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CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND ASTHMA 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. Asthma: 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. Chronic bronchitis: Widespread inflammation of airways with narrowing or blocking of airways, increased production of mucoid sputum, and marked cyanosis. Emphysema: 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- trapping). Note: 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. CARE SETTING Primarily community level; however, severe exacerbations may necessitate emergency and/or inpatient stay. RELATED CONCERNS Heart failure: chronic Pneumonia: microbial Psychosocial aspects of care Ventilatory assistance (mechanical) Surgical intervention Patient Assessment Database ACTIVITY/REST May report: 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 May exhibit: Fatigue Restlessness, insomnia General debilitation/loss of muscle mass CIRCULATION May report: Swelling of lower extremities May exhibit: 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)
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