COPD Literature Review and Analysis

This assignment requires a thorough analysis of the provided literature on Chronic Obstructive Pulmonary Disease (COPD), incorporating multiple sources such as books, journals, and online resources. The student is expected to identify key studies, evaluate their relevance, and synthesize the findings to provide an in-depth understanding of COPD management, patient outcomes, and related interventions.

RESEARCH PROPOSAL

TABLE OF CONTENTS
BACKGROUND TO REVIEW......................................................................................................1
RATIONALE ........................................................................................................................1
RESEARCH QUESTIONS.............................................................................................................2
AIM OF THE RESEARCH ............................................................................................................2
OBJECTIVES..................................................................................................................................2
CRITERIA FOR INCLUDING STUDIES IN THE REVIEW.......................................................2
RESEARCH METHODS ...............................................................................................................4
METHODS OF REVIEW ...............................................................................................................6
PRESENTATION OF THE RESULTS .........................................................................................7
TIME FRAMEWORK ....................................................................................................................7
REFERENCES ...............................................................................................................................8

TITLE - “Challenges in the management of COPD in the elderly population compared to
young people”
BACKGROUND TO REVIEW
Chronic Obstructive Pulmonary Disease (COPD) is the 4th biggest cause for death of
people all around the world. It is mainly observed in elderly population. COPD is defined by
irregular tissue repair in emphysema and airways disease (Liang, Abramson and George, 2017).
There is collection of evidence that ageing hallmarks are great attribute of Chronic obstructive
pulmonary disease. It is also referred by limitation of airflow that is not entirely reversible and is
generally progressive as well as connected with an abnormal inflammatory response of the lungs
to gases or noxious particles, such as smoke of tobacco.
Identification of COPD is usually based on reduction of forced expiratory volume in one
second or forced vital capacity ratio < 70% post-bronchodilators. The distinctive evidences of
Chronic obstructive pulmonary disease are sputum, dyspnea upon exertion and cough. On the
basis of airflow limitation, COPD can be categorized as moderate, mild, severe and very severe.
It can also coexist with asthma, however the inflammation symptom of COPD is different from
that of asthma.
The Ratio of this particular disease dramatically increases with age and complexed by
chronic respiratory failure can be considered as a geriatric state. Unluckily, maximum cases
cannot get diagnosed due to problem with current diagnostic standards of respiratory function.
Chronic obstructive pulmonary disease is a mixed illness consisting of both airway and alveolar
compartments which leads to airways disease. The level of pathological changes in these
different compartments of lungs are not same in every patient. The aetiology generally gets
exposed to noxious particles in external environment, in western community as it is generally
due to cigarette smoking whereas in non-western world, it is mostly due to indoor cooking
(Puhan and et.al., 2015). Young as well as old people are observed to be suffering from COPD
due to increasing pollution in the air and activities such as smoking. This report will identify
major challenges in management of Chronic obstructive pulmonary disease through various
research tools and methods. The report will be based on PICO model which will analyse
population, intervention, comparison and Outcomes of COPD and its management (Gardener
and et.al., 2018).
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Rationale
The main reason for choosing this particular research topic is increasing problems related
to lungs and COPD among patients. In relation to this, the research is initiated to identify various
challenges faced by nurses and physicians in the management of Chronic Obstructive Pulmonary
Disease. Important aim of this research is to promote physician's engagement with COPD
patients (McNamara and et.al., 2017).
Furthermore, it will also help in identifying ways to overcome issues faced while
managing or taking care of individuals suffering from this disease. Researcher will combine the
results of various studies, from books and articles to get the most effective outcomes of this
project. In the present research, COPD guidelines will also be discussed which will consist of
advantages and disadvantages of processes involved in current management for young as well as
elderly patients suffering from this disease.
RESEARCH QUESTIONS
The research questions will help to develop a structured research report along with the
motive of this study. In context to this, researcher has framed the following questions -
1. What are the challenges faced in managing COPD through Pulmonary rehabilitation for
younger and older people?
2. What are the processes involved in intervention of Chronic obstructive pulmonary
disease through its rehabilitation?
3. What is the differences between managing COPD in younger and older patients?
4. What is the impact of Pulmonary rehabilitation in managing patients?
AIM OF THE RESEARCH
“To identify the challenges in management of COPD in older and young people”
OBJECTIVES
 To examine challenges faced in managing COPD in older and younger people
 To identify various processes involved in intervention through Pulmonary rehabilitation
 To determine the difference in management of COPD in younger and older patients
 To detect the impact of Pulmonary rehabilitation in managing patients.
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CRITERIA FOR INCLUDING STUDIES IN THE REVIEW
In order to perform a detailed study and research on the chosen topic, various studies are
useful and can assist in collecting the most appropriate information. In the present research,
various criteria will be included to review literature of the present study or examination.
The criteria to include different studies in the review are discussed as below -
 Population or Participants – Participants for the research includes individual involved
in collection of information or data related to an examination or study. In the present
research, younger and older patients suffering from Chronic Obstructive Pulmonary
Disease will be chosen as participants to collect the data relevant (Young and et.al.,
2017). Involvement of users in the study helped to shape research methods, aims,
synthesis and interpretations of the outcomes. The population is selected with respect to
their knowledge and understanding related to management of COPD and its intervention
as per their experiences (Medline database, 2018).
 Intervention – It refers to therapeutic procedure that implies on taking a holistic
approach to well-being of a patient suffering from chronic respiratory illness generally
chronic obstructive pulmonary disease (COPD) (Westwood and et.al., 2016). Pulmonary
rehabilitation is needed for the life-time management of patients having symptomatic
chronic respiratory disease. Selecting an effective intervention is very useful for giving a
good care to patients suffering from a particular disease or illness. It needs coordinated
action of a multidisciplinary health-care team for delivering an individualized
rehabilitation program for the best impact incorporating various activities, for example:
exercise training, smoking cessation and education related to patient's self-management
(Quon, Gan and Sin, 2018).
 Comparison – There are various reasons which can bound access to intervention of any
disease. Pulmonary rehabilitation is the most useful method of treating or managing
patient suffering from COPD. Comparison in this study will be among older and younger
patients as well as alternative intervention which can be used in management of Chronic
obstructive pulmonary disease (Chen and et.al., 2016). This disease is commonly found
in both young and old individuals due to various reasons such as smoking, indoor
cooking or pollution. According to many studies, it has been observed that there is an
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alternative intervention available for management of COPD such as community standard
of care and usual care.
 Outcome – Pulmonary rehabilitation is known as an effective and successful intervention
technique for management of Chronic obstructive disease. The studies prove that COPD
can be treated easily with the help of various activities such as self-management
approach, advice on smoking cessation and exercise training (Pulmonary rehabilitation
for chronic obstructive pulmonary disease, 2017). A patient can manage this disease by
performing breathing exercises at home, other than this, he or she needs to have
unscheduled physician visits, change in location of care, exacerbation with change in
medication such as prednisone, antibiotics or both. The intervention for COPD is
provided for managing any breathing or issue related to lungs it can also be helpful for
controlling respiratory rate of the patient (Baker and Fatoye, 2017).
 Setting – In order to perform this study, various tools and methods will be utilized, and
settings will include various search tools such as COPD, Intervention, participants etc. In
order to identify and collect the most relevant information related to the subject or topic
in the research.
 Study designs – Researcher will use various sources of database, for example: Embase,
Psynet and Medline for performing this literature research. The search will be narrowed
down by using only latest articles from 2015 to 2018. The major element is to select
primary studies that can help in providing detailed information or data related to
challenges in management of COPD in younger and older patients. Inclusion and
Exclusion criteria were developed in order to review or screen articles from the
publications and reference list were assessed by 2 reviewers independently. Randomized
managed trials give the best level which is the greatest evidence followed by
experimental examinations with no randomization observational studies with control
groups.
RESEARCH METHODS
The Literature search consists of several panelists which is effective in reviewing
questions developed by PICO model. It selected and finalized inclusion and exclusion criteria,
search terms and sources of data that would be examined. The National Guideline Clearing-
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House and Guidelines international network were utilized for searching important guidelines on
COPD. Cochrane Library and PubMed were utilized in primary literature and systematic
reviews. The information will be collected from 400 different articles which will be narrowed to
15 articles due to lack of data associated with COPD and management of patients. Further 10
articles were finalized due to their date of release.
Sections
 Key question 1 - What are the challenges faced in managing COPD through Pulmonary
rehabilitation for younger and older people?
 Key question 2 - What are the processes involved in intervention of Chronic obstructive
pulmonary disease through Pulmonary rehabilitation?
 Key question 3 - What is the difference between managing COPD in younger and older
patients?
 Key question 4 - What is the impact of Pulmonary rehabilitation in managing patients?
Advisory group
An advisory group was established by involving 10 experts in systematic reviews and
involvement of users. In addition to these, three members from UNTRAP were also included,
this advisory group was used as a consultancy at various key points of the research study such as
data retrieval stag, protocol stage and result stage.
Type of study
 Systematic reviews or Meta-analysis
 Cohort studies, prospective studies, Case series studies or retrospective studies
 RCTs – if available
Search terms
 Acute exacerbation
 COPD, Emphysema, chronic bronchitis, chronic obstructive lung disease \
 Management and prevention of chronic disease
 Case management
 Self-management
 Action plans
 In home monitoring
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 Pulmonary rehabilitation, respiratory rehabilitation
 Smoking cessation
 Pneumococcal prevention
 Influenza prevention
 Vaccination and Immunizations
Inclusion criteria
 English language studies
 Studies based on PICO model
 Primary and secondary results included
 Younger and older patients involved
 Evidences from 2017 – 2018
 Impact of research on research team and individual users
 Effect of involvement at each and every stages of social care and health research
 Outcomes of research
 Articles and reports which are publicly available
Exclusion criteria
 Foreign language unless hold a detailed study to consider within the systematic review
 Adolescent and children services
 Editorials, letters and opinions
 If the study had a fatal flaw, in terms of quality which negatively affects its outcomes or
results.
Quality assessment
In order to define a threshold for involving studies in a review, it is important to assess
the quality of studies. In this particular review, if study passed the first two fielding questions
which means that paper reported a clear statement of objectives and aim, stated, clear appropriate
methodology and reporting the outcomes. Quality assessment are reported within the data
extraction tables for each and every study examination.
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METHODS OF REVIEW
Systematic reviews are used in order to determine the gaps within the research or
information on the basis of chosen subject or topic of study. The data is presented in a non-
quantitative and descriptive approach in which researcher has used tabular method to allow
readers for looking effectively at evidences. A qualitative analysis of data will be performed
which involve introduction of the research paper. The systematic review focuses on the
measurement, conceptualization, outcomes and impact of COPD.
Public and Patient involvement in study
Two professional reviewers were recruited within the advisory board of present research
study, which assessed and commented on the methodologies, design and analysis of the
systematic review. Younger and older patients involved in research to collect relevant
information about Chronic Obstructive Pulmonary disease and its management.
PRESENTATION OF THE RESULTS
Electronic database Number from searches
Medline 150
Embase 100
PsycINFO 100
Cochrane 50
Total 400
The total number of searches were 400, from medline: 150 searches were done, with
Embase data base: it was 100, from PsycINFO site, the number of articles searched were 100 and
Cochrane was used for 50 search items in the study. In the end, only 15 articles were observed to
have sufficient information related to COPD and its management which were further reduced to
10 due to their freshness and date of release.
TIME FRAMEWORK
Activities Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
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Literature
Searching
Quality
Appraisal
Data
Extraction
Synthesis
Writing Up
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REFERENCES
Books and Journals
Westwood, M. and et.al., 2016. Relationship between FEV 1 change and patient-reported
outcomes in randomised trials of inhaled bronchodilators for stable COPD: a systematic
review. Respiratory research, 12(1), p.40.
Chen, D. and et.al., 2016. Observational study of inhaled corticosteroids on outcomes for COPD
patients with pneumonia. American journal of respiratory and critical care
medicine, 184(3), pp.312-316.
Quon, B.S., Gan, W.Q. and Sin, D.D., 2018. Contemporary management of acute exacerbations
of COPD: a systematic review and metaanalysis. Chest, 133(3), pp.756-766.
Puhan, M.A. and et.al., 2015. Respiratory rehabilitation after acute exacerbation of COPD may
reduce risk for readmission and mortality–a systematic review. Respiratory
research, 6(1), p.54.
Liang, J., Abramson, M.J. and George, J., 2017. Educational interventions for health
professionals managing COPD in primary care. Cochrane Database of Systematic
Reviews, (5).
Gardener, A. and et.al., 2018. Support needs of patients with chronic obstructive pulmonary
disease (COPD): a systematic literature search and narrative review.
McNamara, R.J. and et.al., 2017. Singing for adults with chronic obstructive pulmonary disease
(COPD). Cochrane Database of Systematic Reviews, (12).
Young, J. and et.al., 2017. Interventions to promote referral, uptake and adherence to pulmonary
rehabilitation for people with chronic obstructive pulmonary disease (COPD). Cochrane
Database of Systematic Reviews, (10).
Baker, E. and Fatoye, F., 2017. Clinical and cost effectiveness of nurse-led self-management
interventions for patients with copd in primary care: A systematic review. International
journal of nursing studies, 71, pp.125-138.
Online
Medline database. 2018, [Online]. Available
through:<https://www.ebscohost.com/nursing/products/medline-databases>
Pulmonary rehabilitation for chronic obstructive pulmonary disease. 2017, [Online]. Available
through:<https://www.cochrane.org/CD003793/AIRWAYS_pulmonary-rehabilitation-
for-chronic-obstructive-pulmonary-disease>
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