● Chronic Obstructive

Pulmonary Disease (COPD)

is a condition of chronic
dyspnea with expiratory
airflow limitation that does not
significantly fluctuate.
● Chronic Obstructive
Pulmonary Disease has been
defined by The Global
Initiative for Chronic Chronic Bronchitis
Obstructive Lung Disease as
“a preventable and treatable ● Chronic bronchitis is a
disease with some significant disease of the airways and is
extrapulmonary effects that defined as the presence of
may contribute to the severity cough and sputum
in individual patients.” production for at least 3
months in each of 2
consecutive years.
● Chronic bronchitis is also
termed as “blue bloaters”.
● Pollutants or allergens irritate
the airways and leads to the
production of sputum by the
mucus-secreting glands and
goblet cells.
● A wide range of viral,
bacterial, and mycoplasmal
infections can produce acute
episodes of bronchitis.
 and hypertrophy of smooth
muscle.
Emphysema

Pulmonary Emphysema is a
pathologic term that describes an
abnormal distention of airspaces
beyond the terminal bronchioles and
destruction of the walls of the alveoli.

-People with emphysema are also

called “pink puffers”.

-There is impaired carbon dioxide

and oxygen exchange, and the
exchange results from the
destruction of the walls of
overdistended alveoli.

-There are two main types of

emphysema: panlobular and
centrilobular.

-In panlobular, there is destruction of the

respiratory bronchiole, alveolar duct, and
alveolus.

-All spaces in the lobule are enlarged. The natural history of COPD is
variable but is a generally
-In centrilobular, pathologic changes occur progressive disease.
mainly in the center of the secondary lobule.
● Chronic cough. Chronic
● Scar formation. This can cough is one of the
cause scar formation in the primary symptoms of
long term and narrowing of
COPD.
the airway lumen.
● Wall destruction. Alveolar ● Sputum production.
wall destruction leads to loss There is a
of alveolar attachments and a hyperstimulation of the
decrease in elastic recoil. goblet cells and the
● The chronic inflammatory mucus-secreting gland
process affects the pulmonary leading to overproduction
vasculature and causes of sputum.
thickening of the vessel lining
 ● Dyspnea on exertion. improves and symptoms
Dyspnea is usually decrease.
progressive, persistent, ● Other medications.
and worsens with Other pharmacologic
exercise. treatments that may be
● Dyspnea at rest. As used in COPD include
COPD progress, alpha1-antitrypsin
dyspnea at rest may augmentation therapy,
occur. antibiotic agents,
● Weight loss. Dyspnea mucolytic agents,
interferes with eating and antitussive agents,
the work of breathing is vasodilators, and
energy depleting. narcotics.
● Barrel chest. In patients
with emphysema, barrel
chest thorax
configuration results
from a more fixed
position of the ribs in the
inspiratory position and
from loss of elasticity. -Pneumonia is an
inflammation of the lung
Pharmacologic Therapy parenchyma caused by
various microorganisms,
● Bronchodilators. including bacteria,
Bronchodilators relieve mycobacteria, fungi, and
bronchospasm by viruses.
altering the smooth
muscle tone and reduce -Pneumonitis is a more
airway obstruction by general term that describes the
allowing increased inflammatory process in the
oxygen distribution lung tissue that may
throughout the lungs and predispose and place the
improving alveolar patient at risk for microbial
ventilation. invasion.
● Corticosteroids. A short
trial course of oral Community-Acquired Pneumonia
corticosteroids may be
prescribed for patients to ● CAP occurs either in the
determine whether community setting or
pulmonary function within the first 48 hours
after hospitalization.
● The causative agents
for CAP that needs
hospitalization include
streptococcus
pneumoniae, H.
influenza, Legionella,
and Pseudomonas
aeruginosa.
● Only in 50% of the cases
does the specific
etiologic agent become
identified.
● Pneumonia is the most
common cause of CAP
in people younger than Hospital-Acquired Pneumonia
60 years of age.
● Viruses are the most ● HAP is also called
common cause of nosocomial pneumonia
pneumonia in infants and and is defined as the
children. onset of pneumonia
symptoms more than 48
hours after admission
in patients with no
evidence of infection at
the time of admission.
● HAP is the most lethal
nosocomial infection
and the leading cause of
death in patients with
such infections.
● Common
microorganisms that are
responsible for HAP
include Enterobacter
species, Escherichia
coli, influenza,
Klebsiella species,
Proteus, Serratia
marcescens, S. aureus,
and S. pneumonia.
● The usual presentation of
HAP is a new
pulmonary infiltrate on
 chest x-ray combined
with evidence of
infection.

Aspiration Pneumonia

● Aspiration pneumonia
Pneumonia in the refers to the pulmonary
Immunocompromised Host consequences resulting
from entry of
● Pneumonia in endogenous or
immunocompromised exogenous substances
hosts includes into the lower airway.
Pneumocystis ● The most common form
pneumonia, fungal of aspiration pneumonia
pneumonias and is a bacterial infection
Mycobacterium from aspiration of
tuberculosis. bacteria that normally
● Patients who are reside in the upper
immunocompromised airways.
commonly develop ● Aspiration pneumonia
pneumonia from may occur in the
organisms of low community or hospital
virulence. setting.
● Pneumonia in ● Common pathogens are
immunocompromised S. pneumonia,
hosts may be caused by H.influenza, and S.
the organisms also aureus.
observe in HAP and
CAP.
 develops as part of the signs of
an infection.
● Pleuritic chest pain.
Deep breathing and
coughing aggravate the
pain in the chest.
● Rapid and bounding
pulse. A rapid heartbeat
occurs because the body
compensates for the low
concentration of oxygen
in the body.
● Tachypnea. There is fast
breathing because the
body tries to compensate
for the low oxygen
concentration in the body.
● Rapidly rising fever. Since ● Purulent sputum. The sputum
there is inflammation of the becomes purulent because of
lung parenchyma, fever the infection in the lung
develops as part of the signs parenchyma which produced
of an infection.
sputum-filled with pus.
● Pleuritic chest pain. Deep
breathing and coughing
aggravate the pain in the
chest.
● Rapid and bounding pulse.
A rapid heartbeat occurs
because the body
compensates for the low
concentration of oxygen in the
body.
● Tachypnea. There is fast
breathing because the body
tries to compensate for the
low oxygen concentration in
the body.
● Purulent sputum. The
sputum becomes purulent
GOALS
because of the infection in the
lung parenchyma which
produced sputum-filled with ● Improve airway patency.
pus. ● Rest to conserve energy.
● Rapidly rising fever. Since ● Maintenance of proper
there is inflammation of the fluid volume.
lung parenchyma, fever
 ● Maintenance of adequate
nutrition.
● Understanding of
treatment protocol and
preventive measures.
● Absence of
complications.

DISCHARGE

● Oral antibiotics. Teach the

patient about the proper
administration, potential side
effects, and symptoms to
report.
● Breathing exercises. Teach
the patient breathing
exercises to promote
secretion clearance and
volume expansion.
● Follow-up check up. Strict
compliance to follow-up
checkups is important to
check the latest chest x-ray
result or physical examination
findings.
● Smoking cessation.
Smoking should be stopped
because it inhibits
tracheobronchial ciliary action
and irritates the mucous cells
of the bronchi.