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A 56-year-old male was diagnosed with Chronic Obstructive Pulmonary Disease, also known as COPD. He has a past medical history of heart failure with an ejection fraction of 35% following a myocardial infarction. He was a smoker for 41 years, has hypertension, and is on 2 liters of home oxygen. The medications that this patient takes are Lisniopril, Metoprolol, Spironolactone, Furosemide, Salmeterol/Fluticasone dry powder puff inhaler, Tiotropium, Albuterol/ipratropium metered dose inhaler, and Levalbuterol. The patient’s health care provider is considering adding Theophylline to the list of medications. Through out this paper, information on the major structures and roles of the respiratory system including the structure that controls respirations, the pathophysiology of COPD and how the current medications and Theophylline works to help treat COPD, and lastly the teaching needs of Theophylline if he is found to have been prescribed this medication.
Respiratory System
Throughout this section information will be discussed about the major structures and roles of the respiratory system as well as the structures that controls respirations. The respiratory system is divided into two parts; the upper and lower respiratory tract. The upper respiratory tract, includes the nose, mouth, and the beginning of the trachea, while the lower respiratory tract includes the trachea, bronchi, bronchioli, and the lungs (Bloomfield Science Museum Jerusalem, 2013). The trachea attaches the throat to the bronchi and then divides into two bronchi, which lead to both the left and right lung. Within the lungs, the bronchi are split up into smaller bronchi (Bloomfield Science Museum Jerusalem, 2013). Bronchioli are smaller tubes that the bronchi branch off of and eventually lead to the pulmonary alveolus. The pulmonary alveoli are minute air sacs that are outlined by a single-layer of blood capillaries (Bloomfield Science Museum Jerusalem, 2013).
The anatomy that is responsible in having the ability to breathe is the pons and medulla (Cherniack and Siebens, 2019). There are three main combinations of neurons that are involved: a group of inspiratory neurons in the dosomedial medulla, another group is made up of inspiratory and expiratory neurons in the ventrolateral medulla, and the last group in the rostral pons consists mostly of neurons that discharge during inspiration and expiration (Cherniac and Siebens, 2019).
Chronic Obstructive Pulmonary Disease (COPD) and Treatment
Chronic Obstructive Pulmonary Disease (COPD) is an advanced inflammatory disease of the lungs (Kim, 2016). COPD is characterized by the limited amount of airflow through the respiratory system. This disease is non-reversible and can get progressively worse overtime. Two pathologic processes that result from this chronic inflammation are the narrowing of the small airways and the emphysematous destruction of the lung parenchyma (Kim, 2016). The airway can become constricted and swollen, as the inflammation continues and then leads to excessive amounts of mucus production and poorly functioning cilia which makes airway clearance difficult (Leader, 2018).
A list of medications was prescribed to this patient to treat his COPD. Spironolactone is a diuretic, which helps treat fluid retention that occur in patients who have hypertension or heart failure (Medi Resource Incorporated, 2019). Spironolactone aids in excreting excessive amounts of water and salt in the body but can also reduce a patient’s serum potassium level (Medi Resource Incorporated, 2019). Salmeterol/Fluticasone is a combination of bronchodilators and inhaled steroids. Fluticasone is a corticosteroid that reduces airway swelling and Salmeterol is a long-acting bronchodilator. These work by opening and relaxing the airways that lead to the lungs, and will aid in making it easier to breathe for this patient (COPD News Today, 2019). Titropium is also a bronchodilator, which helps the air passage relax and aids in the opening to the lungs also making it easier to breathe (Medline Plus, 2019). Albuterol/Ipratropium is a combination of two bronchodilators; this breathing treatment is used when there is an acute spasm of the airways (Obgru, 2019). Albuterol and ipratropium work differently but they both cause the muscles in the airways to relax. Albuterol stimulates receptors on smooth muscle cells that outline the airway to aid in the relaxation of the muscles (Obgru, 2019). Ipratropium blocks the effect of nerves that communicate with muscle cells known as acetylcholine, which causes the muscles of the airway to relax and dilate (Ogbru, 2019). Levalbuterol, is a short-acting bronchodilator, also known as the rescue bronchodilator, this treats and prevent bronchospasms, improve wheezing, coughing, and minimize chest tightness (COPD News Today, 2019).
Teaching Needs
If this patient is prescribed Theophylline, there are teaching needs for this patient since it is a new medication that will be added to his medication list. Theophylline is a bronchodilator, this is used to treat wheezing and acute episodes of shortness of breath (COPD News Today, 2019). Theophylline has two different types of action; one action is the causes the muscles relax by smoothing it and the other action suppress the response to stimuli (COPD News Today, 2019). Side effects of Theophylline, stomach pain, diarrhea, upset stomach, headache, sweating, and insomnia (COPD News Today, 2019). Theophylline is taken orally and is dosed by serum theophylline level. It is key to report if the patient drinks alcohol as theophylline blood levels can be affected by alcohol consumption. Additionally, it can be very easy to overdose with this medication and multiple office visits may be necessary to monitor this theophylline level.
Conclusion
The information provided on the respiratory system and COPD has enhanced my knowledge and because I work on a pediatric pulmonary floor; I now have a better understanding on how the respiratory system works. I can apply this to my clinical practice because most of our pediatric patients have scheduled breathing treatments. I now have more knowledge on how breathing treatments work for patients who have bronchospasms, wheezing, or shortness of breath. The information throughout this case study that I have learned will be extremely beneficial to me.
References
- Medi Resource Incorporated (2019). Aldactone. Retrieved from https://chealth.canoe.com/drug/getdrug/aldactone
- Cherniack, N. S., & Siebens, A. A. (2019). Human respiratory system. Retrieved from https://www.britannica.com/science/human-respiratory-system/Control-of-breathing
- Fluticasone-Salmeterol (Advair Diskus) for COPD. (2019). Retrieved from https://copdnewstoday.com/fluticasone-salmeterol-for-copd/
- Kim, E. (1970) Pathophysiology of COPD. Retrieved from https://link.springer.com/chapter/10.1007/978-3-662-47178-4_5
- Leader, D. (2018). How Does COPD Affect the Function of Your Lungs? Retrieved from https://www.verywellhealth.com/copd-pathophysiology-914745
- Levalbuterol (Xopenex HFA) for COPD (2019). Retrieved from https://copdnewstoday.com/levalbuterol-for-copd/
- Ogbru, O. (2019). Albuterol/ipratropium inhaler (Combivent) Side Effects & Dosage. Retrieved fromhttps://www.medicinenet.com/albuterol_and_ipratropium_inhaler/article.htm#what_is_albuterol_and_ipratropium_inhaler_and_how_does_it_work_mechanism_of_action
- Bloomfield Science Museum Jerusalem (2013). The respiratory system- Structure and function. Retrieved from https://www.mada.org.il/en/about/engineer/challenge/respiratory-system
- Theophylline for COPD. (2019). Retrieved from https://copdnewstoday.com/theophylline-for-copd/
- Tiotropium Oral Inhalation: MedlinePlus Drug Information. (2019). Retrieved from https://medlineplus.gov/druginfo/meds/a604018.html
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