bronchoscopic interventions
Lung volume reduction surgery
Lung transplantation
Long-term oxygen therapy
Non-invasive ventilation

9. Nursing Management

Priority Nursing Diagnoses

Primary Diagnoses

• Ineffective airway clearance
• Impaired gas exchange
• Ineffective breathing pattern
• Activity intolerance

Secondary Diagnoses

• Anxiety related to dyspnea
• Risk for infection
• Imbalanced nutrition
• Knowledge deficit

Respiratory Care

• Monitor respiratory status q4h
• Position for optimal breathing
• Administer oxygen as prescribed
• Assist with bronchodilator therapy
• Encourage deep breathing exercises
• Suction PRN for secretion management

Activity & Comfort

• Plan activities around energy levels
• Promote rest periods
• Encourage gradual activity increase
• Assist with ADLs as needed
• Maintain comfortable environment
• Anxiety reduction techniques

Prevention & Education

• Infection prevention measures
• Medication adherence teaching
• Inhaler technique demonstration
• Smoking cessation support
• Nutritional counseling
• Self-management education

10. Nursing Implementation

Evidence-Based Nursing Interventions

Immediate Care (First 24 Hours)

Baseline assessment and vital signs
Respiratory assessment q2-4h
Administer prescribed medications
Oxygen therapy per protocol
Position for comfort and breathing

Ongoing Care Management

Daily symptom monitoring
Progressive activity planning
Patient education sessions
Family involvement in care
Discharge planning preparation

Breathing Technique Implementation

Pursed-Lip Breathing

1. Inhale slowly through nose (2 counts)
2. Purse lips as if whistling
3. Exhale slowly through pursed lips (4 counts)
4. Practice 10-15 minutes, 3-4 times daily

Diaphragmatic Breathing

1. Place hand on chest, hand on abdomen
2. Breathe slowly through nose
3. Chest should remain still
4. Abdomen should rise and fall

Incentive Spirometry

1. Sit upright
2. Seal lips around mouthpiece
3. Inhale slowly and deeply
4. Hold breath for 3-5 seconds

Medication Administration Guidelines

Inhaler Technique Checklist

Remove cap and shake inhaler 5 times Exhale fully away from inhaler Place lips around mouthpiece Press down while inhaling slowly Hold breath for 10 seconds Rinse mouth if corticosteroid

Monitoring Parameters

Heart rate and rhythm
Blood pressure
Oxygen saturation
Respiratory rate and effort
Mental status changes
Medication effectiveness

11. Complications

Acute Complications

COPD Exacerbation: Acute worsening of symptoms requiring medical intervention
Pneumothorax: Spontaneous lung collapse due to bullae rupture
Respiratory Infections: Pneumonia, bronchitis exacerbations

Chronic Complications

Cor Pulmonale: Right-sided heart failure from pulmonary hypertension
Cachexia: Severe weight loss and muscle wasting
Depression/Anxiety: Psychological impact of chronic illness

12. Prevention & Patient Education

Patient Education Framework

Smoking Cessation

• Benefits of quitting at any stage
• Nicotine replacement therapy
• Support groups and counseling
• Relapse prevention strategies

Medication Management

• Proper inhaler techniques
• Medication schedules
• Side effect recognition
• When to seek medical help

Lifestyle Modifications

• Regular exercise programs
• Nutritional optimization
• Energy conservation techniques
• Stress management

COPD Action Plan Template

Green Zone – Good Day

• Breathing is good
• Can do usual activities
• Sleeping well
• Take regular medications

Yellow Zone – Caution

• Increased cough/sputum
• More breathless than usual
• Less able to do activities
• Use rescue inhaler more often

Red Zone – Emergency

• Very breathless at rest
• Cannot speak in full sentences
• Confused or drowsy
• Call 911 immediately

Key Nursing Points to Remember

Clinical Priorities

• COPD is progressive and irreversible
• Early recognition prevents complications
• Patient education is crucial for management
• Smoking cessation is the most important intervention

Nursing Focus Areas

• Optimize breathing and gas exchange
• Prevent respiratory infections
• Promote activity tolerance
• Support psychological well-being