References
Non-invasive ventilation as a prehospital intervention for acute COPD exacerbation
Abstract
Chronic obstructive pulmonary disease (COPD) is the second most common respiratory illness in the UK, affecting over 1 million people. Acute exacerbations of COPD are a common presentation to the ambulance service and account for thousands of hospital admissions annually. Acute respiratory failure accompanies approximately 20% of exacerbations. Current prehospital treatment focuses on oxygen and pharmacological therapy to treat the underlying causes. Non-invasive ventilation (NIV) is a method of ventilatory support that does not require endotracheal intubation, avoiding significant risks associated with intubation and sedation. While some UK ambulance services have introduced NIV, UK guidelines primarily focus on hospital use. International trials have shown prehospital NIV to be more effective than standard treatment in terms of reducing the need for intubation and invasive ventilation in hospital. However, further research is necessary before NIV is introduced widely in UK prehospital paramedic practice.
Chronic obstructive pulmonary disease (COPD) is progressive and not fully reversible. It is characterised by increasing airflow obstruction, predominantly caused by smoking, although exposure to occupational dusts, chemicals and air pollution are also considered risk factors (Brashers and Huether, 2014). COPD is the second most common respiratory disease in the UK, with 1.2 million people (2% of the population) suffering from the condition (Snell et al, 2016). Airflow obstruction occurs as a result of airway and parenchymal damage, caused by chronic inflammation (National Institute for Health and Care Excellence (NICE), 2010). Exacerbations of COPD are common, where symptoms become pronounced and unstable compared with those on a daily basis, characterised by rapid dyspnoea and hypoxaemia (Clancy and McVicar, 2009).
The clinical forms of COPD are chronic bronchitis and emphysema, although guidelines discourage differentiation between the two forms when making a diagnosis (NICE, 2010). Chronic bronchitis is defined as hypersecretion of mucus and a productive cough over 3 months of the year for at least 2 consecutive years (Brashers and Huether, 2014). Bronchitis occurs as a result of the inhalation of irritants which cause airway inflammation, leading to bronchial oedema, bronchospasm and increased mucous in the epithelium. Impaired ciliary function impedes the clearance of mucous, resulting in frequent infections and mucous plugging (Colbert et al, 2009; Brashers and Huether, 2014). Chronic inflammation results in hypertrophied bronchial smooth muscle and progression of inflammation to other airways; this leads to narrowing of the airways, which worsens during the expiration phase when airways are constricted (Brashers and Huether, 2014).
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
What's included
-
CPD Focus
-
Develop your career
-
Stay informed