CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND
All respiratory diseases characterized by chronic obstruction to airflow fall under the broad classification of COPD,
also known as chronic airflow limitations (CAL). COPD is a condition of chronic dyspnea with expiratory airflow
limitation that does not significantly fluctuate. Within that broad category, the primary cause of the obstruction may
vary; examples include airway inflammation, mucous plugging, narrowed airway lumina, or airway destruction. The
term COPD includes chronic bronchitis and emphysema. Although asthma also involves airway inflammation and
periodic narrowing of the airway lumina (hyperreactivity), the condition is the result of individual response to a wide
variety of stimuli/triggers and is therefore episodic in nature with fluctuations/exacerbations of symptoms. Because
patient response and therapy needs can be similar, asthma has been included in this plan of care.
Also known as chronic reactive airway disease, asthma is characterized by reversible inflammation and
constriction of bronchial smooth muscle, hypersecretion of mucus, and edema. Precipitating factors include
allergens, emotional upheaval, cold weather, exercise, chemicals, medications, and viral infections.
Widespread inflammation of airways with narrowing or blocking of airways, increased production
of mucoid sputum, and marked cyanosis.
Most severe form of COPD, characterized by recurrent inflammation that damages and eventually
destroys alveolar walls to create large blebs or bullae (air spaces) and collapsed bronchioles on expiration (air-
Chronic bronchitis and emphysema coexist in many patients and are most commonly seen in hospitalized COPD
patients when acute exacerbations occur. Chronic bronchitis and emphysema are usually irreversible, although
some effects can be mediated.
Primarily community level; however, severe exacerbations may necessitate emergency and/or inpatient stay.
Heart failure: chronic
Psychosocial aspects of care
Ventilatory assistance (mechanical)
Patient Assessment Database
Fatigue, exhaustion, malaise
Inability to perform basic activities of daily living (ADLs) because of breathlessness
Inability to sleep, need to sleep sitting up
Dyspnea at rest or in response to activity or exercise
General debilitation/loss of muscle mass
Swelling of lower extremities
Elevated blood pressure (BP)
Elevated heart rate/severe tachycardia, dysrhythmias
Distended neck veins (advanced disease)
Dependent edema, may not be related to heart disease
Faint heart sounds (due to increased anteroposterior [AP] chest diameter)
Skin color/mucous membranes may be pale or bluish/cyanotic; clubbing of nails and
peripheral cyanosis; pallor (can indicate anemia)