Chronic Disease: COPD, GERD, and Patient Education Report

This report provides an overview of chronic diseases, specifically focusing on Chronic Obstructive Pulmonary Disease (COPD) and Gastroesophageal Reflux Disease (GERD), using the case of Mr. George Polaris. It explores the health concerns associated with both conditions, detailing the causes, symptoms, and diagnostic methods. The report delves into the appropriate medications for treating COPD, including reliever, maintenance, preventive, and exacerbation medications, and the importance of patient education regarding their use. It also examines pharmacotherapy for GERD, covering antacids, histamine receptor antagonists, and proton pump inhibitors, along with their respective benefits and side effects. The report emphasizes the significance of client education strategies, such as pulmonary rehabilitation for COPD patients and lifestyle modifications for GERD, to improve patient outcomes and quality of life. It highlights the importance of understanding medications, dosages, and potential interactions, as well as the role of nurses in educating patients on disease management and health promotion.

Running head: TYPES OF CHRONIC DISEASES 1
Types of Chronic Diseases
Student’s Name
University Affiliation

TYPES OF CHRONIC DISEASES 2
Overview
This essay demonstrates an understanding of health promotion strategies and education
techniques that address the need for patients with chronic diseases. It focuses on the case study
of Mr. George Polaris, a 62-year old Italian man who was presented to the hospital with
breathlessness, fever and productive cough. After being treated for the chest infection on his first
admission to the hospital, Mr. Polaris underwent a series of respiratory tests and was eventually
diagnosed with ‘chronic obstructive pulmonary disease (COPD)’. He had a history of stomach
disease, ‘Gastro esophageal reflux’ (GERD) after which he was prescribed Esomeprazole
Magnesium to neutralize or control the acid produced in the stomach. After being discharged
from the hospital, Mr. Polaris condition was followed up by a registered nurse where his current
vital signs read normal except the blood pressure which read at 135/88mmHg. Following his
shortness of breath and severe cough, George confessed to the nurse of being a heavy smoker
since his teenage hood.
The Actual Health Concerns for the Patient
Two health concerns manifest in the case of Mr. George; COPD and GERD. The ‘chronic
obstructive pulmonary disease,’ a common name for a group of lung diseases (asthma, chronic
bronchitis and emphysema) is one of the health concerns that manifest in the patient. The disease
is caused by inhalation or long term exposure to noxious substances like tobacco smoke and is
characterized by persistent cough, shortness of breath, fever, and a build-up of phlegm in the
lungs (Barr et al., 2009). Although the symptoms of the disease don’t show up in early stages of

TYPES OF CHRONIC DISEASES 3
life, smoking or working in dusty areas can be some of the key contributing factors to the
disease. Shortness of breath is caused by narrowing of the bronchial tubes (air passages).
Luckily, medications such as Spiriva and Ventolin can help open up the tubes of a patient
hence making breathing easier (Rascon-Aguilar et al., 2011). On the other hand, “GERD is a
chronic disease that occurs when the stomach acid or food content flows back into the food
pipe.” According to Jennings et al., (2015) the reflux irritates lining of the food pipe hence cause
the Gastro esophageal reflux disease. Although there are different treatments for the condition,
antacid medications like Esomeprazole magnesium can be used to limit or neutralize the stomach
acid (Jennings et al., 2015). Statistically, extra esophageal manifestation linked with the reflux
disease occurs in almost 76% of patients with severe hoarseness, 48% of patients with non-
cardiac chest pain, as well as 81% of asthmatic patients. Unfortunately, over 47% of patient with
the disease do not have endoscopic evidence of the illness.
Knowing the Right Medication for Treatment and Management of COPD
To control or manage lung diseases, your physicist might prescribe different medications.
Since chronic obstructive airways disease cannot be reversed or cured, complying with a
prescribed medication helps protect against exacerbations and reduce symptoms such as
breathlessness, fever and chest pain (Kempainen et al., 2007). Although patients are prescribed
different medications according to their health, it is important for them to understand what the
drugs are and how they work, how to take them, possible side effects of the medication and
length of time the effects will last as Kempainen et al., (2007) postulates. If unsure about the
information provided in the medications, it is important to seek help from a respiratory nurse or
pharmacists for a better understanding. This is because patients need to be confident as well as

TYPES OF CHRONIC DISEASES 4
informed about the medication they use. Since medications cause side effects to different
people, it’s vital to note that a small percentage of patients using those medicines may contract
the side effects (Raupach et al., 2008). As it is evident that COPD medications target the
respiratory system, majority of the medications are inhaled using inhalers such that it is delivered
straight to the system. According to Raupach et al., (2008) proper technique is crucial in delivery
of the medication effectively.
However, to ensure that one is receiving complete benefits of the medication, the inhaler
needs to be often checked by a physicist or the respiratory nurse. When the severity of the
disease or symptoms persists, a doctor can prescribe additional drugs (Divo et al., 2012). The
severity of the symptoms in the case for COPD can include shortness of breath, fever and cough.
Ideally, the rate of exacerbations and infections increases with severity of the disease. The type
of medications that can be prescribed include reliever medications (to relieve increased
symptoms of shortness of breath), maintenance medication (to control the symptoms and help
protect against flare ups for a long term period), preventive medication (Usually used when the
COPD becomes severe and experience flare ups) and lastly is the exacerbation medications for
short-term usage for the COPD symptoms (Barr et al., 2009). When diagnosed with COAD, a
doctor can prescribe reliever medications first and when the severity increases, the doctor can
prescribe other medications for maintenance. For example, a patient may find himself on three
distinct medications each with an inhaler. Since this is normal, it’s good to understand the role of
each medication and take them as prescribed.
This topic can be of great significance to Mr. Polaris in understanding the type of
medication prescribed by his doctor. As seen above, Mr. Polaris was prescribed three
medications which are supposed to be taken concurrently. They include Ventolin, Spiriva and

TYPES OF CHRONIC DISEASES 5
Esomeprazole magnesium or Nexium. The patient should understand that Ventolin is an oral
inhalation medication used to relieve acute asthma symptoms that start with one inhalation as a
starting dose. For the case of George, he is prescribed up to four inhalations of Ventolin a day,
but he should note that overdose of the same can cause adverse effects such as tremor,
hypokalemia, and hyperactivity. Another medication prescribed to the patient is Spiriva. Mr.
Polari should understand that the medication is used to prevent asthma attacks and narrowing of
air passage in the lungs. As per doctor’s prescription, the patient is supposed to have two oral
inhalations a day. Since Mr George has had a history of GERD, the doctor prescribed him
Nexium, an antacid medication to neutralize the excessive amount of acid in the stomach. One
key thing Mr. George should understand is that Nexium does not go hand in hand with cigarette
smoking. Therefore, he should shun completely from the habit to ensure the medication is
effective.
Pharmacotherapy for Gastro- Esophageal Reflux
There are various treatments for GERD that depend on the severity of the disease. They include:
Antacids; Antacids neutralize acid content of the stomach and contain elements such as
calcium, magnesium and aluminum (Wahlqvist et al., 2008). The drugs containing these
elements are very effective in treating GORD; however, frequent dosing is significant for severe
diseases. Therefore, the recommended dosage remains a crucial factor for antacids in esophageal
disease. Irrespective of common belief, the actual dosage has no or little influence on
effectiveness. As Smith and Wrobel (2014) states, antacids like Gaviscon form a raft that
suspends on the gastric content to provide a barrier to the esophageal mucosa. However, studies

TYPES OF CHRONIC DISEASES 6
show that these agents are more effective compared to other antacids when it comes to treatment
of gastro esophageal disease. Some of its side effects include diarrhea and constipation.
However, in renal failure patients, toxicity levels of aluminum and magnesium could accumulate
thus regular use of these agents needs to be minimized by such people (Rodriguez et al., 2008). It
should be noted that any medication increasing gastric content in the stomach may also lower the
absorption of such agents.
Histamine receptor antagonists (HRA); HRA are less costly compared to proton pump
inhibitors (Ringbaek et al., 2010). Examples of HRA include Nizatidine, Cimetidine, Famotidine
and Ranitidine. Among these drugs, Cimetidine is known to have unique adverse effects and the
most clinically significant medication interactions. The drug has reportedly decreased the
clearance of other medications and blocks the tubular production of medicines like Metformin.
Proton pump inhibitors (PPI); PPIs are more effective than HRA when it comes to
treating gastro esophageal reflux disease. This is because they block the final pathways of acid
production compared to HRA which block only one passage (Kempainen et al., 2007). Evidence
also shows that compliance to the anti-secretory effects of histamine receptor antagonists may
occur, but the tachyphylaxis doesn’t happen with the PPIs. However, most clinicians consider
PPIs as the drug of choice when it comes to the treatment of gastro esophageal reflux disease.
According to Kempainen et al., (2007), some of the common PPIs which are in the market
include Lansoprazole, Omeprazole, Esomeprazole, and Rabeprazole. Although drug interactions
are rare with these medications, Esomeprazole has been known to increase the anti- coagulant
effect of Warfarin. A majority of gastro esophageal symptoms are well controlled with a

TYPES OF CHRONIC DISEASES 7
standard dose of such symptoms. However, high dosages of a drug like Lansoprazole are
required in a small percentage. Moreover, a small percentage of patients may suffer nocturnal
heartburn symptoms irrespective of the proton pump inhibitor treatment. In such instances, a
possible strategy can be used as PPI in the morning plus a standard dose of histamine receptor
antagonist before going to bed.
Length of therapy; since a high number of people with erosive esophagitis could be
healed with eight weeks of proton pump inhibitor medication, a subgroup will require chronic
lifelong medication. However, maintenance practices are very controversial despite the fact that
many people remain symptom-free with step-down approaches (Divo et al., 2012). Moreover, a
subset of people will require lifelong treatment with surgery or proton pump inhibitors. This
implies that an individualized technique to the treatment of gastro esophageal is a superior
strategy.
This topic can be useful in the case of Mr. Polaris when it comes to Gastro esophageal
reflux disease. Although he has been diagnosed with GERD, Mr. Polaris should understand the
different medications prescribed to him and their various purposes. He has been prescribed
Esomeprazole, an antibiotic to reduce or neutralize excessive stomach acid. Also, the patient
should understand the correct dosage of the drug and whether it should be taken with other
medications. As presented in the case study, the patient also has the chronic obstructive
pulmonary disease, so with continued smoking, the medications could not be effective when it
comes to treatment of the diseases. Most importantly, it would be safe for the patient to know the
different types of treatments for the disease as well as their effects on the body.

TYPES OF CHRONIC DISEASES 8
Client Education Strategies for Patients with COPD and GERD
1. Pulmonary interventions for COPD patients
Pulmonary rehabilitation is a system of care that involves education, exercise regimen
and physiological support delivered by therapists to COPD patients (Barr et al., 2009). It helps
reduce disability, symptoms and improve both physical as well as emotional support. Pulmonary
rehabilitation can also help patients achieve an optimal level of interdependence in the
community. As Barr et al., (2009) holds, the exercise training assists in building patients
confidence, boost breathing strategies and optimize cardiovascular fitness. Nurses can use
education to explain the disease progression, how the treatment works, how to use the drugs and
when to call for help. However, the main component of education advice is to help patients quit
smoking like in the case of Mr. Polaris.
2. Patient education on GERD medication
Nurses should educate patients on all the factors including medications that could worsen
their gastro esophageal symptoms since lifestyle medication alone cannot provide enough relief
for the patients (Rascon-Aguilar et al., 2011). Essentially, adults diagnosed with the disease
should be offered lifestyle changes as a first line therapy. Advice also needs to focus on the
circumstances of individual GERD patients.
Conclusion
The chronic obstructive pulmonary disease is very common among adults. However,
managing gastro esophageal reflux symptoms can help relieve COPD, but when left untreated,

TYPES OF CHRONIC DISEASES 9
the symptoms can worsen over time. Some indications that GERD could be contributing to your
COPD include; breathlessness, coughing and heartburn. However, with adherence to the right
medication and abstinence from triggers like smoking, one can achieve a better control of both
conditions.

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