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Chronic Obstructive Pulmonary Disease (COPD)

Pathophysiology of COPD

The chronic obstructive pulmonary disease consists of chronic lung diseases which creates respiratory problems especially when breathing. COPD causes various consequences on the lungs which makes breathing difficult and the oxygen taken in is decreased and therefore the distribution to other organs is minimal (Brashier &Kodgule, 2012). Chronic bronchitis and emphysema are the main conditions of COPD and they have effects on the various parts of the lungs which lead to lung damage. The major causes of COPD is smoking of tobacco and also taking in chemicals and smoke which damages the air ways and air sacs. The exposure to the second hand smoking also causes COPD and even the environmental chemicals and fumes from the gases burnt.

The pathophysiology of COPD includes the adverse changes in the normal functioning related to the disease. For instance, the people with COPD may start experiencing the destruction of the airways and the air sacs in lungs then eventually progress to coughing and breathing problems (Kim, 2017). The pathological changes in COPD causes physiological abnormalities such as airflow obstruction, pulmonary hypertension, mucous hypersecretion, systemic effects, hyperinflation, ciliary dysfunction and gas exchange abnormalities.

In the case study provided, Nancy had a productive cough with release of sputum that appeared thick and colored. Concerning the pathophysiology of COPD, there is increased mucous production which may cause productive cough. The feature indicates chronic bronchitis but it is not related with the obstruction of air flow and not every patient experiences it. The hypersecretion could be due to squamous metaplasia and the rise in the number of goblet cells as a response to the chronic irritation by the irritants and gases.

There is also the airflow obstruction due to the narrowing and inflammation of the airways and the exudates formed from inflammation. Nancy in our case study experienced breathlessness due to the narrowed airways and struggled to breathe. Some other elements may cause also cause obstruction of the airflows because of the damage of the lung elastic and the damage of the alveolar walls. The obstructed air leads to the trapping of air when one exhales air hence causing hyperinflation. Hyperinflation decreases the ability to breathe therefore causing breathlessness in a case of COPD.

The other problem is the abnormalities with the gas exchange. There is the abnormal distribution of the air in the lungs because of some changes in anatomy in COPD. Pulmonary hypertension also could occur but later in the stages of COPD (Radovanovic et al, 2018). Some of the contributing elements are the narrowed arteries of the pulmonary and the damage of the capillary bed of pulmonary. The structural changes in the arteries of the pulmonary causes the pulmonary hypertension and the dysfunction and increased sizes of the pulmonary vessels. When the COPD continues to progress, multiple other health complications may occur. Apart from coughing, an individual may wheeze when they are breathing. The accumulation of mucus and the constricted bronchioles may be raise the tightness of the chest. The minimal oxygen getting distributed in the body may leave the patient feeling fatigued and light-headed. With a serious COPD, there could be loss of weight since the body needs much energy to breathe.

Pharmacological Management of COPD

In a patient appears stable, the COPD pharmacotherapy is utilized to relieve symptoms and to decrease the number of times that one experiences exacerbations as well as reducing the chances of mortality and disease progression. From the previous concepts, it is stated that the COPD treatment should be done in steps depending on the severity of the condition as shown by the spirometry (Broeders et al, 2011). In a mild COPD, there should be reduction in the risks likely to be encountered with the assistance of the bronchodilators. When the disease continues to develop and the lung function deteriorating, treatment alongside bronchodilators are used.

The drug therapy is useful in regulating and preventing the symptoms of COPD from progressing as well as enhancing the health status of an individual. The general strategy to managing COPD is features by personalized evaluation of the severity of the condition and the response to the treatments being given (Donnell et al, 2016). The treatments that are given are checked closely and adjustments are made as required. Previously, the response to the bronchodilators and the medication like corticosteroid was evaluated using the spirometer. Whereas spirometry is the required method for confirming the diagnosis of airflow obstruction, the reversibility testing is not the everyday suggested method for drug therapy. When on drug therapy, there are measurements that are made including checking the symptoms of the patient, exercise tolerance, daily activities and the exacerbation rates. In case patient’s symptoms are not reacting to the therapy given, the medication should be stopped immediately.

Despite the irreversible airflow obstruction of COPD, many patients still show that they are benefiting from the bronchodilators. The bronchodilator medications are useful in removing the airway smooth muscle tones and enhancing the airways. The bronchodilators are important in preventing the breathing problems and could also reduce the pulmonary hyperinflation while increasing the respirator muscle functions (Currie, 2017). The explanation above is the reason why there are advantages clinically but then one can fail to note the changes in the functioning of the lungs of the patient. The categories of the bronchodilators include; methylxanthines, beta-2-agonists and anticholinergics which include both short and long term actions. Most patients require the short-acting bronchodilators. The long-acting bronchodilators are mostly used in combination with the short-acting. The individuals who experience two or even more exacerbations annually should be kept under the long-acting bronchodilators.

In our case study, Nancy was administered with a bronchodilator by the name Ventolin. The drug has a short action of about 4 to 6 hours action. As discussed in the case study, the drug helped in alleviating the breathing problems that Nancy had first presented with while she was admitted to the hospital. By the following day, the temperatures were within the required limit and the breathing was pretty much better.

Pharmacodynamics of The Medications Used in COPD.

One may prevent the COPD symptoms such as coughing, accumulation of mucus, fatigue, breathing problems through taking the prescribed medication by the doctor. Various types of medications are available for treating COPD. Other times, there could be a flare-up where the symptoms worsen and the physician could prescribe more medications to help improve the situation of the patient. However, an individual could enjoy the full advantages of the medications given by sticking to the instructions given by the physician and taking the medications as shown in the prescriptions. Some of the medications are only taken when necessary for example the bronchodilators that are used to relieve some quick pain while some medications may be used frequently.

The bronchodilators are the main form of treatment of COPD. The beta2-adrenoreceptos agonists are useful in activating the airway smooth muscles hence bronchodilation occurs (Bateman et al, 2013). The muscarinic antagonists on the other hand have an effect on the bronchial motor tome ad the mucus production by cholinergic system. The M2 receptors act indirectly on the airway contraction of the smooth muscles while M3 receptors are useful in dilation and the relaxation of the airway smooth muscles. Furthermore, the M3 receptors help in conducting the cholinergic effects on the secretion of the mucus. The specific M3-muscarinic receptor blockage enhances the bronchodilation as well as activating the secretion of mucus.

The inhaled corticosteroids offer the anti-inflammatory effects but could also increase the chances of one getting pneumonia in patients with adverse effects. The current recommendations are that the peripheral blood eosinophil count is applied when giving the inhaled corticosteroids therapy to help prevent the exacerbation (Quinn et al, 2019). The clinical trial evidence show that patients with more eosinophils count should be given the inhaled corticosteroid medications. When the COPD symptoms have subsided, the patient should stop taking the inhaled corticosteroids.

Apart from the medications used for maintenance, there are other forms of preventive therapies and exacerbation treatments. The non-pharmacological forms of treatments may include the oxygen therapy, participation in the physical activity, the reduction in the lung volume and the pulmonary rehabilitation. One is advised on stopping the smoking habits as well as the onset of counseling programs to help in the management of COPD. Varenicline is a common drug used to help an individual stop smoking. The non-combustible cigarettes, patches, electronic cigarettes and nicotine lozenges are also useful in reducing the habit of smoking or the exposure to carcinogenic and toxic chemicals which are found in the traditional cigarettes.

References for Chronic Obstructive Pulmonary Disease (COPD)

Bateman, E. D., Kornmann, O., Ambery, C., & Norris, V. (2013). Pharmacodynamics of GSK961081, a bi-functional molecule, in patients with COPD. Pulmonary pharmacology & therapeutics, 26(5), 581-587.

Brashier, B. B., & Kodgule, R. (2012). Risk factors and pathophysiology of chronic obstructive pulmonary disease (COPD). J Assoc Physicians India, 60(Suppl), 17-21.

Broeders, M. E., Vincken, W., & Corbetta, L. (2011). The ADMIT series—issues in inhalation therapy. 7) Ways to improve pharmacological management of COPD: the importance of inhaler choice and inhalation technique. Primary Care Respiratory Journal, 20(3), 338-343.

Currie, G. P. (Ed.). (2017). ABC of COPD. John Wiley & Sons.

Kim, E. K. (2017). Pathophysiology of COPD. In COPD (pp. 57-63). Springer, Berlin, Heidelberg.

O’Donnell, D. E., Webb, K. A., Harle, I., & Neder, J. A. (2016). Pharmacological management of breathlessness in COPD: recent advances and hopes for the future. Expert review of respiratory medicine, 10(7), 823-834.

Quinn, D., Barnes, C. N., Yates, W., Bourdet, D. L., Moran, E. J., Potgieter, P., ... & Singh, D. (2018). Pharmacodynamics, pharmacokinetics and safety of revefenacin (TD-4208), a long-acting muscarinic antagonist, in patients with chronic obstructive pulmonary disease (COPD): results of two randomized, double-blind, phase 2 studies. Pulmonary pharmacology & therapeutics, 48, 71-79.

Radovanovic, D., Pecchiari, M., Pirracchio, F., Zilianti, C., D’Angelo, E., & Santus, P. (2018). Plethysmographic loops: a window on the lung pathophysiology of COPD patients. Frontiers in physiology, 9, 484.

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