Chronic Obstructive Pulmonary Disease

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Introduction
“Chronic obstructive pulmonary disease (COPD) is a lung ailment that is characterized by a persistent blockage of airflow from the lungs” ( World Health Organisation (WHO) website, nd). This report will examine the causes, symptoms and treatment of COPD. It will discuss current statistics on COPD and some of the current treatments available. Multiple sources were used including websites, leaflets and government documents.

Over 440,000 people in Ireland are thought to have COPD ( Living with COPD website, nd). By 2020, it is predicted to be the third leading cause of death worldwide (Living with COPD website, 2013).

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A recent COPD audit in Europe discovered that 50% of sufferers will die or be readmitted to hospital within a 3 month period (Living with COPD website, 2013). Approximately 1400 people die every year from the condition (Oireachtas website, 2013). Ireland has one of the highest incidents of death in Europe from COPD (Living with COPD website, 2013). COPD is an irreversible lung disease which causes permanent lung damage. In COPD, the airflow to the lungs become narrower and blocked and breathing becomes difficult (COPD Support website, nd).

COPD is an umbrella term for Chronic Bronchitis and Emphysema (Living with COPD website, nd).

Causes
The single biggest cause of COPD is smoking. 80-90% of people with the condition have COPD due to smoking.

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(COPD Support website, 2009). Other causes are air pollution, exposure to fumes or dust particles at work, passive smoking, recurring respiratory infections in early life and a rare genetic disorder called Alpha-1 Antitrypsin Deficiency (National Heart, Lung and Blood Institute website, nd).

Diagnosis and Symptoms

A breathing test called Spirometry is used to diagnose COPD (COPD FOUNDATION
Website, nd). The test measures how well a person breathes. In Ireland, access to Spirometry Tests is not available nationwide and tests must be carried out in hospital (Oireachtas website, 2013). Early diagnosis can greatly slow down the condition (National Health Service website, 2012).

Often COPD is diagnosed after a person has an exacerbation of the condition (American Thoracic website, nd).

An exacerbation of COPD means the symptoms have become more severe. It is generally caused by an infection in the lungs and hospitalisation is required which leads to diagnosis of the condition ( American Thoracic website, nd).

Symptoms of COPD include wheezing, persistent cough with mucus that will not go away, breathlessness completing everyday tasks and difficulty taking deep breaths (American Lung Association website, nd). Symptoms typically start to emerge from the age of 40 years onwards (Living with Copd website, 2013). Long term complications associated with COPD include, weight loss and swallowing issues known as Dysphagia (Queensland Health and The Australian Lung Foundation, 2012). Swallowing issues can arise as the patient can often breathe when eating, which causes food to enter the lungs. This can lead to reflux, indigestion problems, difficulty in finishing meals and lung infections (Queensland Health and The Australian Lung Foundation, 2012).

Stages
There are 4 stages of COPD: Mild, Moderate , Severe and Very Severe (End Stage) (COPD International website, nd).

Mild: The person may have slight breathlessness and may or may not have a cough but is unaware they have COPD (COPD International website, nd).

Moderate: Breathlessness carrying out day to day tasks, may or may not have frequent cough with mucus. At this stage the condition is normally diagnosed as symptoms become more severe (COPD International website, nd).

Severe: COPD greatly affects the quality of life, physical activity is limited, exacerbations of COPD are much more frequent (COPD International website, nd).

Very Severe/End Stage; At this stage oxygen is required continuously, any exertion at all is difficult. Chronic Respiratory Failure and/or Heart Failure and death occurs (Kenny,T 2011).

This knowledge would enable a Healthcare Support Worker to identify the early signs of the condition, have an increased awareness of a patient with a persistent cough, frequent colds or chest infections and encourage the patient to seek medical help for a diagnosis.

Treatments
Stopping smoking is critical in treating COPD, as giving up smoking greatly prevents the condition worsening. Inhalers are generally used to control and relieve symptoms of COPD. Short-Acting Inhalers are used to alleviate breathlessness, Long-Acting Inhalers which work over 12 hours to relieve symptoms, and Steroid Inhalers also assist breathing (British Lung Foundation website, nd). Oxygen Therapy is used in severe COPD. Patients may require oxygen for day to day tasks, when sleeping or in some cases, 24 hours a day. Oxygen is available in tanks, liquid form or oxygen concentrators (COPD Support website, nd).

Pulmonary Rehabilitation Programmes also plays a vital role in the treatment of COPD (Oireachtas website, 2013). In Ireland, programmes are normally ran over 20 sessions, with patients attending two to three times a week. Group numbers are limited to a maximum of 15 people. The programme consists of Exercise, Nutrition to increase fitness levels and Education to increase the patients awareness of the condition (Health Service Executive website, 2013). COPD patients have been shown to gain hugely from Pulmonary Rehabilitation Programmes, improving quality of life, reducing hospital admissions and increasing survival chances (Oireachtas website, 2013).

A person with COPD uses 10 times the energy to breathe than a person without the condition. It is important to replace lost calories, maintain weight and also to protect the immune system against colds and flu’s (American Lung website, nd). Foods high in both energy, sugar and fat such as fried foods, full fat dairy products and readymade meals are recommended to encourage weight gain. However it is important that a healthy diet is also

maintained (COPD Education website, nd). Supplement drinks are often recommended to increase calorie intake between meals. If swallowing issues occur, soft foods such as soups and stews are recommended and patients are encouraged to eat several smaller meals throughout the day (COPD Education website, nd). With this knowledge a HealthCare Worker would ensure that meals are small but nutritious at regular intervals . A HealthCare Support Worker would also consider how meals are prepared as softer, more manageable foods may be required.

Conclusion
This report has examined the causes, symptoms and treatments of COPD. This report discussed current statistics regarding the condition and some of the treatments available. From researching this report it is clear that more public awareness of COPD in Ireland is essential to highlight the link between COPD and smoking.

COPD needs to feature strongly in Anti-smoking campaigns to promote this awareness, which would enable early diagnosis and treatment.