The term Chronic Obstructive Pulmonary Diseases encompasses two types of obstructive diseases: Emphysema and Bronchitis. The mechanism involved in the pathogenesis of COPD usually are multiple and include inflammation and fibrosis of the bronchial wall, hypertrophy of the submucosal glands as well as the hypersecretion of the mucus, loss of elastic lung fibers and alveolar tissues. All these cause a mismatch of ventilation and perfusion, destroying alveolar tissue and eventually decreasing the surface area for gas exchange, consequential to airway collapse. The following paragraph will then illustrate the course and mechanism of one classic example of a COPD – Chronic Bronchitis. The pathophysiology, manifestation and mechanism of action of the disease, most especially the physiological impact of the disease will be the highlight of this discussion.
Bronchitis is the inflammation of the tracheobronchial tree characterized by chronic cough with thick phlegm. Such phlegm can sit in the lungs for a while and makes a perfect environment for infections to grow. There are two types depending on the course; which may be chronic or acute. The latter type is self-limiting and is usually caused by an infection. As with the former type, there are no true symptoms-free period and is often characterized by chronic cough and sputum production on which acute attacks of wheezing are superimposed (Sidney, 2006). It often occurs in the setting of an upper respiratory illness and is often diagnosed with positive history of asthma. The etiology may usually be caused by either viral or bacterial infection, or at times, pre-existing URTI. In Chronic Bronchitis, airway obstruction is caused by inflammation of the major and small airways. There is edema and hyperplasia of submucosal glands and excess mucus secretion into the bronchial tree (Travis, et al, 1999). Typically, the cough has been present for many years, with a gradual increase of acute exacerbation that produces frankly purulent sputum. Chronic bronchitis without airflow obstruction is often referred to as simple bronchitis and chronic bronchitis with airflow destruction as chronic obstructive bronchitis (American Thoracic Society, 1995). The prognosis with people with simple bronchitis is often good, compared with the premature morbidity and mortality associated with the later type. It is seen most commonly in middle-aged men and is often associated with chronic irritation, which is derived from smoking and or recurrent infection. In the US, smoking is the most common cause of bronchitis.
EXPLANATION OF HOW THIS AFFECTS RESIDENTS OF BALTIMORE:
Chronic obstructive bronchitis is characterized by shortness of breath with progressive decrease in exercise tolerance. As it progresses, breathing becomes increasingly more labored, even at rest. Activities would be less tolerated, therefore people experiencing this kind of disease would become ineffective in their jobs, thereby requiring more time for rest and absences. Imagine if the entire workforce of Baltimore would be suffering from this disease, economy would be affected. The entire state would be suffering from serious financial loss, not to mention an increase in the demand for medical management. How then would the state of Baltimore be able to medically assist an increasing number of people affected with this disease? People with combined forms of COPD characteristically seek medical attention in the fifth and sixth decade of life complaining of cough, sputum production, and shortness of breath. The productive cough usually occurs in the morning. Dyspnea becomes more severe as the disease progresses. Frequent exacerbation of infection and respiratory insufficiency are common, causing absence from work and eventually disability (Nowak, 2006). The late stage is characterized with pulmonary hypertension and chronic respiratory failure. Death usually occurs during an exacerbation of illness with infection and respiratory failure (Wilson, et al, 2006). In 2000, the estimated population of Maryland was recorded to be at 5,296,486 of which, white race predominates at about 65%; and while health statistics statistic profile indicates chronic lower respiratory diseases as among the leading cause of deaths at 44% of its total population; chronic bronchitis is not included in that list. This health issue impacts the residents of Baltimore in the sense that the population most commonly affected by this illness belongs to the adult working groups who smokes heavily.
RELEVANCE TO CURRENT HEALTH CARE TRENDS & ISSUES:
The diagnosis is based upon a careful history taking and physical examination, pulmonary function studies, chest radiographs and laboratory test. Treatment often depends on the stage of the disease which requires an interdisciplinary approach. Smoking cessation is the only measure that slows the progression of this disease (Barnes, 2000). Since smoking is one of the leading risk factors of chronic bronchitis, nicotine replacement therapy such as the likes of gum, patch, or inhaler are often recommended along with noradrenergic antidepressant drug brupropion to reduce withdrawal symptoms (Barnes, 2000). Person in more advance stage of the disease often require measures to maintain and improve physical and psychosocial functioning, pharmacologic intervention, and oxygen therapy (Mensa & Trilla, 2006). Lung volume reduction surgery may be used in some cases. Pharmacologic treatment includes Bronchodilators including; anticholinergic drugs; adrenergic drugs; antibiotics to treat infections; antiviral to treat viral infections, and other drugs specific for symptomatic treatment (Mensa & Trilla, 2006). Symptomatic treatments may include, the use of antitusive drugs to arrest coughing reflex and prevent stress due to bronchial irritation. Since mucus secretion is evidently increased, the use of expectorant and bronchodilators may aid in the relief of symptoms and may help expectorate phlegm. Antypiretics and paracetamols may be employed in order to relieve any secondary onset of fever. Non-pharmacologic means of managing this disease may include increasing nutrition for supportive purpose (Sidney, 2006). It is advisable for patients to maintain broncho-pulmonary hygiene in order to inhibit any presentation or onset of agent that may trigger cough. Always maintain a clean and smoke free environment (Sunyer, et al, 2006). The prevalence of this disease would continue if population would be greater is an area that has high percentage of air pollution. Crowded areas and poor environment would be among the culprit of the earnest and immediate spread of this disease. Poor air quality is the culprit for the consequences that are being suffered by many human and plant communities. Although many people associate smog with Los Angeles, it is not the only area that has been affected by poor air quality. This is among the many contributory reasons why the government has opted for a state regulation banning smoking. “A large pollution study revealed that when smog increases in the Los Angeles Basin area, there is a big jump in the number of people hospitalized for lung and heart problems” (Dreher, 1998). The effects of air pollution can be seen even below the levels that are indicated by air quality standards, since people respond differently to poor air quality. “Concentrations of harmful chemicals in the air have been proven to inflame and destroy lung tissue and weaken the lung defenses. Germs and dirt are normally trapped in the mucus in our air passages and removed by tiny hairs called cilia before entering our lungs. Polluting chemicals can paralyze the tiny cilia, allowing germs to build up in mucus or leave our body poorly protected against disease” (Dreher, 1998).
“The U.S. Centers for Disease Control and Prevention (CDC) estimates that pollution is associated with between 50,000 and 120,000 deaths every year (Dreher, 1998).” The people most affected by poor air quality are people with asthma, bronchitis, heart disease, and similar health conditions. Studies have also shown that children and the elderly may be affected more than adults. “Children are affected more severely than adults because theft airways are relatively narrower and more easily obstructed, and their oxygen demand relative to body weight is higher, resulting in relatively larger inhaled volumes” (Bree, 1993).
PATHOPHYSIOLOGY OF CHRONIC BRONCHITIS:
As earlier mentioned, chronic bronchitis, being an inflammatory disease is caused by the deficiency of the immune system to ward against bacterial or viral infections that invades the lungs. Recurrence of this bacteria and or virus causes the inflammation to persist; increasing ciliary abnormalities and bronchial thickening; which further explains the mucus secretions and cough, presenting as the number one symptom. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the three leading bacterial pathogens isolated from the lower bronchi of patients with chronic bronchitis, in contrast to the causative organisms of acute bronchitis, which include Mycoplasma pneumoniae and Chlamydia trachomatis. Without proper medical management, such as antibacterial drugs, these symptoms persist causing the breakdown of normal alveolar functioning, thus explains the atrophy of the lung alveoli. This furthers the inability of airflow within the lungs, as bronchial walls diffuses and constricts narrowing the airway lumen, thus explaining the inefficiency of oxygen exchange. Diagnostic test includes: chest x-ray, blood testing, sputum cultures; ECG. and lung spirometry. Medical management highly encourages smoking cessation and increased nutrition as part of preventive modes to combat the incidence of onset. Health education with particular emphasis on the means to prevent this disease is also necessary to aware prospects on how to avoid this disease. Health teachings include the maintenance of healthy living conditions, most especially the establishment of cleanliness and sanitation. It also includes the information drive about the disease course as well as the signs and symptoms that they should be aware of, so as to seek early health management. Pharmacologic treatments include the corticosteroid therapy, theophyllins and antibiotic/antiviral therapy that are specific to their causative agent. Pharmacologic management would require an initial diagnostic procedure to ascertain the causative agent prior to implementing and choosing the best medicine to give. Microscopic examination of sputum culture would help determine the strain of bacteria and virus present in order to facilitate the correct pharmacologic intervention. Adjunctive treatments include oxygen therapy, mucolytic agent and bronchodilators to manage and ease severe symptoms. Non-medical measures to address this disease, in a non-expensive way, are the cessation of smoking and increase nutrition as part of the prevention techniques. Since this disease has a functional debilitation characteristic, rest and exercise is encourage to bolster the immune system along with the medical intervention. Early management is important in order to contain the causative pathogens from further destructing the lung physiology (Wilson, et al, 2006).
SUPPORTIVE RESOURCES & RECOMMENDATIONS TO ASSIST IN ACHIEVING DISEASE CONTROL OR IMPROVEMENT:
The current move of the state to address the culprit of this disease in the information drive to its population concerning the risks of smoking, thus the government has now implemented its campaign to ban smoking. The clean air act highlights bronchitis as the main cause of the drive and is now strictly adhered to by almost every state in America. Health educations, vaccinations and clean air campaigns are among the interventions made to support and improve the health of its citizens. Early detections and regular routine check are among the services that may be necessary in the course of prevention. With the recent break through in science, new and improve drugs are now available to help manage this disease while in the early stage. There would only be a need for Federal assistance to insure that prices of medicines be affordable and reasonable rate.
IMPLICATIONS FOR THE FAMILY:
Being this a chronic disease that is preventable through the practice of healthy lifestyle, the implications of having a family member with this disease can also be attributed to the living conditions of the family, i.e., crowded living conditions. Healthy lifestyle also invokes the early health education as a means to prevent the prevalence of this disease among teenagers, which is why efforts are focus on educating and informing the youths about the implications of smoking as detrimental to pulmonary health. It is easier for the younger groups to never start smoking compared to the adults who try and quit smoking. This is a unified effort that requires the cooperation of the entire family, since smoking becomes a habit that is usually seen from parental influences. Therefore the parents must be a role model to their children should they want to invoke on a nicotine free home. It must be well noted also, that passive smoking can bring equal harm to other family members should one of them smoke.
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