In patients with chronic obstructive pulmonary disease (COPD), respiratory infections are a significant concern, exacerbating the condition and leading to more frequent health complications.
nice Patients with COPD should be offered pneumococcal vaccination and an annual influenza vaccination. HSC• Within their licensed indications, zanamivir and oseltamivir are recommended for at-risk patients who present withinfluenza-like illness within 48 hours of onset of symptoms. Patients with COPD should have a fast-acting bronchodilatoravailable when taking zanamivir because of the risk of bronchospasm. NICE
may be helped by increasing the dose of usual treatments
Get immunisedTwo immunisations are advised. * A yearly 'flu jab' each autumn protects against possible influenza and any chest infection that may develop due to this. * Immunisation against pneumococcus (a germ that can cause serious chest infections). This is a 'one off' injection and not yearly like the 'flu jab'.
AntibioticsA short course of antibiotics is commonly prescribed if you have a chest infection, or if you have a flare-up of symptoms which may be triggered by a chest infection.
Assessment
Wheezing with cough and breathlessness may become worse than usual if you have a chest infection
Sputum
Sputum usually turns yellow or green during a chest infection
Use of RLT Model
6. On admission, the control group assessment showed thatthere was a high risk for infection, 50Æ0%
6. Nursingdiagnosis related to maintaining a safe environment: high forrisk infection
6. This study indicates that nursing care, according to theRoper, Logan and Tierney model, provide, improvement inpatients’ outcomes of patients with COPD. Nursing diagnosesin patients with COPD should be considered at the time ofadmission, as they have definite implications for dischargeplanning (Potter & Perry 1995
Medications
Clarithromycin 500mg x 2/7
Vaccine
Influenza
1 that in patients with COPD, trials of injectable pneumococcal vaccines do not show effectiveness
References
6. Using the Roper, Logan and Tierney Model in care of people withCOPDMagfiret Kara Journal compilation 2007 Blackwell Publishing Ltd
Granger R, Walters J, Poole PJ, et al. Injectable vaccines for preventing pneumococcal infection in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD001390.
Infection
5. Respiratory infections and exposure to pollution arethe most common cause of exacerbations, but no cause canbe identified in up to one-third of exacerbations.'*'"' Viralinfections account for about one-half of COPD exacerbations,with rhinovirus as the predominant virus.'*' The primarysymptom in exacerbation is increasing dyspnea. It maybe accompanied by increasing cough with sputum productionand changes in sputum color from the patient's baseline.Patients with COPD can become accustomed tosymptom changes, explaining the tendency to underreportexacerbations.^ While little clinical information is helpful inpredicting an exacerbation, increased prior exacerbation frequencyincreases the likelihood of more exacerbations in the Colds in COPD patients lead to longer and more severeexacerbations. These patients should be considered forearly therapy at symptom onset Antibiotics are effective when two of the following threesymptoms are present: increased dyspnea, increased sputum production, or increased sputum purulence.-^' Antimicrobialagent selection is based on sensitivity to Streptococcuspneumoniae, Haemophilus influenzae, and Moraxella catarrhalis,the most common bacterial strains seen in COPDexacerbation. Increased severity of exacerbation symptoms,nonresponse to treatment, and co-morbidities are reasonsto consider hospital assessment and/or admission (see Table:"Patient Characteristics Indicating Need for Hospital Assessment/Admission") Prevention of COPD exacerbations is an important factorin the management ofthe COPD patient. Influenza andpneumococcal vaccinations have been found to reduce outpatientvisits, hospitalizations, and mortality."'^" The use ofmucolytics in exacerbation prevention remains under investigation.Inhaled steroid use with tiotropium (Spiriva)(long acting anticholinergic), while appearing positive, requirefurther study to determine efficac
Herpes
4. A persistent herpes infection could be the underlying cause of COPD in many patients, according to research presented at the winter meeting of the British Thoracic Society last week.Researchers looked for evidence of infection with Epstein Barr virus (EBV) and other herpes viruses in the lungs of 193 patients with severe COPD who had smoked a packet of cigarettes a day for 46 years.They found evidence of one or more herpes viruses in the lungs of 58 per cent of the patients. The most common of these was EBV, found in 47 per cent of cases.
effect on exacerbations
3. Bronchial infection significantly increases therisk of exacerbations in COPD, according to aSpanish stud
Frequency
2. The researchers found those who had frequent exacerbations were likely to suffer more colds rather than vice versa
