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Wednesday, 16 November 2011

Chronic Pulmonary Disease



The condition of chronic obstructive pulmonary disease (COPD), nothing like a good number of other illnesses, is growing in incidence globally. This boost, at least to some extent, is probably as a result of the population surviving much longer generally and increasing cigarette use in developing nations. Moreover, even though contact to cigarette fumes is by a long way, it is the foremost identifiable origin of COPD. Similarly, contact to specific occupational dirt and chemicals have also been deemed to be another cause of COPD. On the other hand, exposures at home in smoke used for cooking and heating are also liable causes. Furthermore, one could not discount the genetic predisposition which might have triggered the illness among the casualties. This paper will look into the condition of a geriatric patient admitted for COPD exacerbation in which complications have taken place before his release. For clarity and coherence of the paper, the discussions and assessment on the stated case will be divided into several parts. One part will be discussing the probable questions that could help the assessment on making out the complications that the patient has acquired. The subsequent part will be discussing the body systems that will be involved in the assessment of the case. It is in this part where the respiratory system and the heart are to be discussed. Specifically, the parts in which the complications might have been involved in the case of the patient are to be taken into consideration. The third part is going to look into the factors in which the patient might encounter risk with regards to the treatment. And finally, after the discussions regarding the situation, a conclusion will be provided with regards to the condition of the patient and concerns with COPD in general.

Questions Providing Essential Information

In the case study, the patient is admitted in the hospital for exacerbated COPD with complications like pneumonia. An exacerbation of COPD is described by a boost in cough, with an alteration in color or amount of sputum or a worse condition of dyspnea. (Shelley and Salpeter, 2003) Before the patient is discharged, he complained of a pain in the left part of his chest and shortness of breath.   

o       Does the patient have a family history of heart problems?

o       Does he have a hypertension and high cholesterol in his medical history?

o       Has the patient totally stopped smoking tobacco?

o       Does the patient feel emotionally strained?

o       Is the pain felt underneath the breastbone?

o       Is the pain characterized by a prickly, intense, or constricting feeling?

o       Does the pain start after a walk or if he leaves his bed?

o       Is the pain relieved when the patient gets enough rest?

In looking at the response of the patient based on the case, one could suspect that the patient is experiencing an episode of angina. Moreover, if the medical history of the patient is taken into account, one could also presume the existence of a case of chronic heart failure. 

Body Systems Included in the Assessment

The condition of the elderly patient with COPD is actually possible in terms of acquiring heart diseases. Patients with COPD are at bigger danger of acquiring heart illnesses as compared to asthmatics. (Shelley and Salpeter, 2003) Nevertheless, they similarly possess more severe airway impediments such that they may possibly be more susceptible to small alterations in forced expiratory volume of 1 second. (FEV1) In a study of Shelley and Salpeter (2003), they noted that these patients would make the most from the employment of ß blockers.

In a study of Cilli, Uslu, Ozdemir (2004), they noted that patients with chronic obstructive pulmonary disease (COPD) have a bigger possibility of fatality from reasons other than COPD. The most frequent comorbid illnesses include hypertension (22%), coronary heart disease (8.9%), diabetes mellitus (7.4%), cancer (6.4%), heart failure (4.9%) and cerebrovascular disease (2%). Whereas  most  said that sicknesses were stated to be the most frequent comorbid factor, FEV1, heart failure and cancer were related components with bigger threat of death from COPD.

On the other hand, it was stated that the case may possibly be complicated by a heart condition on the part of the patient, thus, it is important to take a look at the possibility of the patient having a chronic heart failure. Left-sided chronic heart failure (CHF) takes place in patients with COPD for the reason of a concurrent cardiac disorder like coronary artery disease or hypertension. (Wilbert and Aronow, 2003) This is apparently present in the case of the elderly patient considering he had a history of hypercholesterolemia and poorly controlled hypertension. It should be treated in concurrence with the COPD, however, on grounds of financial problems with the patient, it was ceased. Moreover, according to the work of Wilbert and Aronow (2003) it is important to establish whether the patient has really stopped smoking. If he did stop, it must be established whether he has been constantly exposed to other probable sources of COPD, like secondary cigarette smoke or chemical dusts.

Another system to be checked is the respiratory tract. (Wilbert and Aronow, 2003) It should be checked if it is infected. If it is infected, it might lead to RV failure. This means that it should be treated quickly. To look if the tract is indeed infected,   the secretions of the sputum should be monitored to establish whether there is a need to employ mucolytic agents to address this condition.

Risk Factors in the Patient’s Condition

This part will be discussing the risk factors involved in the condition of the patient. Particularly, those related to the lifestyle choices, medications, and conditions are going to be pointed out in this context.   


The patient might have exacerbated his condition because of his being bed-ridden for several days caused by his COPD exacerbation. This might have triggered the heart condition that has been caused by his previous illnesses GERD, hypercholesterolemia, and hypertension over and above his exposure to smoking. His old age has also added the risk of the heart condition. Having a geriatric patient lessens the capability and speed of recovery because of the slower metabolism of the patient. Similarly, the inactivity of the patient might have also triggered the disease since he has been confined for several days already. This inactivity might have slowed down his already slow metabolism rate and might have triggered the illness along with the help of the COPD. 

Lifestyle choices

There are two lifestyle choices that should be looked into in taking into account of the risk factors present in the patient’s condition. First is the existence of alcohol abuse or withdrawal. Alcohol consumption is associated with a favorable lipid profile. (Mozaffarian et al, 2004) On the other hand, greater intake is associated to brain atrophy.

Another lifestyle choice is smoking. Cigarette smoking is a well recognized risk factor for illnesses among adolescent and grown-up populations. Older adults who have ceased smoking have inferior risk than those who carry on smoking. (Mozaffarian et al, 2004) However, continuous exposure to cigarette smokes such that of second hand smoke may still trigger the risk factor.


Early methods for the management of COPD are in a lot of aspects considerably unlike from current recommendations. At first, the amount of pharmacologic agents accessible to take care of COPD was inadequate. Antibiotics, mucolytics, and nonselective sympathomimetics were the key agents provided for COPD management. (Petty, 2002) Paradoxically, oxygen and working out a couple of the most common elements of treatment today were deemed harmful.

Antibiotics have been accessible to take care of patients with COPD for years and frequently were controlled consistently in patients with obstructive lung disease. Even though patients with COPD are more vulnerable to pulmonary illnesses than those patients with no COPD and management of these agents is an essential element of the management of infection connected with COPD, antibiotic treatment must be employed more prudently nowadays than it was in the past. Antibiotic resistance formerly was recognized in the 1970s and has been growing progressively in commonness. (Faulkner and Hilleman, 2002) On account of this occurrence, patients nowadays are monitored more cautiously for antibiotic requirement. (Saint et al, 2001)

On the other hand, mucolytic drugs are deemed to boost the expectoration of sputum by lessening its thickness. (Faulkner and Hilleman, 2002) More than a few years ago, mucolytic treatment with an oral mixture of potassium iodide was provided to dilute the mucus of patients with COPD. (Petty, 2002) Nowadays, it would be atypical to see this agent employed in such ability to view its possibly harmful implications in individuals with thyroid disease, and for the reason that other mucolytic agents are readily obtainable. In addition, the effectiveness of mucolytic agents for a good number of patients with COPD has been challenged. Merely lessening the thickness of mucus may possibly be useless with no general reduction in the quantity of mucus emitted. (Rogers, 2002)


Patients who are indicative with constant COPD have need of a range of interventions to optimize their way of life and continued existence. Conditional on their individual conditions, they may possibly take advantage from making the most of airflow, lessening and clearance of secretions, physical treatment, averting infections, and guaranteeing sufficient oxygenation. The different components can be brought in eventually with cautious inspection to establish which intercession has constructive (or adverse) consequences. Responsiveness of other disorders that are frequent among those with COPD will assist in early detection, cure, or prevention. Punctual acknowledgment and efficient administration of acute exacerbations of COPD are necessary. Moreover, facts from this study advocates that diet, physical activity, and smoking habits in the later part of a person’s life may have an effect with health risk. Corresponding to medical or surgical intercessions, such lifestyle alterations are comparatively low risk, low rate, and extensively pertinent. Consequently, even small alterations in risk because of these elements may possibly be important on a population level.


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