Case Study: Mr. X's Chronic Obstructive Pulmonary Disease (COPD)

This case study presents a detailed analysis of a 76-year-old patient, Mr. X, diagnosed with Chronic Obstructive Pulmonary Disease (COPD). The essay explores the pathophysiology of COPD, including the impact of elastin proteolysis, fibrotic alterations, and the resulting airflow limitations. It examines the transformations in respiratory drive, the development of pulmonary artery hypertension, and the physical, social, and psychological challenges faced by COPD patients and their caregivers. The case study highlights the patient's history, symptoms, and prescriptions, as well as the socioeconomic impact of the disease. The analysis includes the impact of the disease on the patient and his family, the role of caregivers, and the importance of addressing psychological parameters like depression and anxiety, often associated with COPD. The study provides a comprehensive overview of the disease and its multifaceted effects, including the importance of the disease management.

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Introduction
The rationale of this essay is to systematically discuss the long term condition on a
patient. A long-term condition is a state which cannot be immediately treated, instead it can be
managed through therapies as well as medications (Conway et al. 2015). The chronic obstructive
pulmonary disease abbreviated as COPD is a condition of airflow problems or limitations that
are not entirely reversible (British Lung Foundation, 2017). Both the severity as well as the
occurrence of the disease are highly connected to age and globally, where the mortality and
morbidity incidences are increasing at a higher rate. Currently, there are over 3.5 million citizens
with the disease in the United Kingdom and only 0.9million diagnosed cases in Wales and
England (Anon, 2017). The disease causes over 30, 000 deaths in the country and is also leading
with high hospital admission rates in the country. Worldwide, it is projected that over 3.2 million
deaths are as a result the condition (Nice.org.uk. 2017). At early development, the condition is
neither recognized nor treated/diagnosed yet early diagnosis can slow the progression of the
disease (Conway et al., 2015). Some of most common COPD symptoms include shortness of
breath, wheezing and having constant coughs (Janson et al., 2013). The symptoms can appear or
even get worse when a person has an infection or is a smoker. For those with severe COPD, they
experience loss of weight, appetite, and swelling of the ankles.
Pain is a significant symptom associated with COPD persons and there are a couple of
elements that might lead to higher pain occurrence especially in patients with COPD (Anon,
2017). For example, the systemic inflammatory process is one of the elements that might activate
cytokines thus generating neuropathic as well as chronic pain (Gionfriddo et al., 2017).
Comorbidities and musculoskeletal problems are also considered to be factors that may lead to
pain for persons with COPD (Leung & Sin, 2017). A case of Mr X whose real name is not

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identified to maintain confidentiality is a 76-year-old pan paper factory worker with COPD is
presented in this write up. He has complications such as hypertension, heart failure as well as
post-traumatic stress disorder. Mr X has been smoking since the age of 18 and smokes up to 12
cigarettes per day. The patients respiratory status has been worsening and this presented by the
inability to walk beyond a 200 meters distant without the need to rest. His prescriptions were
three inhalers; mometasone twice a day, albuterol for every six hours and formoterol twice a day.
He also takes oral medicines such as aspirin, metmorphin, esomeprazole, and mirtazapine among
others. His wife died two years ago, and he has two sons who are his care proxy. The patient
moved to a nursing facility in anticipation to get proper care.
Before the move, he was an active farmer and did all the activities of daily living by
himself apart from shopping due to his mobility problem. Before his admission to the hospital,
Mr X fell with a motorbike en route to the market. He was later diagnosed with COPD
exacerbations and with the continued use of medication, his condition began to improve and was
later discharged from the hospital.
Pathophysiology of Chronic Obstruction Pulmonary Diseases
The pathological ramifications of obstructive pulmonary disease prompt a chain of
physiological transformations that affects the quality of life as well as survival in the real
progression of the disease (Networks.nhs.uk, 2017)). First and foremost, elastin proteolysis leads
to a reduction in the elastic recoil pressures persuaded by the nearby elastic tissues. However,
damage to the elastin in the COPD leads to the narrowing of the airways hence a decline of
airflow in the bronchioles as well as the tapping of air in the lungs (Networks.nhs.uk. 2017).
Next, the fibrotic alteration of the airways leads to fixed air passages narrowing thus causing

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increased air passage resistance that does not at any given moment revert. According to Anon
(2017), the bronchial epithelial cells plus the extensive alveolar and the histological features
including emphysema as well as the decrease surface area of the alveoli for ventilation and
gaseous exchange. The emphysema lowers the elastic recoil pressure of the lung that results to a
decreased driving pressure for processes like exhalation flow via the narrowed air passages
where air flow resistance is very high (Nice.org.uk. 2017)
The fixed air passage obstruction is cardinal the COPD diagnosis plus the severity
grading that shows the intensity of small inflammation of the air passage plus the increased
muscle tone of the cholinergic airway (Nmc.org.uk. 2017) Because of the increased air passage
resistance, there’s a decline in the air flow especially during exhalation that derails the passage of
air from the lung. Ideally, the physiological feature of the COPD is therefore hence detected
using spirometric ways. (Nice.org.uk. 2017). According to the patient presented in the case
study, pathologically weakening of the elastic tissues produces less inward lung elastic recoil
pressure that leads to the removal of air outside the lungs.
Transformations in the Respiratory Drive
The destruction of the pulmonary vasculature, as well as alveoli in patients with chronic
obstruction, lowers the surface area for diffusion of air thus leading to chronic hypersonic as well
as hypoxic forms (RCP London. 2017). However, the chronic carbon dioxide retention lowers
the sensitivity of the gas chemoreceptor apparatus that are not involved in the contribution as the
key mechanism of the respiratory drive in persons having the COPD. However, the respiratory in
such disease is driven by hypoxia via receptors situated at the carotid arterioles as well as the
aortic arch. According to Wise (2016) hypoxia can also lead to the vasoconstriction of the

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pulmonary capillaries that redirects blood away from the poorly ventilated alveoli. , hence
aggression correction of such with a high flow of oxygen in the COPD persons especially during
exacerbations lowers physiological respiratory drive in those patients (Nice.org.uk. 2017). This
can be dangerous hence good management is mandatory.
Pulmonary Artery Hypertension
The structural shifts in the COPD lead to instability in the pulmonary hemodynamics
(British Lung foundation, 2017). Medium to severe chronic obstructive pulmonary patient’s
contract to some extent mild pulmonary artery hypertension over the source of their illness. The
hypertension of the artery is usually known as the independent prognostic marker of the disease,
COPD. Evidently, every episode of the disease exacerbation rises the arterial pressure by 20
mmHg that can develop into a fully-fledged arterial hypertension on recurrent events (Conway et
al., 2015). Pulmonary hypertension usually relies on the pulmonary arterial wedge pressure as
well as the product of cardio output and pulmonary resistance. The pathophysiological
ramifications of chronic obstruction disease like hypoxia and emphysema can lead to pulmonary
capillary masculinization that can lead to pulmonary vascular resistance that predisposes
pulmonary artery hypertension (Anon, 2017). Besides, increased pressure in the intrathoracic in
emphysema produce positive pressure on the right ventricle of the heart this leading to an
increased pulmonary artery wedge pressure.
On the other hand, left ventricular diastolic dysfunction is next to cardiovascular
morbidities in the COPD condition can also lead to back pressure shifts in the right ventricles as
well as the pulmonary vasculature. On the other hand, severe chronic pulmonary hypertension
rises the RV afterload and thus results to the clinical condition of the heart failure with a total

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mobbing as well as incapacity to adopt the RV output to the further vascular demands
(Gionfriddo et al., 2017).
Physical, Social and Psychological Challenges of COPD
Although COPD usually affects the lungs, one can experience other changes that go hand
in hand with the condition (Nmc.org.uk. 2017). Apart from physical challenges and fatigue, the
situation can create social and psychological challenges limiting the patients or carers focus on
life as well as the activities of daily living (Janson et al., 2013). Luckily managing COPD is a lot
easier especially when having a carer to count on such as the family members, friends or a
professional health care from the hospital (Mayor, 2017). In the case presented it is shown that
Mr X has been receiving care from his two sons and in the hospital as well.
Physical Impact of COPD on the Patient and Carers.
Research on how COPD impacts the carers of the patient is limited contrary to other
chronic diseases such as cancer and diabetes (Loymans et al., 2014). Studies show that COPD
patients are less satisfied with life, disabled and inactive in life compared to persons with
coronary diseases. There is also evidence to show that changes and morale of wives with
disabled as well as chronically husbands is the same as to their spouses with poor health
associated to being with an ill person (Anon, 2017). Accompanied by irreversible air passage
obstruction and long years of cigarettes smoking, COPD produces symptoms of the lungs in the
late stages of life. This had led to the diagnosis of a vast number of elderly men in the United
Kingdom(Mayor, 2017). However, persons living with this condition experience lots of
challenges day in day out such as wheezing, breathlessness, dyspnea, loss of appetite and

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mobility as well as a cough (Quint et al.., 2013). This is evident in the case study where the client
cannot walk one block away from his standing point without taking a rest.
According to Leung and Sin (2017), families and carers who live with COPD persons
should also handle these challenges since the society expects both care and support of
chronically ill persons especially the elderly to be provided by the family members. Since a
majority of COPD persons are old like in the case of Mr X above, it is usually older family
members who provide support, and since his wife is no longer alive, his two sons are mandated
to carry out the responsibility (Mayor, 2017). This is because the degree at which a family
member is willing to help in the provision of the activities of daily of life for people with chronic
diseases can help change the life of the patient in a tremendous manner (Mayor, 2017). The
presence of a significant other at home is of great essence to the COPD client’s adjustment as
well as the ability to cope (Networks.nhs.uk. 2017).
Although family members are in the forefront in the provision of care further knowledge
needs to be given on how to take care of the elderly. In summary, it can be noted that the
physical challenges the patient experiences include; dyspnea which is the shortness of breath;
exercise capacity which is the submaximal test; muscle function which helps in executing the
activities of daily living and lastly is comorbidity that is the existence of two or more common
disorders occurring in one person (Nice.org.uk. 2017). This condition may manifest in the case
study where the patient may be asthmatic or having cardiovascular diseases.
Psychological Parameters of COPD
Psychological traits like depressive-like anxiety and depression are very common in
COPD persons. COPD symptoms like lack of sleep and fatigue are all related to depression and

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other problems such as loss of appetite and the need for supplemental oxygen. Individuals with
COPD usually feel weak thus rendering it hard for them to take part in enjoyable activities
(Wise, 2016). Though this, it is therefore of great paramount to get help with emotional stress
due to chronic obstruction depression since will just worsen the condition. Notably, research has
shown that people with COPD have difficulties when it comes to following their treatment plans,
therefore not managing the situation can lead to series flares, more visits to the ICU as well as
hospital admissions (RCP London. 2017).
Socioeconomic Impact of COPD
Recent research has shown a devastating personal as well as financial ramification that
COPD can pose on the working population (Quint et al. 2013). Statistically, the study reported
that over 80% of the working population were not able to keep their lifestyle as before they had
contracted the chronic obstructive pulmonary disease. About 40% of the working population
reported to being not in a position to plan for their future with almost 36% of the respondents
their house income has declined due to COPD. These findings show that the condition restricts
individuals with COPD in regard to achieving their goals in life. The same aspect affirms to the
devastating financial as well as psychological challenge of COPD, especially on people who are
in the employment sector or working age group (Mayor, 2017).
In another research on the socioeconomic impact of COPD, it was noted that the
condition affects different sectors such as household income, planning for the future as well as
the effects of the condition on relatives and friends (Anon, 2017). Therefore, it was evident that a
vast number of people are not in a position to keep their usual lifestyle while living with COPD

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When it comes to the management of this parameter relatives and carers who live with a COPD
patient must deal with the aforementioned problems. COPD disease management for the case of
Mr X would involve a couple of practices would ensure that the condition is well managed.
These practices would include exercise and pulmonary rehabilitation, learning how to control
breathing, taking care of one's feelings managing shortness of breath as well as eating
well/keeping a healthy diet.
Relational impacts
Relational changes between the carers and people with COPD are very common during care
delivery (Anon, 2017). Patient’s resistance to medication can usually lead to relational tensions
between the carer and the patients as well as other family members (Mayor, 2017). In other
instances, patients shortness of breath which is a key symptoms associated with COPD can lead
to patient care communication thus lead to isolation of the patient from other people and also less
relations (Conway et al. 2015). Studies show that the feeling of friendship and intimacy between
a person with COPD and his/her spouse and other family member’s starts to fade away alongside
the couple hood identity (Networks.nhs.uk. 2017).
Positive impacts
Care providers usually express a great sense of duty to care as well as satisfaction when doing
something of need to their relatives with COPD (Networks.nhs.uk. 2017) and also when it comes
to helping the patients alleviate their suffering. According to Mayor (2017), caring for those
with the condition allows carers to find a reason for their involvement, since they usually see it
as a chance for own development. Therefore, proving care to the patient provided in the case
study would be rewarding, where the carers exhibit a degree of resilience (British lung

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foundation). However, when it comes to caring for people at the end of life, nurses need to be
gratified especially when they are in a position to respect the persons will to die at home (Anon,
2017).
Nursing/Medical Care for People with COPD
Symptoms Management
People with COPD usually report symptom burden with poor management of the symptoms as a
key problem of the condition (Nice.org.uk. 2017). The most common symptoms experienced by
a vast number of COPD is breathlessness with over 95% of those patients reporting cases of
chronic dyspnea (Nice.org.uk. 2017). The condition can vary in the degree of severity but it also
affects various aspects of an individual life. Breathlessness accompanied by physical extortion
can also cause people with COPD to reduce their levels of physical activity either knowingly or
unknowingly (Anon, 2017). In some instances, breathlessness can be accompanied by fear, panic
or anxiety, difficulty sleeping as well as weight loss to mention just a few. However, when these
symptoms are properly managed, the physical, social and psychological functioning of a person
can start to improve (Networks.nhs.uk. 2017). It should be noted that symptoms Management is
key since a vast number of COPD patients are not only restricted by the physical impact of the
symptoms but also the fear that the symptoms may worsen (Loymans et al. 2017).
As mentioned above, nursing care for people with COPD focuses mainly on the
management symptoms, maximizing functions as well as teaching skills to boost self-care
(Mayor, 2016). Good referral of clients with COPD to the community resources would help
ensure continuity of high-quality care. For the case of Mr X the family members that is; the two
sons were included in the nursing teachings since they play a critical role in care. They were

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educated about chronic obstruction pathophysiology like how lungs transformations are related
to the symptoms. The two were taught to observe the usual symptoms as well as to reach out to
the healthcare provider when symptoms persist. Reinforcement of the need for quality infection
control like regular hand washing was made to the carers of Mr X. The nurse also provided
education on the prescription of drugs. This entailed the use of inhalers, correct sequence for
taking the medics so as to maximize their effect plus side effects. The patient was also made to
understand how to know the quantity of inhaled medics left such that they can shun from getting
over. The importance of having pneumococcal, as well as influenza vaccines were reinforced.
Finally, the patient was urgent to stop smoking. This is because smoking cessation can help
manage the progression of COPD (Nmc.org.uk. 2017). Below is an illustration showing how
COPD is managed using the smoking cessation technique.
Integrated Care
In the concept above, integrated care refers to pitting together inputs management,
delivery as well as the organization of services connected with health promotion (Anon, 2017).
Integration on the other hand, means to improve the healthcare service regarding quality and user
satisfaction. For a healthcare professional, treating a COPD is of great importance. In the case
study presented in this paper, clinical integration is very wide in terms of scope, starting with
investigating the symptoms as well as disability from a respiratory illness, the systemic
manifestations plus the frequently present co-morbid aspects. Techniques over a long trajectory
of the illness range from the intervention aimed at ceasing from smoking, advocating for regular
exercise to improve the wellbeing of the body. Other strategies include collaborative self-
management and optimizing pharmacotherapy to both palliatives as well as hospice care

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(Loymans et al.2014). Another significant factor is coordination of care among the healthcare
professionals during the peri-hospitalisation time for the exacerbation when the morbidity is high
and fragmentation/ use of care. However, coordination via collaboration among the healthcare
providers for the case of Mr X in the hospital was very important as well as after discharge from
the hospital.
Application of integrated care for the COPD patients.
Systematic reviews as well as randomized trials for the care of COPD provides an
understanding into the existing concepts of complex management technique plus efficacy
(Loymans et al., 2014). For instance, a one year randomized control trial of integrated disease
control involved educating clinicians about the diagnosis and management of lung diseases like
COPD (Mayor, 2016). In a 2013 systematic review, of COPD and management, it included basis
elements of intervention that were improved care for frail persons to avert hospitalization,
wellness and rehabilitation and spirometry for COPD (Quint et al., 2013).
Studies show that with health promotion and patient empowerment, the incidences of
COPD have started to decline in the UK. Surprisingly, men are ceasing from smoking in large
numbers. Such changes in the behavior of the people in the community towards smoking is as
due to the implementation of health promotion techniques in the society (Nice.org.uk. 2017).
Health promotion is both sciences as well as the art of helping those unhealthy living life to
change their lifestyle as well as a shift towards a state of healthy life which is the balance
between physical, social, spiritual as well as the intellectual health. Health promotion involves
some of the undertakings to help boost the ability of healthcare systems for prevention of a
disease plus help people take control of their lives and improve them. Studies show that
knowledge alone is not sufficient but coupled with confidence, people can transform their lives.