References
Preventing prehospital hyperoxygenation during acute exacerbation of COPD
Abstract
Chronic obstructive pulmonary disease (COPD) is a long-term, incurable lung condition. Acute exacerbations are frequently encountered by ambulance clinicians and are routinely treated with oxygen therapy and nebulised drugs. Yet, delivering the appropriate amount of oxygen to these patients is challenging, and the effects of getting it wrong are significant. Hyperoxygenation of patients with acute exacerbation of COPD leads to a significantly increased rate of mortality and morbidity. This article outlines the pathology of COPD and relevant clinical guidelines. It proposes a multi-modal intervention as a solution to the challenge of ensuring the appropriate delivery of oxygen therapy to patients who are experiencing an acute exacerbation of their COPD.
Chronic obstructive pulmonary disease (COPD), believed to be the fifth most common cause of death in the UK (National Clinical Guidelines Centre (NCGC), 2010), is a long-term and incurable lung condition. In the UK alone there are an estimated 3 million people (2-4% of the population) with COPD, up to two thirds of whom remain undiagnosed (NCGC, 2010). Its cost is significant; each year approximately 30 000 people die from COPD and it costs the UK £982 million (Britton, 2003).
COPD, most often caused by smoking (NCGC, 2010; World Health Organization (WHO), 2011), has a complex pathology. The disease results in either hypertrophy of the mucus-secreting glands of the bronchial tree (in the case of bronchitis), or a destruction of the alveoli walls (in the case of emphysema) (Tortora and Derrickson, 2011). Often, however, both conditions coexist with one or other being the more dominant (Porth, 2005; Kumar and Clark, 2009). One of the key features of COPD is the progressive and irreversible nature of the condition (NCGC, 2010). A diagnosis of COPD is considered in individuals with certain risk factors who have signs and symptoms that are supported by spirometry (NCGC, 2010) (Table 1).
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