Chapter 20: Managing Chronic Pulmonary Disease

Managing Chronic Pulmonary Disease establishes COPD as a progressive disease state characterized by airflow limitation that is not fully reversible, comprising two distinct yet often overlapping conditions: chronic bronchitis, defined by the presence of cough and sputum production for at least three months in consecutive years, and emphysema, which involves the destruction of alveolar walls and capillary beds leading to impaired gas exchange and air trapping. The text explores critical risk factors, most notably cigarette smoking and alpha1-antitrypsin deficiency, and details the diagnostic role of pulmonary function tests, specifically spirometry, to measure forced expiratory volume (FEV1) and forced vital capacity (FVC). A significant portion of the chapter is dedicated to therapeutic management, including smoking cessation strategies and pharmacologic therapy utilizing short-acting and long-acting bronchodilators (beta2-adrenergic agonists and anticholinergics), inhaled corticosteroids, and phosphodiesterase inhibitors delivered via metered-dose inhalers, dry-powder inhalers, or nebulizers. The summary further details oxygen therapy protocols, emphasizing the prevention of oxygen toxicity and carbon dioxide retention through precise delivery systems like Venturi masks, alongside surgical options such as bullectomy and lung volume reduction. Nursing management strategies are extensively covered, focusing on airway clearance techniques like chest physiotherapy (CPT), postural drainage, percussion, vibration, and high-frequency chest wall oscillation, as well as breathing retraining methods such as diaphragmatic and pursed-lip breathing to reduce air trapping and fatigue. The chapter also differentiates asthma as a reversible chronic inflammatory disorder involving airway hyperresponsiveness, outlining the stepwise approach to medication, the management of status asthmaticus, and the use of peak flow monitoring and action plans. Finally, it addresses cystic fibrosis, a genetic autosomal recessive disorder affecting the CFTR protein, which results in thick, viscous secretions requiring a complex regimen of airway clearance, CFTR modulators, pancreatic enzyme replacement, and aggressive antibiotic therapy to manage respiratory infections caused by pathogens like Pseudomonas aeruginosa.