Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is characterized by limited airflow and tissue destruction from exposure to harmful substances.
Pathophysiology and clinical presentation – It is an inflammatory condition causing the obstruction of the airways leading to a “decrease in the forced expiratory volume and tissue destruction” (Agarwal et al., 2022), thus limiting airflow and jeopardizing gaseous exchange. The jeopardized gaseous exchange increases carbon dioxide levels in the body, causing pulmonary hypertension. Clinical presentation of this condition includes tightness in the chest and shortness of breath when involved in increased physical activity. Other signs include a frequent cough stained with mucus, wheezing, and a whistling sound when breathing. The patient may also have leg swelling, reduced energy, and unintended weight loss.
Physical examination and diagnostic testing entail the clinician examining the presented symptoms and reviewing the patient’s medical history. Based on the symptoms presented, the clinician will conduct a spirometry test that measures the amount of air in the inhalation and exhalation process and the ease of doing so. In this case, air will be reduced during exhalation as much of the CO2 is retained in the body due to inflammation. Further diagnostic is needed to confirm the condition including arterial blood gas analysis, a blood test that measures the functionality of the lungs in oxygenating the blood. A chest X-ray and a CT scan can identify this (Agusti et al., 2020).
Pharmacological and non-pharmacological management – The goal of managing this condition is to control the symptoms and reduce possible mortality due to a lack of enough oxygen in the body. Pharmacological management includes the administration of bronchodilators, especially through an inhaler, that relax the muscles through the airways. Vaccines for the flu and pneumonia are administered to reduce further complications, and antibiotics are also an option when the condition is linked to a bacterial condition. Non-pharmacological management includes pulmonary rehabilitation, which involves an exercise breathing program, psychological counseling, nutritional counseling, and management of the condition.
Education/Health Promotion – Smoking is among the leading contributors to this condition; thus, smoking cessation, including passive smokers, should be encouraged. Explaining that the condition is caused by what a person inhales will promote healthy behaviors, including reducing exposure to lung irritants like harmful chemicals. Medication adherence is essential, especially the use of the inhalers appropriately to reduce the possibility of making the medication a lung irritant. Pulmonary rehabilitation is highly recommended, especially because of the associated counseling and the breathing exercise to improve the functionality of the lungs.
Need for referral and differential diagnosis – In most cases, a pulmonologist handles COPD cases due to the complications involved, especially when the patient is having problems managing their symptoms because it is a chronic condition. Differential diagnoses include asthma, heart failure, tuberculosis, bronchiolitis, and other respiratory conditions.
Lung Cancer
Lung cancer is characterized by the presence of a tumor originating from the lung or the bronchi and is among the leading cause of cancer-related deaths in America.
Pathophysiology and clinical presentation – Smoking is the leading contributor to lung cancer. Siddiqui et al. (2022) establish that the pathophysiology of lung cancer is relatively complex. However, frequent exposure to carcinogens, especially from smoking, affects the lung tissues. Also, the changes to the DNA compositions that cause cancer can happen anywhere in the body, including the lungs. Cancer will start presenting itself through a persistent cough with blood-stained sputum. Chest pain, trouble breathing, loss of appetite. Weight loss for no specific reason, fatigue, and wheezing.
Physical examination and diagnostic testing- The clinician will listen to the lungs with a stethoscope To identify any abnormality of the lungs. The patient’s medical history, especially family history, combined with the symptoms provided, can indicate lung cancer. However, lung cancer can present itself like any other condition creating the need for further diagnosis where a CT scan can predict the presence of cancer. The standard golden test for cancer is a biopsy which differentiates cancer cells from other cells.
Pharmacological and non-pharmacological management – The aim of managing this condition is to relieve the patient’s symptoms and improve quality of life. Depending on the cancer stage at the time of the diagnosis, there are various pharmacological treatments, including lobectomy, where a part of the lung is removed during the early stages. Later stages include surgery and chemotherapy, while in stage four, the treatment is to ensure that the patient is comfortable. Schabath & Cote (2019) highlight that most patients go for alternative medicine to manage the associated symptoms and the side effects of the side effects of the treatment, especially chemotherapy. For example, meditation manages the psychological impacts of the condition.
Education/Health Promotion- Health promotion activities associated with cancer include early screening for early diagnosis and treatment, increasing survival chances. Eating healthy and exercising are important to cancer patients to boost in fighting the disease and endure chemotherapy. Smoking increases cancer risks and worsens symptoms; thus, smoking cessation is mandatory. The patient should also be educated on their diagnosis, including what to expect throughout the treatment, especially the side effects of chemotherapy. Further, to ensure that the cancer cells are managed, adherence to medication and the proposed treatment is a must to address the symptoms and improve quality of life. As a health promotion, it is important to seek psychological care either through meditation or therapists to deal with the stress associated with treatment and managing this condition.
Need for a referral and differential diagnosis – when diagnosed with cancer, they are immediately referred to an oncologist for better and more effective interventions. Differential diagnoses include tuberculosis, pneumonia, pleural effusion, pneumothorax, and other similar chronic respiratory conditions.
Asthma
This is a chronic condition characterized by having the airways narrow and swollen and blocked by excess mucus, jeopardizing the respiratory process.
Pathophysiology and clinical presentation – Asthma develops when antibodies respond to certain environmental triggers like dust, animal allergens, or mold. When such are inhaled, the body responds through high-affinity mast cells that facilitate the contraction of the smooth muscles in the lungs causing the airways to tighten, jeopardizing the breathing process (Sinyor & Concepcion, 2022). When this happens, the patient manifests chest tightness, shortness of breath, wheezing, and asthma attacks. These cases of airway obstruction may necessitate an emergency medical intervention to help the individual breathe.
Physical examination and diagnostic testing- The clinician will seek information on the patient’s allergies and family history, as aside from environmental factors, the condition is also genetic. Also, a spirometry test may be conducted to measure the airflow through the lungs, where the results will show reduced air intake as the airways are blocked and determine the severity of the blockage. Further, the diagnosis includes a chest x-ray that visually represents the situation in the lungs (Dharmage et al., 2019).
Pharmacological and non-pharmacological management- The goal of managing the condition is to reduce the associated symptoms and improve the patient’s quality of life. The first line of medication is beta-agonists which aim at broncho-dilating the lungs when they become constricted, especially during an attack. Also inhaled and systemic glucocorticoids inhibit the inflammatory agents associated with asthma, thus preventing obstruction. Effective non-pharmacological management is to identify one’s triggers and avoid them. Also, therapies like pulmonary rehabilitation effectively educates the patient about the condition and breathing exercises, especially after an asthma attack.
Education/Health promotion- It is important for the patient to be educated on the importance of knowing their triggers and avoiding them or reducing their exposure to minimize asthma attacks. The patient should always have their inhaler with them at all times to relax their respiratory muscles once they have constricted. Taking their asthma and allergy medication should always be a priority and taken according to the instructions. Regular consultation with their physician is necessary to monitor their symptoms (Sinyor & Concepcion, 2022).
Need for referral and differential diagnosis – Since a significant number of asthma cases are linked to allergies, a referral to an allergist is important, especially in identifying what the patient is allergic to. Non-allergic cases are often handled by a pulmonologist. Differential diagnosis includes bronchiolitis, especially wheezing symptoms, COPD, allergic rhinitis, and other respiratory conditions.
Pneumothorax
Pneumothorax is a collapsed lung where air leaks into the pleural cavity, applying pressure on the lung and leading to its collapse. It can occur for no specific reason due to an underlying pulmonary condition or a traumatic event.
Pathophysiology and clinical manifestation – McKnight & Burns (2023) explain that the pressure in the pleural space is negative compared to atmospheric pressure; therefore, when this pressure increases, the lung collapses because of elastic recoil. This means that the lung gets smaller because of the pressure decreasing oxygen pressure and capacity hence collapsing. These conditions affect the respiratory system leading to clinical presentations of shortness of breath and skin discoloration due to inadequate oxygen in the body. Other symptoms include chest pain, fast heart rate, breathing, cough, and fatigue.
Physical examination and diagnostic testing – Huan et al. (2021) explain that the condition is primarily asymptomatic; thus, the clinician will evaluate some of the symptoms present, especially the chest pain. With a stethoscope, listen to the lungs and measure the inhalation and exhalation process. A chest x-ray confirms the diagnosis better.
Pharmacological and non-pharmacological management – The aim of managing the condition is to relieve the symptoms and restore the functionality of the lung. Pharmacological management includes a needle decompression to balance the pressure. Chest tube drainage involves inserting a tube in the chest cavity to reduce the pressure and re-expand the lung. Non-pharmacological management involves observing when the condition is not severe or using supplemental oxygen therapy to facilitate reabsorption and lung expansion.
Education/Health promotion- a recurrence characterizes Pneumothorax. Thus, the patient should keep close interactions with their physician to identify any symptoms of the condition again. Further, education is needed for the patient to understand what exactly their condition is, especially the fact that it can cause death as an associated complication. The patient should be educated on avoiding activities involving pressure changes, for example, scuba diving. Additionally, smoking cessation is mandatory as it makes the symptoms worse. Adherence to their medication is necessary for positive outcomes and improved quality of life.
Need for a referral and differential diagnosis – For proper interventions, the condition may be referred to a pulmonologist or specialist at a lung center. Differential diagnoses include pneumonia, pulmonary embolism, rib fracture, and pulmonary embolism, among other respiratory conditions with similar signs and symptoms.
Dyspnea
This condition is characterized by shortness of breath, where one’s chest gets tight, and one cannot get enough air into the lungs. Though not dangerous on its own severe shortness of breath can be life-threatening. It is usually an indication of something wrong in the respiratory system.
Pathophysiology and clinical presentation – Dyspnea can be associated with any underlying condition that has shortness of breath as a symptom but develops from “multiple interactions of signals and receptors in the CNS, peripheral receptors chemoreceptors and mechanoreceptors in the upper airway, lungs and chest wall” (Hasmi et al., 2023). The activation of the various pathways increases the demand for more oxygen, stimulating various parts of the respiratory system hence the strain and breathlessness. Some of the clinical presentations of dyspnea include tightness of the chest, wheezing, rapid breathing, and heart rate. The patient usually feels a tightness in their chest.
Physical examination and diagnostic testing. The physical examination of dyspnea involves listening to the chest for any abnormal breathing. A pulse oximeter may be placed on the patient’s finger to measure the amount of oxygen in one’s red blood cells, which in this case should be lower. Further diagnosis involves imaging of the chest to identify any abnormalities in the chest. Blood tests are also effective in measuring the oxygen content in the blood.
Pharmacological and non-pharmacological management – Pharmacological management involves the use of medications, including bronchodilators, that relax the airways when they tighten, relieving and reducing the shortness of breath. Oxygen therapy involves the clinician adding a mask or a tube to supplement the inadequate oxygen supply in the blood. Non-pharmacological management of the condition includes relaxation techniques. This involves relaxation techniques and practices that prompt the lungs to function accordingly (Stevens et al., 2019).
Education/ Health Promotion- It is important that the patient is educated on the importance of avoiding any irritants because, once inhaled, they worsen the symptoms. Since the condition has been linked to sudden deaths, the patient must maintain a close relationship with their care provider to monitor and manage any underlying conditions. Smoking cessation is mandatory as the tobacco or substance being smoked can act as an irritant to the lungs worsening the condition. Healthy eating and managing one’s weight are important to ensure that the body organs, including the respiratory system, do not strain when distributing oxygenated blood to all body parts.
Need for referral and differential diagnosis- The persistence of the condition may require the interventions of a pulmonologist or a lung specialist. Differential diagnoses include myocardial ischemia, pulmonary embolism, pulmonary infection, and pneumothorax, among other conditions.
References
Agarwal AK, Raja A, & Brown BD (2022). Chronic Obstructive Pulmonary Disease. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK559281/
Agustí, A., Vogelmeier, C., & Faner, R. (2020). COPD 2020: changes and challenges. American Journal of Physiology-Lung Cellular and Molecular Physiology, 319. (5), L879-L883 https://journals.physiology.org/doi/full/10.1152/ajplung.00429.2020
Dharmage, S. C., Perret, J. L., & Custovic, A. (2019). Epidemiology of asthma in children and adults. Frontiers in pediatrics, 7, 246. https://www.frontiersin.org/articles/10.3389/fped.2019.00246/full
Hashmi MF, Modi P, Basit H, et al. (2023). Dyspnea. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK499965/
Huan, N. C., Sidhu, C., & Thomas, R. (2021). Pneumothorax: classification and etiology. Clinics in chest medicine, 42(4), 711-727. https://www.researchgate.net/profile/Nai-Chien-Huan/publication/356144983_Pneumothorax_Classification_and_Etiology/links/620cef419f071a51e6943938/Pneumothorax-Classification-and-Etiology.pdf
McKnight CL, & Burns B (2023). Pneumothorax. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK441885/
Schabath, M. B., & Cote, M. L. (2019). Cancer progress and priorities: lung cancer. Cancer epidemiology, biomarkers & prevention, 28(10), 1563–1579. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777859/
Siddiqui F, Vaqar S, & Siddiqui AH. Lung Cancer. Treasure Island (FL): StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK482357/
Sinyor B, & Concepcion Perez L. Pathophysiology of Asthma. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK551579
Stevens, J. P., Sheridan, A. R., Bernstein, H. B., Baker, K., Lansing, R. W., Schwartzstein, R. M., & Banzett, R. B. (2019). A multidimensional profile of dyspnea in hospitalized patients. Chest, 156(3), 507-517. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090324/
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