Summary: Systematic Review

The study began with 32 patients having stages II to IV COPD. They had to meet the criteria pertaining to the Global Initiative for Chronic Obstructive Pulmonary Disease; total lung capacity >120%, (FEV1/FVC) <70%, FEV1 <80%, RV/TLC >140% and >40% of predicted values in stable conditions. Patients were removed from the study if they had asthma, heart failure, orthopedic impairments of the shoulder girdle, recent surgery, past thoracic fractures, pneumothorax, and claustrophobia.

The study included 100 patients with COPD. All patients fulfilled the inclusion and exclusion criteria. According to its demographic and clinical parameters and treatment groups differ among themselves. Completed the study, all patients included in the study. The therapy in all patients with a clinically meaningful improvement of symptoms was observed.

Within the confines of this assignment, it is the hope of the author that the reader will obtain an understanding of Chronic Obstructive Pulmonary Disease (COPD). This will be achieved by bringing the reader through the patients’ illness journey. The assignment will begin by defining COPD and briefly going through the pathophysiology and incidents of the condition. From there the reader will embark on the journey, starting with diagnosis.

Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992).

As of not long ago, the significant objective of COPD treatment was the diminishment of side effects. Nonetheless, with the acknowledgment that intensifications of COPD are extremely normal, have a noteworthy antagonistic effect on personal satisfaction, and may speed sickness movement, rules and clinical consideration are concentrating on decreasing future dangers, for example, the counteractive action and treatment of intensifications (2013, August 23). In created nations the hospitalization of COPD patients, brought on transcendently by intensifications, represents over half of direct human services

51 patients (46.8%) were assigned to the case cohort and 58 patients (53.2%) were assigned to the control cohort. The difference in the rate of 30-day readmission between cases (21.6%) and controls (13.8%) was not statistically significant (P = 0.3203). The overall rate of 30-day readmission in the study population was 17.4%. The mean hospital length of stay was similar between both groups. A history of COPD exacerbation in the preceding 12 months was the only significant predictor of 30-day readmission (P = 0.0114). The mean PIF (50.4 ± 19.35 L/min, n = 49) was similar between the patients with a 30-day readmission and those without (P = 0.7608). There was a significant negative correlation between PIF and patient’s age (r = -0.378; P =

Recognizing the risk factors with COPD are explained as, exposure to tobacco smoke, people who have Asthma who smoke, work-related exposure, age and genetics. Through further details presented in the article, it brings awareness that COPD has 4 different stages, the authors explain the different stages of COPD with the GOLD classification (Global Initiative for Chronic Obstructive Pulmonary Disease). GOLD 1 Mild stage, GOLD 2 Moderate Stage, GOLD 3 Severe Stage and GOLD 4 Very Severe, each stage is determined by the amount of airflow limitations that is produced through the spirometry test and other lung

“Direct Costs of Chronic Obstructive Pulmonary Disease.” International Journal of Chronic Obstructive Pulmonary Disease, Dove Medical Press, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2962300/.

Zakrisson, A. B., Engfeldt, P., Hägglund, D., Odencrants, S., Hasselgren, M., Arne, M., & Theander, K. (2011). Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial. Primary Care Respiratory Journal, 20(4), 427–433. doi:10.4104/pcrj.2011.00060

Higgins & Green in Cochrane Handbook for Systematic Reviews of Interventions described systematic review as a summary result of “available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions. Judgments may be made about the evidence and inform recommendations for healthcare” (Higgins & Green, 2011). Systematic review is now replacing traditional narrative reviews as a way of summarizing research evidence. As Ralf W. Schlosser noted systematic reviews is replacing traditional narrative reviews because it “aim to minimize bias in locating, selecting, coding, and aggregating individual studies. This rigor in minimizing bias is what makes these reviews

The severity of COPD is clinically categorised into four stages by the Global initiative for Obstructive Lung Disease (GOLD), based on the predicted percentage (%) of normal FEV1, in subjects presenting with < 0.7 FEV1/FVC post-bronchodilator ratio (GOLD,2006) (Table 1.1). Introduction

The relationship between COPD and depression is related the losses in physical, social and emotional realms. For example, the loss of function including the decline in mobility and ADL increase risk of depression. Likewise the changing social roles such as decline in the ability to take part in leisure activities and function within the family unit contribute to depression (Norwood, 2007). Furthermore, the use of supplemental oxygen presents barriers to movement and self-image (Norwood, 2007). Along the same lines self-efficacy and perceptions of social support also dictate the level of depressive symptoms (Norwood, 2007). Finally, an overall perception of losses unilaterally increases the co-morbidity of

Effective preventative and treatment strategies need to be devised and implemented to control COPD (Rennard & Drummond,

Mclvor et al. state that the epidemiology of this disease will continue to change and the number of cases among women will rise (2010). In 1998, the WHO estimated that COPD was the fifth most common cause of death worldwide. (Mclvor et al., 2010) Also, the Global Burden of Disease Studies estimated that COPD would become the third most common cause of mortality by 2020 (Calverley et al., 2003). COPD presents a personal burden. Sufferers of this disease have reported significant disability and restriction as a result of COPD (Calverley et al., 2003). “Patients tend to be slow to seek medical help and are reluctant to press for more public attention to their problems” (Calverley et al., 2003). This is most likely due to the social stigma attached to being diagnosed with a disease. Under diagnosis of this disease is a major problem. In fact, Decramer, Janssens & Miravitlles state that 60-85% of patients (usually with mild to moderate disease) remain undiagnosed

In 2002, Chronic Obstructive Pulmonary Disease (COPD) was identified as the 5th leading cause of death worldwide, and it is forecast to become the 3rd leading cause of death by 2030 (WHO, 2016). COPD is an umbrella term used to describe a group of irreversible but treatable lung diseases including emphysema and chronic bronchitis. The disease, which primarily affects the respiratory system, is characterised by chronic and progressive airflow limitation due to inflammation of the airways and lungs caused by inhalation of harmful particles or gasses. Characteristic symptoms of COPD include increased breathlessness, cough, and sputum production.