COPD Management and Treatment Options

This assignment provides an overview of the management and treatment options for chronic obstructive pulmonary disease (COPD). It includes a review of various studies, guidelines, and resources related to COPD care. The assignment highlights the importance of early diagnosis, proper medication use, and pulmonary rehabilitation in improving patient outcomes. It also discusses the potential cost-effectiveness of different treatment approaches and the need for individualized care plans. Overall, this assignment is a valuable resource for students, researchers, and healthcare professionals seeking to understand COPD management strategies.

CARE DELIVERY AND MANAGEMENT
1
CONTRIBUTING TO CARE DELIVERY AND MANAGEMENT OF A COPD PATIENT
By Student’s Name
Course + Code
Class
Institution
Date

CARE DELIVERY AND MANAGEMENT
2
Patient Admission
Mr. James, a 69 years old man comes to St Bartholomew's (Bart's) hospital with his
wife complaining of difficulty in breathing and shortness of breath. James says “ever since
this cold weather started, I have been having a hard time breathing. I need my lungs to be
checked”. James wife explains that James has been having a hard time recently to the extent
that he could not do normal routines anymore. In addition to that, James stated that he had
had persistent coughs, especially during the night. Although a cough is productive, James and
his wife fail to give an estimate of the sputum produced. Sleeping in the bed has been a
problem in the previous night that he spent setting his back on his easy chair. James wife
further explained that it is by her effort that James was able to come to the hospital. James
wife came had come with the last medical records for review.
Past Medical/Surgical History
James reported having been admitted several times in the past years. The patient was
first diagnosed with Chronic Obstructive Pulmonary Disease(COPD) at the age of 65 years
and admitted for one month. One year later the patient was diagnosed with type 2 diabetes
and Osteoporosis of which the conditions were managed. James was on anti-diabetes
medication for one year at which the condition was later managed using diet and physical
exercises. From the past health records, the patient was put on biophoshates for the treatment
of osteoporosis. At the age of 67 years, the patient developed hypertension of which the
condition was managed using several antihypertensives. Patient has been on a proper diet and
physical exercises until recent days where he could not perform enough activities. The patient
has healthy siblings.

CARE DELIVERY AND MANAGEMENT
3
Social history
James is married with four children of which three are girls and one boy. Patient has a
forty years history of smoking cigarettes. James used to smoke one pack of cigarette daily but
reduced to a quarter pack after being diagnosed with COPD. The patient explains he had not
been able to quit smoking, but he is working toward it. Patient has 35 years of taking alcohol
but entirely after diagnosed with diabetes and osteoporosis. Currently, the patient lives with
his wife only as all the children are grownups working at long distances from home. No
known allergies.
Current medication
James has been on prednisolone 30mg daily, Saltemerol inhaler 50 twice daily, Aspirin 81mg
daily and tiotropium inhaler only when needed.
Physical examination and Assessment data
Warm skin and dry with no rashes. BP170/87. RR 32, Temperature 37.5 celsius,
weight-76kilograms, 5’9, pulse rate80 beats per minute, oxygen saturation 85%.No skin
crackles, patient well nourished. The patient seems confused. Spirometry of FEV1 45% is
predicted that does not seem to change with the use of inhaled bronchodilators. The patient is
audible but unable to make full sentences. The patient has dyspnea with a productive cough
with grey sputum, audible wheezing, mild chest tightness. Patient seems to adopt tripod
sitting position .the use of accessory respiratory muscles and neck muscles while breathing is
noted.
Independent contribution of care by Assistant Practioner
As an assistant practitioner, the first line in managing the Patient is by detecting and
checking the presence of airway obstruction by performing the post-bronchodilator

CARE DELIVERY AND MANAGEMENT
4
spirometry (Wise, 2016). James seems to have an air obstruction. His spirometry is FEV1 of
45 %, indicating his condition is severe(NHS, 2018). James will definitely need a formoterol
20 mcg inhaled via nebulizer in 12 hours or indacaterol 75 mcg inhaled orally daily(NHS,
2018). Musculonist agonist such as glycopronium one capsule inhaled per twelve hours using
a neon inhaler can be useful(NHS, 2018).
If Long-acting beta-agonist does not work, add an added dose of inhaled
corticosteroid can also be used if James continues to have shortness of breaths(NHS, 2018).
This includes drugs like a high dose of budesonide powder inhalation of about 1200ug (Wise,
2016). Since James seems to have developed exacerbations, pulmonary rehabilitation should
be advocated and made available to him (Wurst, Punekar, and Shukla, 2014).Management of
exacerbations should be minimized by giving advices to James and his wife. In addition, the
assistant practitioner should always respond immediately to any symptom of an exacerbation
(Resuscitation Council,2015). Other than that, appropriate use of inhaled corticosteroids,
vaccination with pneumococcal vaccine and bronchodilators should be enhanced. Try to use
noninvasive ventilation whenever indicated and advocating for the hospital at home can also
be used in the management of James condition(Resuscitation Council,2015).
In addition, giving James proper education and psychological support in order to help
him cease smoking completely can be one of the essential actions of James management.
James should be explained the need for quitting smoking encouraged to stop and even given
an offer in the process to promote positive results (Wurst, Punekar, and Shukla, 2014).
James who is at risk of having more COPD aggravating factors should be given a self-
management advise which will encourage him to respond promptly and call for help when
symptoms arise. James should be instructed to start oral corticosteroids whenever the
breathing start interfering with daily living activities(Resuscitation Council,2015). The

CARE DELIVERY AND MANAGEMENT
5
assistant practitioner should always make sure that antibiotics and corticosteroids are always
available near the patient for a self-management strategy. The patient should be enforced with
a proper education in order to ensure the adherence to the guidelines of use(Resuscitation
Council,2015).
Impacts practitioner will have on the multidisciplinary team
In Management of COPD patients like James, working with other healthcare workers
is the most critical role in management (Yeung et al., 2014). An assistant care practitioner
should always involve all healthcare professionals in the care of people with COPD,
especially when assessing the spirometry (Yeung et al., 2014). Other than that, treatment and
care should take into account patients needs and preference. James being a patient should be
given an opportunity to make informed decisions about his care and treatment including a
partnership with all other healthcare workers(Resuscitation Council,2015). If James cannot be
able to make health care decisions, it is the responsibility of the assistant practitioner to be
involved plus including other medical teams to follow the code of practice that is usually
accompanied by the mental status act.
The assistant practitioner should also ensure there is a good communication between
him and other healthcare workers and even with the patient(NHS, 2018). Communicating
with the patient and other healthcare workers should be culturally appropriate. Other than
that, family and cares like James wife should be given enough information and support they
need about the patient (NHS, 2018). The assistant practitioner should always refer to
specialist advice in certain levels of disease care like when exacerbations are challenging to
manage. However, it is advisable to ask for advising all levels to prevent
mismanagement(NHS, 2018).

CARE DELIVERY AND MANAGEMENT
6
Managing smoking cessation is a multidisciplinary action that requires patient, family
members and other healthcare teams (Parkes, 2013). Enquire from the patient and family
members the number of years the patient has been smoking in order to determine the correct
therapy (Parkes, 2013). Help the patient using other health care workers like a therapist to
choose the proper recommendation of smoking cessation in all opportunities the patient to
have (Parkes, 2013). All multidisciplinary teams should also be included in undertaking
activities which aim to avoid emergency admissions, advising the patient and educating the
patient on other healthy lifestyle issues (Parkes, 2013).
ABCDE approach to COPD
There are various underlying principles used in assessing patients with COPD. This
includes airway, breathing, circulation, disability, and exposure (Yeung et al., 2014). All the
above principles are needed to be done initially and regularly so as to be able to manage any
life-threatening problems or complication that may arise (Yeung et al., 2014). This will still
enable one to know when there is a need for extra help in order to be able to call for assistant
early enough (Yeung et al., 2014). Always remember it may take a while for treatment to
work therefore it is always for the best to take few minutes before reassessing the patient
(Yeung et al., 2014).
During the initial assessment as an assistant practitioner always ensure you have
adequate self-protection (McNulty, Jordan and Hopkinson, 2014). This includes wearing face
mask, aprons and gloves appropriately (McNulty, Jordan and Hopkinson, 2014). In addition
to that, it is always crucial to observe the patient keenly in order to assess general patient
appearance (McNulty, Jordan and Hopkinson, 2014). This is done by checking if the patient
is fully awake, whether he or she can speak, and his general feelings including what is his
complain at the moment. Good indications of sufficient breathing can be merely be identified

CARE DELIVERY AND MANAGEMENT
7
through checking if the patient can be able to talk or respond to general commands (Malcolm
et al., 2017). However, if unable to talk or speaking is not clear, it is a good indication of
some difficulty in breathing which demonstrates that the patient has developed signs of
critical illness (Malcolm et al., 2017). Always use the basic resuscitation principles which
involve asking general questions like patient names, looking the general appearance of the
patient, listening to the patient talk and feel if the patient is breathing or not (Malcolm et al.,
2017). If the patient is unresponsive or having occasional gasps always check the strength of
the pulse. From the results, you start cardiopulmonary resuscitation according to resuscitation
guidelines (Malcolm et al., 2017). Monitor vital signs as early as possible by attaching pulse
oximeter, ECG monitor, thermometer and non-invasive blood pressure monitor (Malcolm et
al., 2017). In addition, it is always advisable to Insert an intravenous cannula and take blood
for investigations as soon as possible (Malcolm et al., 2017).
AIRWAY (A)
Airway obstruction is emergency and needs immediate intervention since if left
untreated it can cause hypoxia leading to multiple organ damages and death (Lim et al., 2015)
Treat airway obstruction as an emergency, try to check what can be causing the obstruction.
In case of secretions, suction is recommended to achieve airway clearance (Lim et al., 2015).
Tracheal intubation is required only where there is a complete obstruction (Lim et al.,
2015).Where there is no complete obstruction, put the patient on high oxygen concentration
via mask to ensure good air circulation in the body and to prevent hypoxia. Always maintain
oxygen concentration at 94-98% (Lim et al., 2015).
BREATHING (B)
When assessing James breathing assistant practitioner need to look, listen and feel for
the general sign of respiratory distress which includes cyanosis, sweating, nasal flaring and

CARE DELIVERY AND MANAGEMENT
8
breathing using accessory muscles(Resuscitation Council,2018). Count the respiratory rate,
anything above 25 breath/min is an indicator of distress as the standard rate is 12-20
breath/min. Listen to patient’s breath sounds a short distance from his face, ratting airway
noises shows the presence of secretions that can be caused by the inability of the patient to a
cough(Resuscitation Council,2018). Wheeze sounds suggest of partial but severe airway
obstruction. Auscultate the chest to check if there is the presence of reduced bronchial
breathing which may indicate pneumothorax or presence of pleural fluid that can cause a
complete obstruction(Resuscitation Council,2018).
CIRCULATION (C)
In most of the medical and surgical emergency, hypervolemia is the most cause of
shock unless proven otherwise (Punekar, Shukla and Muellerova, 2014). Unless James
circulation has any cardiac cause, give intravenous fluids if the patient has cold extremities
and fast breathing (Punekar, Shukla and Muellerova, 2014).Assess for cyanosis especially
from the extremities and treat the underlying causes to prevent further complications
(Punekar, Shukla and Muellerova, 2014).
DISABILITY (D)
Common causes of unconsciousness are hypoxia, cerebral hypoperfusion,
hypercapnia or use of sedativesJames general assessment should be done which includes
checking the patient alertness, if he responds to vocal response and painful stimuli or if he is
unresponsive to all stimuli. Glasgow coma scale( GCS ) score can also be used to assess the
level of consciousness. Blood sugars should also be taken and recorded to exclude
hypoglycemia (Resuscitation Council,2018). In case James has hypoglycemia you should
correct blood glucose levels using glucose solution intravenously(Resuscitation
Council,2018). Be cautioned not to raise too much of blood sugars as James had a history of

CARE DELIVERY AND MANAGEMENT
9
diabetes type 2. The unconscious patient should be managed in a lateral position where the
airway is not protected(Resuscitation Council,2018).
EXPOSURE (E)
Perform a head to toe exam when assessing the patient. During assessment remember
to respect patients dignity and minimize the heat loss (Davidson, 2013). Take a detailed
clinical history of James and his wife (Davidson, 2013). Review your patient regularly and do
the recording of patients responses. Treat any other underlying condition that may lead to the
respiration distress (Davidson, 2013)
NURSING CARE PLAN
Nursing diagnosis
Ineffective Airway Clearance related to bronchospasm, increased production of secretions as
evidenced by patient complaining of difficulty breathing and presence of abnormal breath
sounds (wheeze) (Hertel et al., 2012).
Expected outcomes
James will maintain a patent airway with clear breathing sounds, be able to expectorate
secretions effectively (Hertel et al., 2012).
interventions Rationale
Assess and monitor respiration rate and
sounds such as wheeze and crackles
Auscultate for breath sounds
Suction can be done to remove excretions.
Tachypnea and dyspnea is usually present
and can be realized on admission
To detect any breathing obstructions present.
Removal of secretions will reduce resistant to

CARE DELIVERY AND MANAGEMENT
10
(Hertel et al., 2012)
Elevate the head of bed and patient to
assume the lean position.
Keep the environment clean from pollution
such as dust
Observe cough characteristics and assist with
a measure to improve the effectiveness
Administer bronchodilators as prescribed
(George et al., 2013)
air movement in the bronchi (Hertel et al.,
2012)
The lean position will ease breathing and
facilitates respiratory function by use of
gravity.
Precipitation of allergic reactions can trigger
COPD exacerbations.
Persistent coughing may lead to discomfort.
To maintain airway patency
(George et al., 2013)
Nursing Diagnosis
Impaired Gas Exchange related to altered perfusion ( obstruction of the airway by
secretions, bronchospasm ) as evidenced by dyspnoea, abnormal breathing, changes in vital
signs and cyanosis (George et al., 2013)
Expected outcome
James will present with improved ventilation and tissue perfusion and free from symptoms
of respiratory distress within 1 hour.
Interventions Rationale
Acquire and assess the respiration rate Respiration rate is useful in evaluating the

CARE DELIVERY AND MANAGEMENT
11
Administer oxygen in a higher concentration
Elevate the head of the bed
Monitor skin color
(George et al., 2013)
degree of respiratory distress.
Oxygen supply with aid in tissue perfusion
Elevating the head of the bed will ease the
breathing.
Cyanosis may be present which indicate
advanced hypoxia (George et al., 2013)
Nursing Diagnosis
Imbalanced Nutrition Less than the body requirement related to dyspnoea as evidenced by
weight loss reported altered taste sensation and lack of interest in food (George et al., 2013).
Expected outcomes
James will demonstrate progressive weight gain appropriately and regain food appetite
Interventions Rationale
Assess understanding of individual nutrition
needs and dietary habit of the patient.
Acess the dietary habits and recent food
intake
This to determine the informational need and
how to improve.
Many COPD patients eat poorly due to
dyspnea, and they may develop malnutrition
Nursing diagnosis

CARE DELIVERY AND MANAGEMENT
12
Risk of infection related to inadequate primary defense (stasis of secretions) (George et al.,
2013)
Expected outcome
James will have reduced chances of infection during the treatment period
Interventions Rationale
Monitor body temperatures
Administer antibiotics prophylaxis
(George et al., 2013)
the temperature will be high in case of
infection
Antibiotics Prophylaxis is a good measure
when preventing infections. Antibiotics kill
any introduced bacteria in the body thus
preventing infections to occur. (George et al.,
2013)
MEDICATION
The aim of the therapy is to control the symptoms, reduce the risk of complications and
exacerbations, and improve your ability to lead an active life (Thomas et al., 2013).
Smoking cessation
Encourage the patient to stop smoking and offer to help. Unless where it is
contraindicated, offer varenicline or bupropion as appropriate and combine with a support
programme (Thomas et al., 2013). Varenicline is only recommended where the patient
express a desire to quit smoking and it is only prescribed as part of support programme of
behavioral change (Thomas et al., 2013).

CARE DELIVERY AND MANAGEMENT
13
Bronchodilators
Inhalers that containing vasodilators and muscle relaxants around the airways easing
breathing and relieve a cough, according to the severity of the disease one can use short
acting or long acting for daily use (Thomas et al., 2013). There are two types of short-acting
bronchodilator inhalers which Include Beta 2 agonist inhalers such as salbutamol and
antimuscarinic inhalers such as ipratropium (Thomas et al., 2013). Short-acting inhalers
should only be used where there is shortness of breath to a maximum of four times a day.
Long-acting inhalers should only be recommended where symptoms persist
throughout the day (Rothnie et al., 2017). These inhalers work similarly as short-acting
inhalers only that their action last for at least twelve hours (Rothnie et al., 2017). Therefore
long-acting inhalers should only be used once or twice a day. There are two types of these
inhalers which include beta 2 agonist inhalers such as salmeterol and antimuscarinic inhalers
such as tiotropium (Rothnie et al., 2017) .
Steroid Inhalers
These are corticosteroids medications that reduce inflammation and prevent
exacerbations(NHS, 2018). Steroids inhalers can only be used when long-acting inhalers fail
to work (Hertel et al., 2012). These types of medications normally help to reduce
inflammation along the airway pathways and are usually used alongside with long-acting
inhalers as combination therapy. A good example is budesonide inhalers (Hertel et al., 2012).
Oral steroid
This medications should not be used for a long time due to there side effects, for
example, they increase the risk of weakened bones (osteoporosis), diabetes and catarac
(Gruffydd-Jones and Loveridge, 2015)t. A 7 to 14 days treatment is usually recommended.

CARE DELIVERY AND MANAGEMENT
14
Long-term prescription can only be prescribed by COPD specialist (Gupta, Allen-Ramey and
DiBonaventura, 2012). These oral steroids prevent inflammations of the airways. A good
example of commonly used oral steroid is prednisolone (Gupta, Allen-Ramey and
DiBonaventura, 2012).
Antibiotics
Antibiotics are only prescribed where there are symptoms such as fever, coughing up
yellow sputum, rapid heartbeat, and chest pains (Gruffydd-Jones and Loveridge, 2015).
Theophylline Tablets
This medication normally opens up the airways and it is usually taken twice a day.
Blood tests are recommended when taking theophylline in order to check the level of
medication in the blood. This helps to reduce side effects such as headaches, insomnia, and
palpitations (Gruffydd-Jones and Loveridge, 2015).
References
Davidson, C. (2013). NICE COPD update: a good reminder of best practice. Prescriber,
21(20), pp.6-9.
George, P., Stone, R., Buckingham, R., Pursey, N., Lowe, D. and Roberts, C. (2014).
Changes in NHS organization of care and management of hospital admissions with COPD
exacerbations between the national COPD audits of 2003 and 2008. QJM, 104(10), pp.859-
866.
Gruffydd-Jones, K. and Loveridge, C. (2015). The 2010 NICE COPD Guidelines: how do
they compare with the GOLD guidelines?. Primary Care Respiratory Journal, 20(2), pp.199-
204.

CARE DELIVERY AND MANAGEMENT
15
Gupta, S., Allen-Ramey and DiBonaventura, M. (2012). Patient characteristics, treatment
patterns, and health outcomes among COPD phenotypes. International Journal of Chronic
Obstructive Pulmonary Disease, p.779.
Hertel, N., Kotchie, Samyshkin, Radford, Humphreys and Jameson (2012). Cost-
effectiveness of available treatment options for patients suffering from severe COPD in the
UK: a fully incremental analysis. International Journal of Chronic Obstructive Pulmonary
Disease, p.183.
Health, (2018). History and Physical Exam for COPD | Michigan Medicine. [online]
Available at: https://www.uofmhealth.org/health-library/hw165182
Lim, W., Smith, D., Wise, M. and Welham, S. (2015). British Thoracic Society community
acquired pneumonia guideline and the NICE pneumonia guideline: how they fit
together. Thorax, 70(7), pp.698-700.
Malcolm, D., Orme, M., Morgan, M. and Sherar, L. (2017). Chronic obstructive pulmonary
disease (COPD), illness narratives and Elias's sociology of knowledge. Social Science &
Medicine, 192, pp.58-65.
McNulty, W., Jordan, S. and Hopkinson, N. (2014). Attitudes and access to lung volume
reduction surgery for COPD: a survey by the British Thoracic Society. BMJ Open
Respiratory Research, 1(1), p.e000023.
NHS (2018). Treatment. [online] Available at: https://www.nhs.uk/conditions/chronic-
obstructive-pulmonary-disease-copd/treatment/#inhalers
Parkes, G. (2013). Asymptomatic COPD and NICE guidelines. British Journal of General
Practice, 61(585), pp.294-295.

CARE DELIVERY AND MANAGEMENT
16
Pharmacy COPD (2014) screening could save the NHS £264m. The Pharmaceutical Journal.
Punekar, Y., Shukla, A. and Muellerova, H. (2014). COPD management costs according to
the frequency of COPD exacerbations in UK primary care [Corrigendum]. International
Journal of Chronic Obstructive Pulmonary Disease, p.247.
Rothnie, K., Chandan, J., Goss, H., Müllerová, H. and Quint, J. (2017). Validity and
interpretation of spirometric recordings to diagnose COPD in UK primary care. International
Journal of Chronic Obstructive Pulmonary Disease, Volume 12, pp.1663-1668.
Resuscitation Council(2015) Guidelines feature expanded section on pre-hospital
resuscitation. Journal of Paramedic Practice, 7(11), pp.538-539.
Resuscitation council (2018). ABCDE approach. [online] Available at:
https://www.resus.org.uk/resuscitation-guidelines/abcde-approach/
Thomas, M., Radwan, A., Stonham, C. and Marshall, S. (2013). COPD Exacerbation
Frequency, Pharmacotherapy and Resource Use: An Observational Study in UK Primary
Care. COPD: Journal of Chronic Obstructive Pulmonary Disease, p.131023065803008.
Wise, J. (2016). NICE recommends pulmonary rehabilitation programmes for patients with
COPD. BMJ, p.i768.
Wurst, K., Punekar, Y. and Shukla, A. (2014). Treatment Evolution after COPD Diagnosis in
the UK Primary Care Setting. PLoS ONE, 9(9), p.e105296.
Yeung, J., Perkins, G., Davies, R., Bullock, I., Lockey, A., Gwinnutt, C., Lott, C. and
Hampshire, S. (2014). Introducing non-technical skills teaching to the Resuscitation Council
(UK) Advanced Life Support Course. Resuscitation, 85, p.S71.