Transitional Management for Adult Patients of COPD

Address the disease management needed of adult patients with COPD for a safe transition
between the acute care setting and home and the role of the interdisciplinary team in that
transition.

Transitional Management for Adult Patients of COPD

Chronic Obstructive Pulmonary Disease (COPD) is an incurable medical condition that is
more prevalent in older people than in the young. Even though COPD is incurable, it is possible
to minimize the severity of its symptoms by structuring optimal management techniques. Such
practices should minimize the rate of disease progress and offer patients a chance to lead high-
quality lives. However, it is often challenging to ensure that patients receive optimal
management for the disease, more so when they are leaving acute care centers for their homes.
There are important approaches to consider in ensuring that patients practice the recommended
strategies for managing COPD at their homes. The activity would involve an interdisciplinary
collaboration between professionals in the healthcare setup.
Part 1: The Use of Bronchodilators and Corticosteroids in the Management of COPD
1.0 Why They are Used
Bronchodilators and corticosteroids are effective in the alleviation of clinical
symptoms of COPD. Bronchodilators such as salmetrol, formoterol, and tiotropium work on
a long-term basis to enhance lung functionality and reduce the occurrence and severity of
exacerbations, hence improving patient’s quality of life. The drugs also enhance patient’s
tolerance to exercises and improve protect them from lung hyperinflation as well as dyspnea

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(Tashkin, & Ferguson, 2013). Drugs such as indacaterol and aclidinium are new
developments that require less dosage frequencies hence reducing chances of drug non-
adherence among patients. Other bronchodilators with lengthy frequencies of intake include
glycopyrrolate, vilanterol, and olodaterol (Tashkin, & Ferguson, 2013).
Corticosteroids are also important medications in the management of exacerbations
experienced in COPD. Nebulized budesonide is not only a primary care corticosteroid in
managing OCPD in adults, but it is also the drug of choice for children with COPD.
Clinicians prefer the drug on the basis of its considerably less severe side effects compared to
those associated with the use of other steroids (Gaude, & Nadagouda, 2010, Pg. 230). Timely
administration of corticosteroids also results in improved functionality of the lungs. Some
glucocorticoids also find use in reducing inflammation. They act by inhibiting the genetic
pathway leading to the production of inflammatory mediators such as chemokines and
cytokines (Gaude, & Nadagouda, 2010, Pg. 231). Instead, they promote the production of
anti-inflammatory molecules such as beta-2 adrenoceptors. Through such a mechanism,
glucocorticoids reduce swelling and exudation on the airway hence enhancing the respiratory
system.

2.0 Side Effects of Corticosteroids and Bronchodilators
The use of corticosteroids has adverse effects such as sleep abnormalities, exaggerated
appetite, and weight gain. They also subject adult users to ailments such as osteoporosis,
diabetes, pneumonia, hypertension, cardiac anomalies, cataracts, and peptic ulcers (Gaude, &
Nadagouda, 2010, Pg. 232). The side effects are severer when patient are on oral and
parenteral treatment with corticosteroids as compared to when they take inhaled and

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nebulized formulations. The prevalence of the undesirable effects also increases with the
dosage amount. Bronchodilators also have associated adversities. They include muscle
crumps, headache, dizziness, nausea, vomiting, palpitations, and cardiac abnormalities
(Cleveland Clinic, 2014a). Patients should report severe critical side effects so that
prescribers can substitute their regimens with others that have minimal adversities.
Occurrences such as hypertension, severe headaches, persistent vomiting are worth reporting
as they may indicate the development of other critical conditions such as cardiac diseases and
peptic ulcers. Patients may not have to report effects such as dizziness, nausea, and minor
headaches as such complications are common with most medications. Besides, such
symptoms are often temporary, and they would rarely indicate serious clinical adverse
conditions.

3.0 Special Instructions Regarding Drug Use
Both bronchodilators and corticosteroids require special directions for their use. For
instance, health professionals should advise their patient to take bronchodilators before
taking other inhaled medications such as corticosteroids. Again, it is important to inform
patients that they do not have to chew bronchodilator tablets, and instead, they should
swallow them as whole. It is also necessary to inform patients on the purpose of each
medication. For instance, patients should know that bronchodilators help them overcome
shortness of breath associated with COPD. Some of the additional directions also apply to the
use of corticosteroids. For instance, patients would always require taking bronchodilators
first when they are co-administered with steroids. For corticosteroids, patients should know
that they require rinsing their mouth with clean water to minimize the occurrence of side

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effects such as nausea. Also, it is important to inform the patient that unlike bronchodilators,
corticosteroids take a considerably longer time to work, and they are not applicable for
instant relief of COPD symptoms. Again, patients should know that corticosteroids may not
stop attacks that have already started (Cleveland Clinic, 2014b).
4.0 An Important Healthcare Discipline that would Facilitate Medication Adherence
Medication adherence entails the degree of compliance with the recommended drug
use practices. So as to ensure optimal treatment adherence among patients, various healthcare
disciplines should collaborate. Among such disciplines are the nursing and pharmacy
departments. Nurses have most interactions with patients as their primary role is to monitor
patients. On the other hand, pharmacists are the custodians of drug use, and they would be
relevant in promoting adherence to medications. Pharmacists should cooperate with nurses to
schedule follow up activities to monitor drug use among patients (Jimmy, & Jose, 2011, Pg.
156). They should for instance establish strong interactions with patients, teach them on how
to use devices such as inhalers, and monitor their use of adherence devices such as calendars
and reminders.

Part 2: Dietary Modification in the Management of COPD

5.0 The Role of Diet in Managing COPD
Diet is a crucial consideration in the management of COPD. Either form of
malnutrition, be it excessive nutrient consumption, or low intake of the same has an
undesirable impact on the pathogenesis of COPD. Dieting habits that promote the
development of conditions such as obesity have severe impact on COPD development.
Usually, obesity leads to other respiratory abnormalities that worsen the condition of COPD
patients. Such illnesses include asthma, hypoventilation, and pulmonary embolism (Hanson,

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Rutten, Wouters, & Rennard, 2014, Pg. 724). On the other hand, COPD patients with
advanced disease experience pulmonary cachexia, a state in which their body weight is
abnormally low, and their free fatty mass is extremely reduced.
Dietary modifications would be necessary to enhance the nutritional status of patients.
Malnourished COPD patient would have to rely on dietary supplements to boost their health.
Alternatively, patients would have to include high-calorie foods and beverages in their
dietary plans. Studies indicate that lean COPD patients should maximize their fat intake at
the expense of carbohydrates (Itoh, Tsuji, Nemoto, Nakamura, & Aoshiba, 2013, Pg. 1318).
Some cultures encourage consumption of meat while others discourage it. Likewise, cultures
have varying influences regarding intake of fruits and vegetables.

6.0 Possible Obstacles to Dietary Modification
Patients may find it hard to adopt new dietary practices. Also, people’s living
conditions may influence their ability to adopt certain therapeutic dietary approaches.
Patients from poor economic backgrounds may not access the recommended dietary
practices. Cultural beliefs may also influence the adoption of dietary changes. Some cultures
may not encourage certain recommended dietary approaches. Patients’ taste and preferences
may also hinder the adoption of dietary changes. Some nutrients are only abundant in foods
that some patients may be unwilling to take. Such foods include fish and mushrooms, both
which are sources of vitamin D, an element crucial for COPD patients (Itoh et al., 2013, Pg.
1320).

7.0 An Important Healthcare Discipline in Facilitating Dietary Modifications

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Nurses should seek the collaboration of dieticians in promoting effective dietary
modifications. COPD patients experience important nutritional complications such as
appetite loss. Medical dieticians are best placed to inform patients on practices that would
promote their appetite. They should offer nutrition therapy to protect patients from weight
loss and attacks by COPD Comorbidities (Seo, 2014, Pg. 151). Likewise, the professionals
would advise obese persons on measures they should take to avoid worsening their health
status. Dieticians should also collaborate with the families of patients by advising them on
the foods that their patients may need as well as the ones they should avoid.

Part 3: Physical Activity in COPD Management

8.0 The Role of Physical Activity in COPD Management
While it is advisable for people to engage in physical exercises, COPD patients should
maintain their level of involvement to a certain level. Too much strenuous activities may
have adverse consequences in the population. The pathophysiology of COPD involves
dyspnea, a condition that may worsen with engagement in exercises. Simple exercises are
however necessary to ensure that patient’s respiratory system is strengthened. Energy
conservation is crucial in COPD patients both in the sense that the victims could easily ran
malnourished and also considering the appropriate management of dyspnea. Recommended
physical exercises for the group include diaphragmatic and pursed-lip forms of breathing
techniques (Broward Health, 2015). COPD patients also require physical exercises for
psychological health. There are multiple factors that would predispose the group to stress,
depression, and anxiety. The knowledge of having a chronic ailment is among such factors.
Also, experiences of dyspnea and its associated discomfort would easily trigger anxiety.

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Patient would need keeping themselves busy through exercises so as to overcome such
events.

9.0 The Role of RN in Promoting Effective Physical Practices in COPD Management
Registered nurses prioritize on the welfare of patients. They should structure an
exercise strategy that would not harm but benefit patients. They would do so by warning
patients against engagement in strenuous activities and advise them on appropriate activities
they should explore. Nurses should also monitor the performance of their patients to help
them maintain healthy physical conditions. Nurses should educate patients on activities that
would promote their pulmonary system. Such advice should also entail practices that patients
should engage in so as to overcome symptoms such as dyspnea. Also, nurses should advise
patients on relaxation strategies that would promote healthy air flow in their systems.

10.0 An Essential Healthcare Discipline in Facilitating the Healthy Physical Activities
Physical therapists would be relevant professionals in enhancing the effectiveness of
physical activity in the management of COPD patients. The specialists should collaborate
with nurses in ensuring that COPD patients are at their optimum physical health. Physical
therapists should teach patients on how to perform various exercises in a safe manner. COPD
patients often have a delicate physical health, and the specialists should purpose to promote
their (patients’) stability. Also, it is important for physical therapists and nurses to engage
patients’ family members in strategizing physical activities for their patients. They should
encourage patients’ family members to support their loved ones in exercising. Families
would do so by monitoring their patients as they engage in various activities. They could also

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contribute by helping patients to undertake manual activities that could otherwise trigger
hypoventilation and dyspnea in the high-risk group.

Part 4: Conclusion

11.0 The Effectiveness of an Interdisciplinary Team in Managing COPD
It is important to maintain the quality of care for COPD patients at a high level,
especially during transitions from hospital care to home-based attendance. The process
involves various considerations ranging from medication adherence, dietary practices, and
the performance of physical activities. As such, the process would require various clinical
professionals to cooperate for high-quality outcomes. Engaging nursing care and other
relevant specialties in the transition would be a promising move. The team should work
jointly with the common goal of bettering patient outcomes. A team involving specialties
from the most relevant departments and professions would be effective in achieving utmost
patient satisfaction and fetching desirable outcomes. It is also vital that such a team involve
the families of patients. The extent of patient satisfaction would be a reflection of the
ultimate achievements of the interdisciplinary team involved in the entire process.

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References

Broward Health. (2015). Struggling to breath: tips for managing dyspnea.
ary_Rehabilitation_Is_it_for_You/hic_fast_acting_bronchodilators_for_copd
Cleveland Clinic. (2014b). Anti-inflammatory medications for COPD. inflammatory_medications_for_copd
Gaude, G. S., & Nadagouda, S. (2010). Nebulized corticosteroids in the management of acute
exacerbation of COPD. Lung India : Official Organ of Indian Chest Society, 27(4),
230–235.
Hanson, C., Rutten, E. P., Wouters, E. F., & Rennard, S. (2014). Influence of diet and obesity on
COPD development and outcomes. International Journal of Chronic Obstructive
Pulmonary Disease, 9, 723–733.

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Itoh, M., Tsuji, T., Nemoto, K., Nakamura, H., & Aoshiba, K. (2013). Undernutrition in Patients
with COPD and Its Treatment . Nutrients, 5(4), 1316–1335.

Jimmy, B., & Jose, J. (2011). Patient Medication Adherence: Measures in Daily Practice. Oman
Medical Journal, 26(3), 155–159.
Seo, S. H. (2014). Medical Nutrition Therapy based on Nutrition Intervention for a Patient with
Chronic Obstructive Pulmonary Disease. Clinical Nutrition Research, 3(2), 150–156.

Tashkin, D. P., & Ferguson, G. T. (2013). Combination bronchodilator therapy in the
management of chronic obstructive pulmonary disease. Respiratory

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