Linked with COPD due to shared symptoms of exertional dyspnea and a productive cough, asthma is mainly defined by inflammation and irritation of the airways when exposed to various irritants. The characteristic airway hyperreactivity results in wheezing, cough, and mucus production that reverses when treated solely with B-agonist inhalers or with a combination of anticholinergics, methvlxanthines, and/or corticosteroids. COPD and asthma may become nearly indistinguishable as the diseases progress. An improvement in airflow limitation when treated with a bronchodilator type drug(s) indicates an asthmatic or reversible component of COPD.
Dyspnea on exertion requires additional time and energy to complete daily activities. These activities include shopping for groceries, obtaining prescriptions, keeping appointments (doctor, haircut), and social events (hobbies and meeting with friends) as well as the daily self-care activities of bathing, feeding, grooming, and dressing. Progression from exertional dyspnea to dyspnea solely at rest will eventually render the COPD patient debilitated and nearly immobile. The loss of mobility will decrease quality of life and increase morbidity and mortality. Weight loss and anorexia commonly occur as dyspnea and fatigue increase. As many as one fourth of outpatients and nearly one half of those with COPD admitted to the hospital are malnourished. This condition is attributed to the increased work of breathing and caloric demands of the diaphragm and accessory muscles. Guidelines support aggressive nutritional supplements to maintain COPD patients at appropriate weight and muscle mass to promote adequate functional ability. Strategies to improve nutritional intake include altering meal patterns from three meals to six smaller meals to alleviate stomach distension that would interfere with the work of the diaphragm and regular high calorie snacks. Oral intake of six to eight glasses of fluid is needed daily to improve airflow limitation by thinning secretions. Sleep pattern disturbance may be a common occurrence with COPD. As sleep patterns become more disrupted reports of fatigue, anxiety, and depression increase. Sputum production, wheezing, cough, medication side effects, age related insommnia and oxygen desaturation are believed to play a major role in disturbing sleep patterns. Supplemental nocturnal oxygen has been found to improve sleep patterns, pulmonary function, and general well being. Feelings of depression, hopelessness, low self-esteem, and anxiety are common among COPD patients. The goal of ongoing medical management and nursing care is organized around the promotion of active patient participation in A D L ’s. nutrition, and the balance between activity and rest so a satisfactory quality of life can be achieved. The resulting sense of well being is helpful in minimizing the incidence and severity of depressive symptoms.
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