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Chronic Obstructive Pulmonary Disease

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Submitted By mareee
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Chronic Obstructive Pulmonary Disease |

INTRODUCTION
We are doing a case study on medical, nursing, pharmacological management of COPD (Chronic Obstructive Pulmonary Disease). We took a COPD patient and assessed the patient for clinical manifestation, the medical, nursing, pharmacological care given to the patient. In our case study we will include the care Hawwa is receiving now and the care we can add to daily routine to help her recover faster.
Hawwa Ismail is admitted to Medical ward with diagnosis of COPD. She is 145cm tall, slim, with dark complexion. She is 79 years old. She said that she has difficulty in breathing, she cannot sleep in night time ,she do not feel like eating food and she was having cough.
Physical assessment revealed BP 138/47mmHg right arm in lying position, pulse 84 regular and strong, and breathing pattern was irregular labored, tachypnic at 40 breathes per minute,SpO2 99% in room air and temperature 360C (96.80F).Her facial color and lips are ruddy, but nails are clean ,pale and clubbed. She has a little barrel chest, uses accessory muscle to breathe. She has prolonged expiration. While auscultating lungs, diminished breath sound in most of the lower lobes and a small wheezing sound in right lower lobe was noted.

PERSONAL DETAILS

PATIENT NAME: Hawwa Ismail
ADDRESS:Iruvaige/R.Inguraidhoo

GUARDIAN:

NAME: Abdul HameedHussain
CONTACT NO: 7772099

AGE: 79yrs
SEX: female

NATIONALITY: Maldivian
LANGUAGE: Dhivehi
RACE: Asian

RELIGION: Muslim

MARITAL STATUS: Widow
NO.OF.CHILDREN: 9
OCCUPATION: House wife

EDUCATION LEVEL: Basic Education
EATING HABITS: she eats twice a day, mostly garudiya and rice

PRESENT HISTORY: 79 year old female (Hawwa Ismail) came to casualty with the complaints of productive cough, decreased appetite, fever and body ache since one week. On admission vitals were as following; BP: 114/77mmHg, Pulse: 100/min, SpO2: 99%, temp: 100oF, RR: 40/min and patient had wheezing right lower zone of chest, patient was conscious and oriented.
PAST HISTORY: known case of IgM multiple myeloma (II), NSTEMI (Non ST elevation myocardial infarction), upper lobe pneumonia with secondary bronchiectasis, oral candidiasis. Previously admitted in medical ward related multiple myeloma and NSTEMI, one year backand patient was diagnosed for COPD two years back.
FAMILY HISTORY:Nil significant informed.

DISEASE CONDITION
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
DEFINITION:group of pulmonary disorder characterized by air flow limitation that is not fully reversible. (Smeltzer,Bare,Hinkle&Cheever,2010,p.602)
TYPES:
1. 2. Emphysema 3. Bronchitis

CHRONIC BRONCHITIS
DEFINITION:a disease of the airway is defined as presence of cough and sputumproduction for at least 3 months in each 2 consecutive years.(Smeltzer,Bare,Hinkle&Cheever,2010,p.602)
INCIDENCE: The WHO estimates that in 2000, 2.74 million people died of COPD worldwide. Mortality of COPD among women has increased since 2nd world war in 2005, more women than men died of COPD. An additional 12 million Americans may have COPD but remain undiagnosed
PATHOPHYSIOLOGY:
Smoke or other environmental pollutant irritates the airways (Smeltzer,et.al.,2010,p.602) |

Resulting in hyper secretion of mucus and inflammation
Constant irritation causes the mucus-secreting glands and goblet cells to increase in number.
Ciliary function reduces and more mucus is produced.

Bronchial walls become thickened; the bronchial lumen narrows and mucus plug the airway

Airway obstruction
RISK FACTOR: * Exposure to tobacco smoke accounts for an estimated 80% to 90% COPD cases. * Passive smoking * Occupational exposure * (Smeltzer,Bare,Hinkle&Cheever,2008,p.688)
Ambient air pollution * Genetic abnormalities
RISK FACTORS IN HAWWA:
She is exposed to dust while cleaning the house, before she used to cook with wood so she was exposed to smoke regularly. She is exposed to cigarette smoke because many people in her house smokes.
CAUSES:
* Airway obstruction * Diffuse airway injury * Pulmonary infection and obstruction of the bronchus or complications of long-term pulmonary infections. * Genetic factors * Abnormal host defense * Idiopathic causes
CAUSES IN HAWWA:
She had a history of pneumonia a pulmonary infection leading to chronic obstructive pulmonary disease. SIGNS AND SYMPTOM * COPD is characterized by three primary symptoms: * Chronic cough * Sputum production * Dyspnea on exertion * Weight loss is common, because Dyspnea interferes with eating the work of breathing is energy-depleting * Use of accessory muscle * Patients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure. * Barrel chest * Shortness of breath * Wheezing * Prolonged expiration * Enlarged heart clubbing of nails. * (Smeltzer,Bare,Hinkle&Cheever,2008,p.689)
Cyanosis
* Peripheral edema SIGNS AND SYMPTOM IN HAWWA: She has excessive mucus production, as a way of elimination coughing is present. She is having dyspnea, shortness of breath and wheezing. Prolonged coughing and dyspnea and use of accessory muscle, increase work load of chest leads to barrel chest and she feel tired. Her nails are clubbed. Presences of other diseases such as myocardial infarction make her immunosuppressed to other pulmonary infections. ASSESSMENT AND DIAGNOSTICS FINDINGS ASSESSMENT * Obtain history * Ask about exposure to risk factors * Family history * Pattern of symptoms developed * History of previous hospitalization * Appropriateness of current treatment * Impact of the disease on quality of life * Available social and family support for patient * Potential for reducing risk factors. DIAGNOSTIC TESTS * Pulmonary function studies: helps to confirm the diagnosis of COPD, determine disease severity, and monitor disease progression * Spirometry: to evaluate airway obstruction, by ratio of FEV, to forced vital capacity (FVC). * Arterial blood gas measurement: to assess baseline oxygenation and gas exchange. * X-ray or Computer tomography (CT) scan: to check presence or absence of bronchial dilation. In Hawwa, in addition to above diagnostic tests her sputum culture was sent to test for pulmonary infections. (Smeltzer,Bare,Hinkle&Cheever,2008,p.689)

BLOOD INVESTIGATION DONE FOR HAWWA ISMAIL
Investigation done on 19th June 2012 Haematology Name of test | Result | Normal Range | Remarks | Haemoglobin | 7.1 g/dL | 11.5-17 | low | PCV | 22.1% | 35-48 | low | Total leukocyte count | 2.18x10^3/uL | 4-11 | low | Differential count | | | | Neutrophils | 56.0% | 40-72 | Normal | Lymphocytes | 32.1% | 20-40 | Normal | Monocytes | 10.1% | 2-10 | Normal | Eosinophils | 1.8% | 1-6 | Normal | Basophils | 0.0% | 0-1 | Normal | Platelet count | 56x10^3/uL | 150-400 | Very low | erythrocyte sedimentary rate (ESR) | 95 | 1-15 | High |

When we saw the reports of 19th June we came to know that patient’s haemoglobin was low and she was given two pints of blood. After transfusing two pints of blood her haemoglobin was increased. Increase ESR indicates inflammation and decrease leukocyte count show that she was having an infection for which she was treated with antibiotics. Decreased number of platelets indicates risk of bleeding.

Investigation done on 21st June 2012
Mantouxtest:To test for positivity or negativity of tuberculosis Test | 10 tuberculin unit PPD given intradermally | Date of administration | 21/6/2012 | Date reading | 23/6/2012 | Indurations | 00mm |
Investigation done on 23rdJune 2012

Name of test | Result | Normal Range | Remarks | ESR | 95mm/1Hr | 1-15 | HIGH | CRP | 41mg/l | 0-10 | HIGH |

CLINICAL CHEMISTRY. Name of test | Result | Normal Range | Remarks | Blood urea | 13.5mg/dl | 15-36 | low | Serum Sodium | 136.1mmol/l | 137-145 | Normal | Serum Potassium | 2.94mmol/l | 3.5-5.1 | low | Serum Creatinin | 0.9 mg/dl | 0.7-1.2 | Normal |
Investigation done on 23rd June 2012 Haematology Name of test | Result | Normal Range | Remarks | Differential count | | | | Neutrophils | 66.6% | 40-72 | Normal | Lymphocytes | 20.3% | 20-40 | Normal | Monocytes | 15% | 2-10 | High | Eosinophils | 2.0% | 1-6 | Normal | Basophils | 1% | 0-1 | Normal | Platelet count | 56x10^3/ul | 150-400 | Very low | ESR | 84 | 1-15 | High |

Investigation done on 24th june2012

CLINICAL CHEMISTRY. Serum Sodium | 131.9mmol/l | 137-145 | Normal | Serum Potassium | 3.46mmol/l | 3.5-5.1 | Normal |
Investigation done on 25thjune 2012 Haematology Name of test | Result | Normal Range | Remarks | Haemoglobin | 11.2 g/dl | 11.5-17 | Normal | Total leucocyte count | 3.39x10^3/ul | 4-11 | low | Differential count | | | | Neutrophils | 46.9% | 40-72 | Normal | Lymphocytes | 33.7% | 20-40 | Normal | Monocytes | 14.9% | 2-10 | High | Eosinophils | 3.4% | 1-6 | Normal | Basophils | 1.1% | 0-1 | Normal | Platelet count | 101x10^3/ul | 150-400 | low | ESR | 51 | 1-15 | High |

MEDICAL MANAGEMENT RISK REDUCTION Smoking cessation: Smokingparalyzesciliary action, increasing bronchial secretions. PHARMACOLOGICAL THERAPY 1. Bronchodilators: * To relive bronchospasm * To reduce airway obstruction * Improve alveolar ventilation 2. Corticosteroids: inhaled corticosteroids (oral or intravenous) may be used to relieve bronchospasm. 3. Vaccination against diseases such as influenza, pneumonia is given to prevent infection. 4. Oxygen therapy: to prevent acute dyspnea. (Smeltzer,Bare,Hinkle&Cheever,2008,p.691)

MEDICATIONS HAWWA RECEIVES: Generic Name | Cefotaxime | Brand names | Claforan | Caution | sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity reaction),false positive urinary glucose (if tested for reducing substances) and false positive Coombs’ test | Indication | Used to treat gonorrhoea, meningitis, and severe infections including infections of the kidney (pyelonephritis) and urinary system. Also used before an operation to prevent infection after surgery.Cefotaxim was given for patient because she was having infections. | Dosage | 1g, IV, TDS (3 times a day) | Contraindication | cephalosporin hypersensitivity | Side effects | diarrhoea (rarely antibiotic-associated colitis), nausea and vomiting, abdominal discomfort, headache; allergic reactions including rashes, pruritus, urticaria, serum sickness-like reactions with rashes, fever and arthralgia, and anaphylaxis; Stevens-Johnson syndrome, toxic epidermal necrolysis reported; disturbances in liver enzymes, transient hepatitis and cholestatic jaundice; other side effects reported include eosinophilia and blood disorders (including thrombocytopenia, leucopenia, agranulocytosis, aplastic anaemia and haemolytic anaemia); reversible interstitial nephritis, hyperactivity, nervousness, sleep disturbances, hallucinations, confusion, hypertonia, and dizzinessno side effect seen in patient | Pharmacodynamics | Cefotaxime is a third generation intravenous cephalosporin antibiotic. It has broad spectrum activity against Gram positive and Gram negative bacteria. It does not have activity against Pseudomonas aeruginosa. Cefotaxime works by inhibiting bacterial cell wall biosynthesis. A positive feature of cefotaxime is that it displays a resistance to penicillinases and is useful to treat infections that are resistant to penicillin derivatives. | Mechanism of action | The bactericidal activity of cefotaxime results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs). Cefotaxime shows high affinity for penicillin-binding proteins in the cell wall including PBP Ib and PBP III. | Nursing implication | Monitor for adverse reaction. | Name | Pantoprazole | Brand names | Astopan, Pantoloc, Pantoc, Pantozol, Protium, protonix | Caution | Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with ‘alarm features’, in such cases gastric malignancy should be ruled out before treatment. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically. | Indication | Gastro-oesophageal Disease | Contraindication | Nil | Dosage | 40mg, IV, BD (2 times a day) | Side effects | Side effects of the proton pump inhibitors include gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation), and headache. Less frequent side effects include dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Other side effects reported rarely or very rarely include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, hypomagnesaemia (with long-term treatment), blood disorders (including leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk of gastro-intestinal infections (including Clostridium difficile infection).There is no side effects seen in patient | Pharmacodynamics | Pantoprazole is a substituted benzimidazole indicated for the short-term treatment (up to 16 weeks) in the healing and symptomatic relief of erosive esophagitis. Pantoprazole is a proton pump inhibitor (PPI) that suppresses the final step in gastric acid production. | Mechanism of action | Pantoprazole is a PPI that suppresses the final step in gastric acid production by forming a covalent bond to two sites of the (H+,K+ )- ATPase enzyme system at the secretory surface of the gastric parietal cell. This effect is dose- related and leads to inhibition of both basal and stimulated gastric acid secretion irrespective of the stimulus. | Nursing implication | Monitor for Side effects |

Name | Domperidone | Brand names | Motilium, Nauzelim | Caution | children | Indication | To treat nausea and vomitingNausea related to administration of cafotaxim. | Contraindication | prolactinoma; if increased gastro-intestinal motility harmful | Dosage | 100g, PO, TDS (3 times a day) | Side effects | rarely gastro-intestinal disturbances (including cramps) and hyperprolactinaemia; very rarely ventricular arrhythmias, agitation, drowsiness, nervousness, seizures, extrapyramidal effects, headache, and rashes; also reported QT-interval prolongationThere are no side effects seen in patient. | Pharmacodynamics | Domperidone is a specific blocker of dopamine receptors. It speeds gastro-intestinal peristalsis, causes prolactin release, and is used as antiemetic and tool in the study of dopaminergic mechanisms. | Mechanism of action | Domperidone acts as a gastro-intestinal emptying (delayed) adjunct and peristaltic stimulant. The gastroprokinetic properties of domperidone are related to its peripheral dopamine receptor blocking properties. Domperidone facilitates gastric emptying and decreases small bowel transit time by increasing esophageal and gastric peristalsis and by lowering esophageal sphincter pressure. Antiemetic: The antiemetic properties of domperidone are related to its dopamine receptor blocking activity at both the chemoreceptor trigger zone and at the gastric level. It has strong affinities for the D2 and D3 dopamine receptors, which are found in the chemoreceptor trigger zone, located just outside the blood brain barrier, which - among others - regulates nausea and vomiting | Nursing implication | Monitor for side effects | Name | Bromhexine Hydrochloride | Brand names | Bisolvon | Caution | Gastric ulceration | Indication | As a mucolytic in the management of viscid mucoid secretions associated with bronchitis, bronchiectasis, and sinusitis.To dilute bronchioles to improve gases exchange rate. | Contraindication | BISOLVON CHESTY should not be used in patients known to be hypersensitive to bromhexine or any other component of the formulation.In case of rare hereditary conditions that may be incompatible with an excipient of the product (refer to Precautions), the use of the product is contraindicated. | Dosage | , 10ml, PO, TDS (3 times a day) | Side effects | Immune system disorder, skin and subcutaneous tissue disorders and Respiratory, mediastinal and thoracic disorders Anaphylactic reaction including anaphylactic shock, angioedema, bronchospasm, rash, urticaria, pruritus and other hypersensitivity. | Pharmacodynamics | Bromhexine is a synthetic derivative of the herbal active ingredient vasicine. Preclinically, it has been shown to increase the proportion of serous bronchial secretion. Bromhexine enhances mucus transport by reducing mucus viscosity and by activating the ciliated epithelium (mucociliary clearance). In clinical studies, bromhexine showed a secretolytic and secretomotor effect in the bronchial tract area, which facilitates expectoration and eases cough.Following the administration of bromhexine antibiotic concentrations (amoxycillin, erythromycin, and oxytetracycline) in the sputum and bronchopulmonary secretions are increased. | Nursing implication | Monitor for side effects |

SURGICAL MANAGEMENT * Bullectomy: removal of a portion of the diseased parenchyma. * Pneumonectomy: removal of entire lung * Lobectomy: removal of a lobe * Segmental resection: removal of a segment of a lobe * Lung transplantation PULMONARY REHABILITATION Pulmonary rehabilitation for patient with COPD is well established and widely accepted as a means of alleviates symptoms and optimizes functional status. Pulmonary rehabilitation services are multidisciplinary. It include: * Assessment * Education * Physical reconditioning * Skill training * Psychological support * Teaching * methods to alleviate symptoms * Breathing exercises * Exercise to improve functional status COMPLICATION Some of the complications include; * (Smeltzer,et.al.,2008,p.694)
Respiratory insufficiency or failure * Atelectasis * Pulmonary infections * Pneumonia * Pneumothorax * Pulmonary hypertension

NURSING MANAGEMENT:
NURSING ASSESSMENT
1. Vital Signs

Temperature: 360C
Pulse: 84/min
Respiration: 40/min
Blood Pressure: 138/74mmHg
Weight: 40kg
Height: 145cm

2. Respiration

Breathing: irregular
Presence of: Cough, Wheeze, Dyspnea
Smoking: No

3. Circulation

Pulse:regular
Presence of:warm

4. Neurosensory

Level of consciousness: respond verbally, moves to command and responds to pain.
Orientation: knows time, place and person.
Mood: Anxious
Speech:Appropriate
Pupil: equal 5.

6. Skin /Hygiene

Color:Pale
Temperature: warm

Turgor: Non Elastic
Integrity: Cannula present

Hair: Clean
Mouth: Moist

Tongue: Moist
Teeth: -
Nails: Clean

7. Food/ fluid /electrolytes
Diet:normal
Appetite:Poor
Weight:weightloss

8. Elimination
Urinary:Normal, on nappy related to generalized weakness.
Usual bowel habit:once a day
Last bowel movement:Todaymorning around 8 am

9. Sleep: Usual

10. Sexuality and reproductively: Expressed no concern related to illness.

11. Mental State behavior: Anxious Looking

12. Safety

History of fall:NO
Fall risk level assessment Done: Yes

Perception/ coordination

Visual:good
Speech:good

Auditory: good
Sensory:Good

13. Mobility
Activity of daily living:needsassistance related to generalized weakness.

NURSING CARE PLAN
In this we will include the care Hawwa is already receiving and the care we can improve. The care Hawwa now receives is shown underlined and bold, as we add new care we can give to Hawwa. Nursing diagnosis | Goal | intervention | rational | 1. Ineffective airway clearance related to bronchoconstriction and increase sputum production | Achieving airway clearance | * Assess the patient * Check vitals every 4th hourly * Administer medication as prescribed. * Encourage eliminate or reduce all pulmonary irritants * Increase fluid intake * Provide steam inhalation. | * To see for Dyspnea and hypoxemia * To have base line data * To relief bronchospasm * To reduce the risk of bronchospasm * To make secretion tin and relief * To loosen the secretion and bronchospasm | 2. Ineffective breathing pattern related to shortness of breath | To maintain and improve breathing pattern | * Inspiratory muscle training and breathing * Encourage and teach diaphragmatic breathing. * Position the patient in fowlers. | * To improve breathing pattern * To increase alveolar ventilation * To increase amount of air expel during expiration. * To open the airway and maintain breathing pattern |

Nursing diagnosis | Goal | intervention | rational | 3. Bathing/ hygiene self-care deficit related to fatigue | Adhere to therapeutic program and more care. | * Give bed bath * Encourage patient to begin to bath self, dress self, walk and drink fluids, discuss energy conservation measures. * Help the patient to take toilet bath with the help of relatives. | * To provide comfort * Encourage the patient to avoid increasing dependence. * Promote the relationship between patient and relatives. | 4. Anxiety related to threat to self concept | Attainment of an optimal level of coping | * Help the patient develop realistic goals * Encourage activity to level of symptom | * Developing realistic goals with promote a sense of hope and accomplishment rather than hopelessness. * Activity reduces tension and decreases degree of Dyspnea as patient becomes conditioned. | 5. Deficient knowledge related to self management to be performed | Adhere to therapeutic program and home care | * Teach the patient about disease, medications procedures and how and when to seek help. * Refer patient to pulmonary rehabilitation | * Patient needs to be partner in developing the plan of care and needs to know what to expect. * Improve quality of life. |
DISCHARGE PLAN
Patient is still not plan to discharge and she had not been told about any discharge plans.
Our discharge plan will include guidance to take medicine, how to recognize side effects, diet plan. * Medicine
Cefotaxime 1g, IV, TDS (3 times a day)
Pantoprazole, 40mg, IV, BD (2 times a day)
Domperidone, 100g, PO, TDS (3 times a day)
Bromhexine hydrochloride, 10ml, PO, TDS (3 times a day)
KCL ampoule 20mg, PO, BD (2 times a day) * If there is any sign of fever, headaches and other side effects such as loose stool and vomiting, immediately consult a health care provider. * Diet plan
Provide small frequent meals because she has decreased appetite and in between meals she can be provided with nuts and fruits as snacks. Time | Types of food | Nutrient | Breakfast | Roshi and fish curry, can change the curry according to the taste.1 glass of ,milk | Carbohydrate,protein, fats | Lunch | 1 cup Rice ,garudiya1 glass Mango juiceCarrot and cucumber | Minerals, carbohydrates, vitamins protein | dinner | 1 cup rice, curry1 glass milkVegetables and fruits. | Vitamins, carbohydrates, protein, minerals | * The nature of Bronchitis as a disease of the airway, which is defined as presence of cough and sputum production for at least 3 months in each 2 consecutive years. * Triggers to avoid * Dust * Passive smoking

REFLECTION
During this activity we learned a lot about COPD. Our confidential level to with communicate with patient increased.COPD is very common in Maldives especially in older people.We learned how to manage cases of COPD, read and comparediagnostic test results, plan and imply the most appropriate care according to the patient need, administer medication, its side effects and indication.
. We learned that nursing care given to the patient should be carefully monitored and planed according to the patient’s needs. We compared the care given to the patient with the care that can be improved for the patient. As a nurse we have to plan a comprehensive care to the patient. After doing this care study we have learned how to plan a complete nursing care to the patient who is diagnosed with COPD.

REFERENCES
Smeltzer,S.C.,Bare,B.G.,Hinkle,J.L.,&Cheever,K.H.(2010).Brunner and suddarth’s textbook of medical-surgical nursing(12th ed.).Philadelphia:Lippincott Williams & Wilkins.
Wilson, B.A., Shannon, M.T., Shields, K.M. (2011).Pearson Nurse’s Drug Guide 2011.Pearson,USA.
Waugh,A.Grant,A.(2006).Ross and Wilson Anatomy and Physiology in health and illness.(10th ed.).Churchill Livingstone Elsevier,Spain.
Doenges,M.E.,Moorhouse,M.F.,&Geissler-murr,A.C.(2002).Nursing Care Plans Guidelines for individualizing patient care.(6th ed.).Philadelphia:F.A.Davis Company.
Morton,I.,&Hall,J.(1988.).Medicines the comprehensive guide.(1st ed.).Bloomsbury publishing limited, Great Britian.
Pagana,K.D.,&Pagana,T.J.(1998).Mosby’s Manual Of diagnostic and laboratory tests.Mosby.
Rozenberg.G.,(1997).Microscopic haematology a practical guide for the laboratory.Syndey:Harwood academic publisher,Australia.

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...Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease also referred to as COPD is the name that identifies a group of lung diseases. These diseases consist of bronchiectasis, chronic bronchitis, emphysema, and refractory asthma. An individual can have COPD for years and not know it. When the disease is in the early stages the symptoms are not completely mature and are barely discernible. As the disease matures and progresses the symptoms become more noticeable. Although millions of individuals are living with COPD, this disease is the fourth leading cause of death in the United States; and smoking, second-hand smoke, air pollutants, occupational dust, chemicals, and genetics are factors that can cause the disease for which there is no cure; however numerous treatments are available to help live an active and healthy life (COPD Foundation, 2010). Many people who have COPD are undiagnosed with the disease. Undiagnosis could derive from several reasons, which may include no health insurance, afraid to seek medical attention, or belief that the symptoms are of another illness such as a cold that will not go away. However, most cases of COPD are undiagnosed because of a lack of education concerning the disease. Many communities and employers fail to educate the public concerning diseases like COPD.I was surprised to find that the......

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