The prevalence of these conditions warrants more education as to their identification and treatment. Pulmonology (previously Revista Portuguesa de Pneumologia) is the official journal of the Portuguese Society of Pulmonology (Sociedade Portuguesa de Pneumologia/SPP). Pavord, P.W. Patient-reported outcomes in primary care patients with COPD: psychometric properties and usefulness of the Clinical COPD Questionnaire (CCQ). Johnston, K. Lambert, P. Hussack, M. Gerhardsson de Verdier, T. Higenbottam, J. Lewis. COPD is a clinical syndrome representing a spectrum of lung pathologies associated with systemic comorbidities and exacerbations, which contribute substantial morbidity and mortality. It will locate the point of the trajectory of the disease, as well as the care environment the assessment takes place with, and why these are important in relation to the relevance of the chosen assessment. The patient can plan for simplification of his activities. Do Not contact by post Mackay, G.C. In addition to this service, Independent Nurse and other parts of the Mark Allen Group may like to contact you about related products, events, surveys, special offers and services that we think you might enjoy. Relationship between the GOLD combined COPD assessment staging system and bacterial isolation. 1218-1224. He is an former smoker, having stopped when he was diagnosed with COPD, but he has a significant pack-year history of 60 years. Wilkinson, G.C. Do Not contact by telephone, From time-to-time we would like to contact you with business focused messages, special offers and information from other partner organisations that we think may be of interest to you. Eur Respir J Suppl, 41 (2003), pp. The definition of COPD exacerbation has evolved over time, from more specific to broader definitions, based on symptoms or event-based, according to treatment needed or to health care resources used.3 Lack of expert consensus may be responsible for this shift toward generic definitions. 46s-53s. Holistic nursing assessment has a key role in identifying anxiety and depression, and there is evidence to support the role of nurses in delivering a cognitive behavioural therapy approach to help patients with COPD manage the two conditions (Heslop-Marshall et al, 2018). Detecting exacerbations using the Clinical COPD Questionnaire. Therefore, identifying these phenotypes and developing a phenotype-specific treatment approach and prevention strategies has the potential to improve outcomes. He was seen by the advanced nurse practitioner (ANP) who recognised that his symptoms may have indicated that he was having an exacerbation of his COPD.Please login or register to read the rest of the article and to have access to downloads and comments. See Terms Click here to read a selection of free to access articles from Practice Nursing Journal. Are you a health professional able to prescribe or dispense drugs? Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Pathogens in COPD exacerbations identified by comprehensive real-time PCR plus older methods. Seasonality, ambient temperatures and hospitalizations for acute exacerbation of COPD: a population-based study in a metropolitan area. de Weert-van Oene, J. Bourbeau, E.M. Monninkhof, T.J. Verheij. … Pop. This material is protected by MA Healthcare Ltd copyright. Continuing navigation will be considered as acceptance of this use. Patel, P.W. Protocol for management of COPD exacerbation in primary care. 1. Shielding people with COPD from COVID-19: what you ... Association of Respiratory Nurse Specialists travel ... See Terms Int J Chron Obstruct Pulmon Dis, 7 (2012), pp. The degree of exacerbation severity should be ascertained in order to define the management setting.7 However, a consensual and universal severity classification system for an exacerbation is still lacking1 and there are no established criteria for the assessment of severity in less severely ill patients, not requiring hospital care.3, The American Thoracic Society/European Respiratory Society severity scale can be used in the assessment of exacerbations: level I (mild) patient is treated at home; level II (moderate) patient requires hospitalization; and level III (severe) exacerbation leads to respiratory failure, one of the indications for intensive care.36 Other severity scales exist, e.g., in mild exacerbations the patient is treated at home, in moderate exacerbations the patient is medicated with systemic corticosteroids, antibiotics or both, and severe exacerbations require hospital admission or emergency treatment.34 Yawn et al. In many cases an exacerbation is caused by an infection in the lungs, but in some cases, the cause is never known. Pizzichini, P.W. M. Gallego, X. Pomares, S. Capilla, M.A. 2581-2591. The authors acknowledge the difficulty in establishing a consensual definition of COPD exacerbation and favor the definition provided by GOLD 20172 after excluding worsening of comorbidities. Jones, P.R. Do Not contact by telephone. Use of predictive algorithms in-home monitoring of chronic obstructive pulmonary disease and asthma: a systematic review. A.M. Pommer, F. Pouwer, J. Denollet, J.W. Find out how to contribute to Independent Nurse here. and Conditions. Many patients with COPD have acute exacerbations that lead to acute respiratory failure and require hospitalization. 2633-2640. Health Details: Indications for hospitalization for acute exacerbation of COPD include severe dyspnea that does not respond to initial therapy, confusion or lethargy, respiratory muscle fatigue, paradoxical chest wall movement, and peripheral edema. This article, the second in a two-part series on COPD, outlines current guidelines and evidence-based recommendations for identifying, assessing, and managing COPD exacerbations (the first article in the series, "An Evidence-Based Approach to COPD," March 2012, focused on the management of stable COPD in the outpatient setting). Spirometry. In addition, nurses must take an interactive and team approach to the care and management of patients with COPD who have acute respiratory failure. The receptionist advised him to attend so that he could be assessed. Strategies for the prevention of exacerbations include non-pharmacological and pharmacological approaches. Wheezing is not an indicator of severity of disease and is often absent in stable, severe COPD. and Conditions. S214-S219. - Exacerbation recording. Please login or register to read the rest of the article and to have access to downloads and comments. NPJ Prim Care Respir Med, 26 (2016), pp. 75-80. Health Qual Life Outcomes, 8 (2010), pp. Clear, even, non-labored breathing while maintaining optimal oxygenation for patients. Written by: COPD exacerbation, assessment, interventions, nursing Evaluation/validation: This scenario was developed in 2005 and was pilot tested with students and peer reviewed (internal and external) prior to curriculum integration. Int J Chron Obstruct Pulmon Dis, 11 (2016), pp. Bridevaux, L. Kaiser, J.P. Janssens, O.T. Int J Chron Obstruct Pulmon Dis, 11 Spec Iss (2016), pp. Regarding pharmacological treatment, LABA+LAMA are the preferred option for symptomatic patients with ICS, macrolides or phosphodiesterase inhibitors reserved for specific patient sub-populations.2,4,36, A change of ≤4 points in the CAT score at discharge compared to that obtained at hospital admission due to a severe exacerbation predicts therapeutic failure, namely a new exacerbation, hospital re-admission or death in the subsequent three months.42 CAT seems to be a simple tool to assist in the identification of patients at increased risk of further exacerbations.22 Viral exacerbations do not seem to be associated with a higher rate of successive exacerbations or mortality during the following year.43. Care plans are very helpful because they provide a means of communication among the patients, nurses, and healthcare providers to attain health care outcomes. You may experience COPD symptomslike fatigue, wheezing, and exercise intolerance on a regular basis—or even every day. N. Gupta, L.M. COPD exacerbations: management and hospital... COPD: How can evidence from randomised controlled trials... Creative Commons Attribution 4.0 International License. N.R. Etiologically, exacerbations of COPD can be precipitated by several factors. Patients should be provided with and bring a summary of their medical problems and treatment (eg, a […] Discussions of COPD and COPD management, evidence levels, and specific citations from the scientific literature are included in that source The GOLD 2017 recommendations classify exacerbations as mild – treated with short acting bronchodilators only, SABDs, moderate – treated with SABDs plus antibiotics and/or oral corticosteroids, severe – patient requires hospitalization or visits the emergency room; these exacerbations may also be associated with acute respiratory failure – and very severe if they require admission to an Intensive Care Unit (ICU).2 In 2013, Trigueros Carrero proposed a more complex classification, grading exacerbations in mild, moderate, severe and very severe, based on past medical history, history of present illness, clinical examination features and severity of stable COPD.7 The panel considers that despite being an interesting classification, comprising a larger complexity of characteristics, it has limited prognostic value and has not been validated for clinical use. Less usually, definitions are event-based, taking into account the necessity to search health care resources. Heterogeneity of chronic obstructive pulmonary disease exacerbations: a two-axes classification proposal. 662-671. Anthonisen, J. Manfreda, C.P. Indacaterol–glycopyrronium versus salmeterol–fluticasone for COPD. Independent Nurse is the professional resource for primary care and community nurses, providing clinical Potential indications for hospitalization assessment focus on acute respiratory failure, severe symptoms such as sudden worsening of resting dyspnea, high respiratory rate, decreased oxygen saturation, confusion and drowsiness, failure to respond to initial medical treatment, presence of serious comorbidities and insufficient home support.2 The NHS protocol for management of COPD exacerbations in primary care also recommends referral to a Hospital in severe exacerbations as patients need to be assessed by a specialist in adequate settings.37 One study proposes that CAT provides a reliable score, with scores increasing at the time of exacerbation and reflecting its severity.38. How should we define and classify exacerbations in chronic obstructive pulmonary disease?. This article discusses the causes, clinical features, current approach to diagnosis and management, and nursing … SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. Chapman, J. Vestbo, N. Roche, R.T. Ayers. Nelson. Matthew is a 72-year-old retired policeman with a complex medical history, including type 2 diabetes, a myocardial infarction eight years ago and moderate/severe COPD diagnosed three years ago. Global Initiative for Chronic Obstructive Lung Disease. Currently, there is a lack of clinically useful questionnaires and a widespread classification system to assess severity of exacerbations that can be used in all settings, which might not only lead to under-reporting of less severe exacerbations but may also hamper their proper management. | Published: R.A. Stockley, C. O’Brien, A. Pye, S.L. articles for practice nurses and prescribers. Some people rarely experience COPD exacerbations, while others have frequent episodes. A standardized color chart is available to differentiate between bacterial and non-bacterial exacerbations by sputum color, which separates exacerbations that can be safely managed without an antibiotic from those requiring an antibiotic.3,7,12 This color chart has a 94.4% sensitivity and a 77.0% specificity.39 Sputum color can be reproducibly classified by trained technicians using this standardized color chart. The COPD care plan for activity intolerance may include a nursing diagnosis of insufficient energy to endure or accomplish daily activities, which may be related to dyspnea and debilitation due to COPD. M. Karloh, A. Fleig Mayer, R. Maurici, M.M. Detection of COPD exacerbations and compliance with patient-reported daily symptom diaries using a smart phone-based information system [corrected]. Schrijvers, J.W. It will prioritise this health need with a specific focus on a holistic approach to nursing assessment, when assessing patients with Chronic Obstructive Pulmonary Disease, known as COPD. Desired Outcome. Niewoehner, T. Sandstrom, A.F. However, most questionnaires remain of limited clinical utility, and symptom scales seem to be more useful in clinical practice. R. Boixeda, P. Almagro, J. Diez-Manglano, F.J. Cabrera, J. Recio, I. Martin-Garrido. Antibiotics for an acute exacerbation of COPD should be considered on an individual patient basis with uncertain benefit of antibiotics balanced against severity of symptoms, need for hospital treatment, exacerbation and hospitalisation history, risk of complications, and previous sputum culture results. Questionnaires can be self-administered, based on self-perception, symptoms and quality of life records, and can detect significant clinical changes.22–26 Scales that are symptom-based seem to be better suited to support clinical decisions.27–29, Several questionnaires exist for the assessment of both symptoms and quality of life in COPD patients, namely the modified Medical Research Council (mMRC), the Clinical COPD Questionnaire (CCQ), the COPD Assessment Test (CAT), and the health-related quality of life St. George's Respiratory Questionnaire (SGRQ).2,6, Questionnaires such as the mMRC, CCQ and CAT may be helpful in the evaluation of exacerbations.1 Although a specific CAT score increase, suggesting the presence of an exacerbation, has not been validated,7 two studies have shown that this questionnaire is sensitive to the change in health status associated with COPD exacerbations,30,31 and that changes in CAT correlate well with changes in SGRQ.31 CAT can indeed be used to predict COPD exacerbations, health status deterioration, depression and mortality.27 Another study proposes that, in primary care, a shortened and more specific version of the CCQ could be used to screen for exacerbations by measuring dyspnea, coughing and phlegm32 production. Maintenance of optimal activity levels. Patel, R. Singh, B. Kowlessar, J.A. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Rutschmann. Despite growing evidence supporting the importance of COPD exacerbations in disease burden and the implications on its natural history, many remain unreported and untreated by health care professionals.3,4 It is known that unreported exacerbations have an impact on the health status of patients, although they are usually shorter in duration and with lower severity.2 The early recognition of exacerbations allows for early therapy, leading to faster recovery, better QoL and reduced risk of hospitalization.5, The choice of a definition for exacerbation determines the rate of the observed events, permitting better treatment. Validation of the breathlessness, cough and sputum scale to predict COPD exacerbation. Funding for this paper was provided by Novartis Portugal. Detection and severity grading of COPD exacerbations using the exacerbations of chronic pulmonary disease tool (EXACT). This work can range from peer-reviewed original articles to review articles, editorials, and opinion articles. On the other hand, including minor symptoms will increase the number of patients treated, and decrease the number of patients with need of in-hospital treatment.11. The optimal management should take into account not only the severity but also the type of exacerbation, in order to select the appropriate treatment and to improve outcomes. Nursing Diagnosis: Impaired Gas Exchange related to altered oxygen supply as evidenced by shortness of breath, oxygen saturation of 82%, restlessness, and reduced activity tolerance Donaldson, A.R. Garcia-Rivero, A. Herrejon. : A systematic review and meta-analysis about clinical outcomes prediction and classification of patients into GOLD stages. Pinto, A. Morogan, J. Bourbeau. You can view our archive, or alternatively contact us. 899-908. The large clinical and physiopathological heterogeneity of COPD exacerbations between patients, and within the same patient, leads to the absence of an evidence-based or generally agreed definition.3. 01878373. Hershfield, G.K. Harding, N.A. The early identification of exacerbations is of utmost importance since these events have a great impact on patients’ morbidity, mortality and quality of life.2,6,7,21 Less than one third of exacerbations are estimated to be reported, with the number of symptoms at onset being the most important predictor of reporting an exacerbation,6 meaning if more symptoms are present it is more likely that the patient reports an exacerbation. Tel: +44 (0)20 7738 5454 This worsening of respiratory symptoms occurs acutely and normally requires additional medical therapy . J Prim Care Community Health, 4 (2013), pp. S.E. However, these definitions tend to fail to capture all exacerbations, underestimating true rates by 50%, as patients do not always seek medical attention.6 Moreover, they depend on the organization of each specific health system and resources.

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