COPD, also known as CAL (chronic airflow limitation) is a chronic debilitating disease.
What does the Respiratory System do ?
The respiratory system consists of the lungs, airways and blood vessels. The function of the respiratory system is to absorb oxygen into the body and to remove carbon dioxide from the body. A normal breath requires a complex coordination between the nervous system (brain & spinal cord) and the muscles of breathing (including the diaphragm and muscles between the ribs).
Abnormal and or inadequate breathing can occur as a result of:
- An interruption to the nervous system (head injuries or spinal injuries for example)
- Barriers to the absorption of oxygen (eg fluid in the alveoli);
- Obstruction to the flow of gases through the lungs, both breathing in or out (eg asthma);
- Damage to the rib cage (in motor vehicle trauma for example);
- Pain, which makes taking a normal breath difficult.
There are many respiratory conditions which if not treated can result in respiratory failure and require the patient to be admitted to a high dependency or intensive care unit for further monitoring and ventilation support (help with breathing). This support may be through the use of oxygen masks, CPAP or via a breathing tube(endotracheal tube) and ventilator (breathing machine).
Chronic Obstructive Pulmonary Disease (COPD)
COPD, also known as CAL (chronic airflow limitation) is a chronic debilitating disease. Patients include those with emphysema and chronic bronchitis, which can result from long-term smoking. In this disease the lungs lose their capacity to absorb adequate oxygen and/ or excrete adequate amounts of carbon dioxide from the body. Typically patients will have a limited exercise tolerance and may also have problems with chronic sputum production. Patients with COPD have little reserve when it comes to dealing with additional demands such as when attempting to fight off an infection. This is often referred to as an ‘exacerbation’ or acute deterioration of their respiratory failure.
What happens in intensive care?
Treatment will be aimed at identifying the cause of the exacerbation and treating it whilst supporting the patient. This support includes providing adequate nutrition and lots of physiotherapy. Investigations such as a Chest Xray and blood tests may be done. Medications may include Ventolin (salbutamol) if there is some airway spasm and less often oral or intravenous steroids. Patients with a severe attack, which lands them in intensive care, will require breathing assistance, which may include mask BiPAP. In some extreme cases the patient may require full assistance using an endotracheal tube (breathing tube) and ventilator (the breathing machine). You can expect the patient to have frequent chest x-rays and blood tests especially arterial blood gases (ABGs). The patient will be closely monitored using an oxygen saturation monitor, bedside monitor and occasionally an arterial line.
How long will the patient remain in Intensive Care?
If the cause of the exacerbation is straight forward and easily treated the patient will normally stay in intensive care/high dependency for several days. Under some circumstances the patient’s condition is a result of the natural progression of their disease and this last ‘exacerbation’ is the final insult, which they may not be able to overcome. While intubation and ventilation are avoided, if possible, this event does outline the seriousness of the condition and poor outcome.
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
COPD ~ Version 1 September 2004 (Authors C Inness & K Rolls)
First Posted December 2004, revised October 2005