Chronic obstructive pulmonary disease

Introduction

Severe body attacks and mortality arises from different conditions which manifest in patients based on key predisposing factors. Chronic obstructive pulmonary disease is one of the difficult to detect medical condition that has the ability to cause serious health implication and even mortality to the patients. Chronic obstructive pulmonary disease (COPD), from its name, is a medical condition that affects the respiratory system of the patients, fostered by some predisposing factors (Watson et al 2018). This condition can be defined as a preventable and treatable disease that manifests itself with significant extra pulmonary effects which contribute to the severity in the individual patients (GOLD 2018). This condition obstructs the respiratory system responsible for the air flow limiting the flow of the air to the lungs and this airflow limitation is largely not fully reversible. This paper examines the COPD condition by providing a description of the condition, its symptoms, effects and the treatment as well as prevention interventions that can be used to manage the condition.

Diagnosis and symptoms

In the diagnosis of the COPD, the physician categorises the condition based on the severity of the condition (van Gestel et al 2009). This severity depends on the post brochodilator FEV1 which is focused on the level of reversibility of the condition following the attack on the respiratory system (Woodruff et al 2015). The diagnosis of the chronic obstructive pulmonary disease can be achieved through a number of steps that can be adopted by the physician. These include asking the patients about the presence of the symptoms of the condition, use of the spirometry examinations, and classification of the diagnosis by understanding the stages of the condition and finally, categorization of the severity of the COPD (Woodruff et al 2015).

Considering the nature of chronic obstructive pulmonary disease, and the difficulties in the detection of the conditions due to its interrelation with other similar diseases, it is important to explore the common conditions associated with the disease. Exacerbation has been identified to manifest in the patients with the COPD. This is similar to other conditions such as asthma, but the exacerbations associated with the chronic obstructive pulmonary disorder take longer to resolve (GOLD 2018). The other symptom of COPD is the post bronchodilator FEV1 which is not often reversible unlike other similar conditions such as asthma which are generally reversible after the episodes (Vanfleteren et al 2016). Furthermore, the most common manifestation of the condition is based on the obstructions of smaller airways, abnormal gas exchange and elevated residual volume.

Patterns of COPD

Studies have sought to examine the health patterns of the COPD in the health inequalities by presenting statistics of the conditions and the categories of the people mostly affected by the condition. To begin with, tobacco smoking has been identified as the key contributor to COPD conditions. According to the PHE (2016), 77% of all the COPD deaths recorded in England are attributed to smoking. It is approximated that 16.9% of adults in England smoke with some disparities occurring from one group to the other. In this case, DOH (2008) report that socioeconomic status is linked with the smoking attributes. At the workplace, for instance, 26.5% of the routine workers smoke compared to 11.95 of those occupying managerial level. Furthermore, 23% of the people earning less than £10,000 are smokers compared to 11% of those earning over £40,000 (PHE 2016). Furthermore, 31.2% of people with mental illness smoke 15 and above cigarettes a day and 23.3% smoke 1-14 cigarettes a day (PHE 2016).

According to the statistics presented by the PHE (2016), approximately 85% of the homeless people smoke. The study also established that smoking rates are high among the gay and lesbians compared to the general population at 24.2%. Furthermore, 80% of the prisoners are also engaged in smoking.

According to the Department of Health (2008), COPD is the fifth largest killer in England with over 30,000 deaths recorded annually. The condition is also the second largest cause of emergency admissions in the hospitals, out of which 15% of those admitted die within 3 months and 90% of those with severe COPD are unable to participate in socially-important activities. While COPD condition has been prevalent for many years, efforts are being focused on the managing of the conditions in England, with a multiagency approach involving the department of health, NHS and NICE being developed to tackle the condition (McManns et al 2010). Currently however, unlike other chronic conditions, COPD lack intense public campaigns aimed at sensitizing the people on the management, detection and prevention of the condition

Populations affected by COPD

The data above provides an insight on the population groups at the highest risks of COPD in UK. From the above statistics and as will be seen in detail, it is evident that socioeconomic status and occupation are the main dimensions used in the classification of the people affected by the condition. With regard to the socioeconomic status, inequalities exist in the distribution of COPD among different social classes (Howards et al 2010).

According to Pleasants et al. (2016), the environmental risk factors for the development of COPD are pronounced among people with low socioeconomic status. These factors include tobacco smoking, environmental tobacco smoke, indoor and outdoor air pollution as well as biomass fuel exposure.

It is estimated that approximately 3 billion of the poor people live in poor housing conditions and rely on the use of solid fuels such as wood, animal dung, coal and charcoal for lighting and heating functions (Healthy People 2010). The inhalation of the smokes from these fuels has been attributed to poor housing conditions such as overcrowding and poor ventilation. This increases the risk for development of COPD condition. Bearing in mind that, as supported by the above statistics, people in the low socioeconomic status have higher smoking tendencies compared to those in high socioeconomic status, the risk of COPD is even more pronounced (Pleasants et al 2016).

Occupation is another aspect that can be used to explain for the inequalities in the COPD distribution. A study conducted in the United States revealed that approximately 15% of COPD cases are linked to the inhaled particles at workplaces such as plastics production, textiles, leather, building and construction, chemicals and petroleum as well as coal mines (Howards et al 2010). In this case, Pleasants et al (2016) explains that there is greater risks among the people who work in the occupational environments with risks for the COPD and equally smoke or are living in smoking exposure environments. The authors explain that the range score for the occupationally exposed smokers is 4.0 to 6.2 against 1.4 to 3.2 for occupationally non-smokers.

It is therefore crucial to state that the risk of COPD is high among the people in low socioeconomic status, smokers as well as among those working in occupations that are considered at a risk for the inhalation of particles that can cause COPD. According to PHE (2016), smoking prevalence among the Black Caribbean men stands at 37%, Bangladeshi men has 36% while the White women have a 26% smoking prevalence. However, bearing in mind the prevalence of the COPD among the people in the low socioeconomic status the unequal access to the quality healthcare affects more the people in low status due to their limitations in meeting the medical bills associated with the treatment of the condition.

The difficulty in the diagnosis of the condition is vested on the difficulties providing effective therapy to patients with the condition. The potential success of therapeutic interventions can’t be known before the outcomes of relatively large phase II trials (McManns et al 2010). Despite the difficulties in the diagnosis of COPD condition, the patients with the condition may be at risk for osteoporosis and deaths may also occur from atherosclerosis-related complications (Watson et al 2018). The cases of COPD condition are common among the patients aged 40 years, mostly with over 20 years tobacco use. This is irrespective of the gender of the patients affected. In this case therefore, therapeutic management of the condition is necessary.

COPD intervention

Reducing the health risks associated with COPD is necessary for managing the condition. Bearing in mind the severity of the condition and the available data of the prevalence of the condition, it is curial to manage the condition. Therapeutic intervention of the condition seeks to provide relief to the symptoms of the condition, prevention of COPD, as well as manage the progression of the condition (GOLD 2018). Additionally, there is need for prevention and treatment of exacerbation, improved exercise, tolerance and the improvement of the health status of the patients.

Pharmacological and non-pharmacological therapies are used to manage the COPD condition as well as prevent the occurrences of the condition. The paper has identified a relation between tobacco use and COPD, thus, this paper recommends tobacco cessation as the therapeutic approach towards managing the condition.

Tobacco abstinence and cessation is an approach that seeks to prevent the occurrence of COPD. Tobacco use patterns begin early in adolescence and prevail as the people age. The indicators of the regular use of tobacco begin at the age of 18 years for most people, with experimentation beginning as early as 9 years (Appolonio et al 2016).

The implementation of tobacco cessation can be achieved using the five A’s which entails asking all the information about the tobacco use, including the experimentation and frequency of the use of tobacco, advising the patient on the potential implication of tobacco use to their health, and assessing the potential health complications related to tobacco use (GOLD 2018). The other measures include assistance of the patients with the tobacco cessation measures and implementation of the plan to avoid the use of tobacco as well as arrangements for the follow-up of the progress of the tobacco cessation intervention (GOLD 2018).

Tobacco smoking has been exposed as the leading cause of COPD. Statistics presented above concur that the concentration of the smoking is more among the people living in low socioeconomic class (Pleasants et al 2016). Additionally, the poor and homeless people living in the streets as well as the prisoners present a category of the poor members of the society who have little or no money to buy medication and foot the medical expenses associated with the treatment of COPD. Bearing in mind that the condition is also associated with other chronic conditions such as the heart disease, a multidisciplinary approach involving NICE, Department of health and NHS seeks to champion the COPD prevention programs, thus tobacco cessation should be the main focus of the interventions (NICE 2010). The effectiveness of the multidisciplinary approach in the COPD prevention will enhance the health of the people, especially those in low socioeconomic class thus leading to a bridge of the health inequalities gap in the UK. Among the interventions would include public education campaigns on the tobacco cessation, restricting the production and sale of tobacco products and provision of government funded treatment to ensure the people from low economic status benefit from the COPD treatment program (Pleasants et al 2016).

Counselling to quitting smoking tobacco is crucial and necessary and the counsellor plays a crucial role in behaviour change of the tobacco smokers which can lead to cessation (Appolonio et al 2016). The interventions should be individualised and tailored on the needs of the patients. However, this may be complemented by pharmacotherapy through use of tobacco replacements that aid in the cessation of tobacco smoking. These replacements include nicotine patch, bupropion or inhaler.

Conclusion

Chronic obstructive pulmonary diseases are severe complications that have the mortality potential. This condition is difficult to diagnose as has been identified by this paper since it’s often confused with other health conditions such as asthma. Generally, the patients aged 40 years and above are at high risk of COPD especially if they have a long standing history of tobacco use. The use of tobacco has however ben associated with other complications such as bronchitis, and erectile dysfunction which are equally harmful to the health of the affected patients. Bearing in mind the severity of the condition, it is crucial for intervention measures to be adopted to manage the COPD. This paper has rightly identified that both pharmacological and non-pharmacological therapies can be used to manage the condition. Therefore, tobacco cessation has been discussed as one of the recommended approaches to treating the COPD condition and can result in the bringing of health inequalities in UK.

References

Appollonio D, Phillipps R, Bero L. 2016. Interventions for tobacco use cessation in people in treatment for or recovery from substance use disorders. Cochrane database of systematic reviews, DOI: 10.1002/14651858.CD010274.pub2.

Department of Health. 2008. Raising the Profile of Long Term Conditions Care: A Compendium of Information. DH,

Global initiative for chronic lung disease (GOLD) 2018: global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary diseases 2018 report. Retrieved from

Healthy People 2020; Office of Disease Prevention and Health Promotion; US Department of Health and Human Services. Phase I Report: Recommendations for the Framework and Format of Healthy People 2020. Section IV. Advisory Committee Findings and Recommendations.

Howards C, Dupont S, Haselden, Lynch & Wills 2010. ‘The effectiveness of a group cognitive-behavioural breathlessness intervention on health status, mood, and hospital admissions in elderly patients with chronic obstructive pulmonary disease’, Psychology, Health & Medicine, 15:4, 371-385

McManus S, Meltzer H, Campion J. 2010. Cigarette smoking and mental health in England. Data from the Adult Psychiatric Morbidity Survey, National Centre for Social Research,

NICE. 2010. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care. NICE.

Pleasants R, Riley I, and Mannino D. 2016. Defining and targeting health disparities in chronic obstructive pulmonary disease. International Journal of COPD

van Gestel R, Hoeks S, Sin D et al 2009. COPD and cancer mortality: the influence of statins. Thorax 64: 963-67

Vanfleteren L, Spruit M, Wouters E and Franssen F. 2016. Management of chronic obstructive pulmonary disease beyond the lungs, The Lancet

Watson L, Hay-Smith C, Davies C, Ingham T, Jones B, Cargo M, Hughton C, McCarthy B. 2018. Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: a qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers. Cochrane database of systematic reviews, DOI: 10.1002/14651858.CD013195

Woodruff P, Agusti A, Roche N, Singh D, Martinez J. 2015. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. The Lancet 385: 1789-98