Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) remains a significant challenge in post-acute and long-term care (PALTC) settings, with its significant impacts on functional status, quality of life, and comorbidities in older adults.
COPD arises predominantly due to long-term exposure to harmful particulates, most commonly tobacco smoke. The disease process involves chronic inflammation leading to bronchitis and emphysema, causing dyspnea, chronic cough, and sputum production. As the disease progresses, exacerbations can occur, often due to infections or environmental triggers.
Management Strategies in PALTC
- Pharmacological Therapy: Bronchodilators (beta-agonists and anticholinergics) and inhaled corticosteroids form the backbone of COPD treatment. Their judicious use can alleviate symptoms, improve quality of life, and reduce exacerbation frequency.
- Non-pharmacological Interventions: Pulmonary rehabilitation, encompassing exercise training and education, plays a pivotal role in improving functional status and symptom burden. Furthermore, interventions such as chest physiotherapy and breathing techniques can aid sputum clearance and dyspnea management.
- Oxygen Therapy: Chronic hypoxemia, typically defined as PaO2 less than 55 mmHg or oxygen saturation less than 88%, necessitates long-term oxygen therapy, which has been shown to improve survival.
- Management of Exacerbations: Rapid identification and management of COPD exacerbations, which may manifest as increased dyspnea, sputum production, or purulence, are critical. Broad-spectrum antibiotics and systemic corticosteroids can hasten recovery in such scenarios.
Prevention and Patient Education
Smoking cessation remains the most effective intervention in halting disease progression. Annual influenza vaccination and regular pneumococcal vaccination reduce the risk of infectious exacerbations. Patients and caregivers should be educated about early signs of exacerbation and the importance of adherence to inhaler techniques and medications.
