Abstract
COPD is an illness that primarily affects the respiratory system. It is a treatable and preventable illness that is characterized by persistent and progressive limitation of airflow into the lungs. in its severity, COPD is a condition that requires frequent hospitalizations due to exacerbations that occur once there is a trigger effect or the patient is exposed to an allergen. Within the US, COPD is regarded as the third leading cause of death and there is evidence to show that up to 11 million persons have been diagnosed with COPD (Global initiative for Chronic Obstructive Lung Disease Inc, 2015). It is estimated that a further 24 million have the illness but they do not know until it progresses to a condition where it leads to disabilities and deaths. At the national level, the cost and economic burden for the management and treatment of the cases of COPD and related complications is estimated at $36 billion annually for medical costs alone. Absenteeism associated with COPD is estimated to cost $3.9 billion while a total of 16.4 million work days are lost each year (American College of Chest Physicians, 2014). Up to 51% of the total medical costs were handled by the Medicare, 18% by the private insurance and 25% by Medicaid. It is estimated that with an increasing population and with the prevalence of COPD significantly rising, as at 2020, the economic costs for COPD will rise to $49 billion annually (American College of Chest Physicians, 2014). However, appropriate use of bronchodilators, adherence to medication, smoking cessation and avoidance of trigger factors have been found to be effective management techniques for COPD patients.
COPD Diagnosis and risk factors
The prevalence of COPD is associated with several causes. These include cigarette smoking which is the major influencing factor for the development of COPD. It is estimated that for all the cases of COPD that have been diagnosed, up to 79% have a positive history with cigarette smoking (Global initiative for Chronic Obstructive Lung Disease Inc, 2015). Other causes include the indoor and outdoor air pollution all which contributes to the burden of foreign material that ultimately causes leads to the COPD manifestation. Further, those individuals who work within areas where there are poisonous vapors, fumes and irritants are at higher risk of COPD that those who may be working in offices or setting where such material may not be present in the air in large quantities. Therefore, such vapors, fumes and irritants are regarded as occupational hazards that increase the risk of COPD (Price, Yawn & Jones, 2010).
In the diagnosis of patients who may present with symptoms that are related to COPD, it is important to consider their work place and their family history as influencing factors. A positive family history as well as the work environment could provide the primary illness or causes for the condition as presented by the patient. The unique presentations for COPD could include a progressive dyspnea that worsens with time and could exacerbate with little exercise or physical activity (Global initiative for Chronic Obstructive Lung Disease Inc, 2015). On the other hand, the patient may present with a chronic cough which at times may be unproductive or intermittent. In other instances, the cough may be productive of sputum and this could be used as a perfect indicator for exposure history. Once each of these has been ascertained, the illness can be labeled as severe or mild based on the functionality of the lungs and the burden of the symptoms as observed and presented (Price, Yawn & Jones, 2010).
Drug therapy
The management and treatment of COPD is based on the need to reduce or limit the severity and frequency of exacerbations, improve the health status of the individual as well as improve the ability of the patient to withstand exercise and physical activity. With COPD, it is apparent that there is blocking and narrowing f the airways and bronchioles in the lower respiratory tract. In this regard, the first line drug therapy is the use of bronchodilators. On the other hand, there is a close link between the occurrence of symptoms and exacerbation and bacterial infection (American College of Chest Physicians, 2014). Therefore, antibiotics feature as the second line drug therapy for COPD patients. Supplemental oxygen which is used selectively can be applied as the third line drug therapy and it is used by the patient when asleep or when taking part in some physical activity.
Bronchodilators are the most important drug therapy for COPD patients since they work to help in the relaxation of the muscles as well as widening of the airways while also helping clear out the airways that have been clogged by mucus. Therefore, these bronchodilators are effective for managing the three main conditions that define COPD namely Bronchitis, emphysema and nasal congestion. Examples of bronchodilaots include Beta2-agonists, Anticholinergics, steroids, glucocorticoteroids, theophyllline and mucolytics all which have been found to have common or similar adverse reactions such as insomnia, elevated blood pressure, palpitations and restlessness (Price, Yawn & Jones, 2010).
Apart from the pharmacological therapy, patient education is a key component in the management of COPD. One of the major aspects of consideration is the emphasis on adherence to medication and treatment regimen. Poor adherence to the drug regimen is regarded as one of the major challenges that have lead to progression of COPD to severity and leading to increased mortalities and morbidities. Donohue, Fogarty, Lötvall, Mahler, Worth, Yorgancioglu & Kramer (2010) in their research focused on developing evidence to determine the effectiveness of two bronchodilators namely Indacaterol and Tiotropium by utilizing them in a random sample of COPD patients and utilizing a placebo to control the extraneous factors. In their study, the researchers had up to 1, 683 participants in which they were randomly placed in four groups. Two groups were regarded as the experimental groups in which the participants were subjected to Indacaterol and Tiotropium respectively. The other two groups were subjected to a placebo treatment each group as a control for the each of the experimental groups.
Apparently, the results indicated significant improvement in the experimental groups as compared to the control groups. However, the group that was subjected to Indacaterol indicated improved outcomes than that which was subjected to Tiotropium a finding that was associated with the fact that there was better drug adherence for users of Indacaterol since it is once-daily medication. Further, patients should be informed and trained on self-care and self-management technique particularly in reference to the identification and avoidance of any trigger factors that exacerbate the condition. Smoking cessation should be a key goal for patients with COPD and under medication to eliminate the burden that is associated with smoke on a system that is already straining (Global initiative for Chronic Obstructive Lung Disease Inc, 2015).
References
American College of Chest Physicians. (2014). CDC reports annual financial cost of COPD to be $36 billion in the United States - American College of Chest Physicians. Retrieved from http://www.chestnet.org/News/Press-Releases/2014/07/CDC-reports-36-billion-in-annual-financial-cost-of-COPD-in-US
Donohue, J. F., Fogarty, C., Lötvall, J., Mahler, D. A., Worth, H., Yorgancioglu, A., & Kramer, B. (2010). Once-daily bronchodilators for chronic obstructive pulmonary disease: indacaterol versus tiotropium.American journal of respiratory and critical care medicine, 182(2), 155-162.
Global initiative for Chronic Obstructive Lung Disease Inc. (2015). Global initiative for Chronic Obstructive lung Disease: Pocket Guide to COPD Guide Diagnosis, Management and Prevention. Retrieved from http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf
Price, D. B., Yawn, B. P., & Jones, R. C. (2010). Improving the differential diagnosis of chronic obstructive pulmonary disease in primary care. In Mayo Clinic Proceedings (Vol. 85, No. 12, pp. 1122-1129). Elsevier.
