What is the role of treatment for chronic obstructive pneumonia (CAP)?
The rationale for treating patients with CAP is to reduce the inflammatory response to pneumonia, which may contribute to its morbidity and mortality. However, the population that may benefit most from this intervention is not well defined, and adverse effects are potentially severe.
What is a nursing care plan for chronic obstructive pulmonary disease?
A Nursing Care Plan (NCP) for Chronic Obstructive Pulmonary Disease (COPD) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient.
What is supplemental oxygen therapy for patients with COPD?
Supplemental oxygen is a well-established therapy with clear evidence for benefit in patients with COPD and severe resting hypoxemia, which is defined as a room air Pao2 ≤ 55 mm Hg or ≤ 59 mm Hg with signs of right-sided heart strain or polycythemia.
What are the treatments for COPD flare-ups?
Your doctor may give you a prescription for antibiotics to fill at the first sign of a flare-up. With COPD, you may not get enough oxygen due to trouble breathing. As part of your ongoing treatment, your doctor may prescribe oxygen therapy. Oxygen therapy helps relieve the shortness of breath that occurs during a flare-up.
How is COPD treated in the elderly?
Nowadays a therapy that allows modifying the long-term decline in lung function of patients suffering from COPD does not yet exist and, therefore, the treatment of this disease is mainly focused on the administration of bronchodilators and the use of inhaled glucocorticoids.
What is CAP COPD?
COPD is a common comorbidity of CAP and associated with increased short- and long-term mortality. Age and ICU-admission, and not COPD per se, were independent risk factors for CAP mortality. Additionally, CAP in COPD patients is related to increased severity of pneumonia and prolonged hospitalization.
What treatments are commonly used with COPD patients?
You may take some medications on a regular basis and others as needed.Bronchodilators. Bronchodilators are medications that usually come in inhalers — they relax the muscles around your airways. ... Inhaled steroids. ... Combination inhalers. ... Oral steroids. ... Phosphodiesterase-4 inhibitors. ... Theophylline. ... Antibiotics.
What is the treatment for CAP?
The initial treatment of CAP is empiric, and macrolides or doxycycline (Vibramycin) should be used in most patients.
Which pathogens are most likely responsible for CAP in patients with COPD and or smokers?
[60] Among patients with CAP and COPD, S. pneumoniae remains the most common cause, but H. influenzae, Moraxella catarrhalis, and P. aeruginosa are also often isolated in CAP.
What is the most common organism causing pneumonia in COPD patients?
47 reported in a study of severe pneumonia patients with COPD that microbiological diagnosis occurred in 46% patients, and blood cultures were diagnostic in 12% of cases. The most frequent microorganism identified in COPD patients with pneumonia was S. pneumoniae .
What is the latest treatment for COPD?
There's also a triple inhaled therapy for COPD that combines three long-acting COPD medications. The first approved triple inhaled therapy for COPD was called fluticasone/umeclidinium/vilanterol (Trelegy Ellipta). In 2020, the FDA approved a second: budesonide/glycopyrrolate/formoterol fumarate (Breztri Aerosphere).
What are nursing interventions for COPD?
Nursing InterventionsInspiratory muscle training. This may help improve the breathing pattern.Diaphragmatic breathing. Diaphragmatic breathing reduces respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration.Pursed lip breathing.
Which medication should be used cautiously in patients with COPD?
Conclusion: Selective beta-blockers can be cautiously prescribed for patients with COPD and cardiovascular disease (CVD), however, nonselective beta-blockers should not be prescribed for patients with COPD.
How is CAP inpatient treated?
Antibiotic recommendations for hospitalized patients with CAP are divided by the site of care (medical ward or intensive care unit [ICU]). Most hospitalized patients are initially treated with an intravenous (IV) regimen but can transition to oral therapy as they improve.
What is the most typical presenting symptom for elderly patients with CAP?
Patients with typical CAP classically present with fever, a productive cough with purulent sputum, dyspnea, and pleuritic chest pain.
What is the pathophysiology of CAP?
PATHOGENESIS Traditionally, CAP has been viewed as an infection of the lung parenchyma, primarily caused by bacterial or viral respiratory pathogens.
Why are RCTs of antibiotic treatment regimens for adults with CAP important?
RCTs of antibiotic treatment regimens for adults with CAP provide little evidence of either superiority or equivalence of one antibiotic regimen over another, because of small numbers and the rare occurrence of important outcomes such as mortality or treatment failure resulting in hospitalization. Several published trials included comparators that are no longer available (e.g., ketolides). This paucity of data was noted in a 2014 Cochrane review ( 68 ).
What are the arguments for trying to determine the etiology of CAP?
Arguments for trying to determine the etiology of CAP are that 1) a resistant pathogen may be identified; 2) therapy may be narrowed; 3) some pathogens, such as Legionella, have public health implications; 4) therapy may be adjusted when patients fail initial therapy; and 5) the constantly changing epidemiology of CAP requires ongoing evaluation.
What is HCAP based on?
The introduction of HCAP was based on studies identifying a higher prevalence of pathogens that are not susceptible to standard first-line antibiotic therapy, in particular MRSA and P. aeruginosa, in some subsets of patients with CAP ( 123 ).
What is HCAP in nursing home?
HCAP was defined for those patients who had any one of several potential risk factors for antibiotic-resistant pathogens, including residence in a nursing home and other long-term care facilities, hospitalization for ≥2 days in the last 90 days, receipt of home infusion therapy, chronic dialysis, home wound care, or a family member with a known antibiotic-resistant pathogen. The introduction of HCAP was based on studies identifying a higher prevalence of pathogens that are not susceptible to standard first-line antibiotic therapy, in particular MRSA and P. aeruginosa, in some subsets of patients with CAP ( 123 ). Since then, many studies have demonstrated that the factors used to define HCAP do not predict high prevalence of antibiotic-resistant pathogens in most settings. Moreover, a significant increased use of broad-spectrum antibiotics (especially vancomycin and antipseudomonal β-lactams) has resulted, without any apparent improvement in patient outcomes ( 124 – 133 ).
What is the yield of repeat lung cancer screening?
Available data suggest the positive yield from repeat imaging ranges from 0.2% to 5.0%; however many patients with new abnormalities in these studies meet criteria for lung cancer screening among current or past smokers ( 216 ).
How long does it take to stop antibacterial therapy?
Randomized controlled studies are needed to establish whether antibacterial therapy can be stopped at 48 hours for patients with CAP who test positive for influenza and have no biomarker (e.g., procalcitonin) or microbiological evidence of a concurrent bacterial infection.
Is there a need for head-to-head prospective RCTs of outpatient CAP treatment?
There is a need for head-to-head prospective RCTs of outpatient CAP treatment, comparing clinical outcomes, including treatment failure, need for subsequent visits, hospitalization, time to return to usual activities and adverse events. Furthermore, the prevalence of specific pathogens and their antimicrobial susceptibility patterns in outpatients with pneumonia should be monitored. Newer agents, including lefamulin and omadacycline, need further validation in the outpatient setting.
What is CAP in medical terms?
Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community, as distinguished from hospital-acquired (nosocomial) pneumonia (HAP).
Is CAP a serious illness?
CAP is a common and potentially serious illness [ 1-3 ]. It is associated with considerable morbidity and mortality, particularly in older adult patients and those with major comorbidities. (See "Prognosis of community-acquired pneumonia in adults" .) The treatment of CAP in adults in the outpatient setting will be reviewed here.
Is continuous oxygen better than nocturnal oxygen?
Taken together with the results of the MRC study, the findings suggest that in patients with COPD and resting hypoxemia, some oxygen is better than none, and continuous oxygen is better than nocturnal oxygen. Pulmonary Hemodynamics.
Does oxygen help with COPD?
Long-term use of supplemental oxygen improves survival in patients with COPD and severe resting hypoxemia. However, the role of oxygen in symptomatic patients with COPD and more moderate hypoxemia at rest and desaturation with activity is unclear. The few long-term reports of supplemental oxygen in this group have been of small size ...
Does supplemental oxygen help with COPD?
In addition, supplemental oxygen appeared to improve exercise performance in small short-term investigations of patients with COPD and moderate hypoxemia at rest and desaturation with exercise, but long-term trials evaluating patient-reported outcomes are lacking. This article reviews the evidence for long-term use of supplemental oxygen therapy ...
Does COPD require oxygen?
The trial plans to enroll subjects with COPD with moderate hypoxemia at rest or desaturation with exercise and compare tailored oxygen therapy to no oxygen therapy. Use of supplemental long-term oxygen therapy (LTOT) by patients with COPD is common, with more than 1 million Medicare recipients using oxygen at an annual cost ...
What is the best treatment for COPD?
The best interventions for COPD are smoking cessation to decrease damage, nebulizers, and inhalers to open the lungs and decrease inflammation, careful oxygen supplementation, and a BIPAP or CPAP to blow off built-up carbon dioxide from the body.
How much should COPD patients be kept?
As a general rule, COPD patients should be kept around 88%-92%. Obtain an ECG. The lungs and the heart are in the same general area if someone is having problems breathing, make sure their heart is ok. Sometimes people having a heart attack can feel like they can’t breathe due to the pressure or pain on their chest.
What to do if a patient is smoking?
If the patient is smoking still this is a priority, they need to quit smoking. Provide education on smoking with COPD and the benefits of quitting. If the patient has been working very hard to breathe for a long period and is getting worse, be prepared with an airway cart.
What causes COPD?
The obstruction is caused by a combination of inflamed damaged alveoli and mucus build-up.
What are the two types of COPD?
There are two types of COPD: Chronic Bronchitis and Emphysema. The most common cause of COPD is smoking of any form: cigarette, pipe, cigar, second hand. Any lung irritant can cause COPD and also exacerbate it.
Can emphysema patients be thin?
Plus, generally, those who lose weight are also moving more to lose the weight, double win. Some patients (especially those with emphysema) can be very thin (barrel-chested) and it is important to make sure they are getting the proper nutrition so their body is at the optimal performance (for that patient).
Is COPD stressful on the heart?
Also, COPD is stressful on the heart, so even if the main problem is breathing, monitoring the heart, especially during an episode/exacerbation is important. Encourage a healthy weight can be either overweight or underweight. Having access to weight on the patient decreases the space for the lungs to expand.
What is CAP in healthcare?
Introduction. Community-acquired pneumonia (CAP) is a leading cause of hospitalization and death worldwide. 1-3 Most guidelines recommend that antibiotic treatment be based on the severity of disease at presentation, assessed either on the basis of the level of care needed or on the basis of a prognostic risk score.
Where was the CAP-START study performed?
The Community-Acquired Pneumonia — Study on the Initial Treatment with Antibiotics of Lower Respiratory Tract Infections (CAP-START) was performed in seven hospitals in the Netherlands, from February 2011 through August 2013 (see the Supplementary Appendix, available with the full text of this article at NEJM.org). The design and rationale of the study have been described elsewhere, 18 and the data are reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) statements for cluster-randomized and noninferiority studies. 19,20 Additional study details are provided in the study protocol and statistical analysis plan, which are available at NEJM.org. The study protocol was approved by the ethics review board at the University Medical Center Utrecht (reference number 10/148), by the local institutional review boards, and by the antibiotic committee at each participating hospital.
How many patients were included in the beta lactam strategy?
A total of 656 patients were included during the beta-lactam strategy periods, 739 during the beta-lactam–macrolide strategy periods, and 888 during the fluoroquinolone strategy periods, with rates of adherence to the strategy of 93.0%, 88.0%, and 92.7%, respectively. The median age of the patients was 70 years. The crude 90-day mortality was 9.0% (59 patients), 11.1% (82 patients), and 8.8% (78 patients), respectively, during these strategy periods. In the intention-to-treat analysis, the risk of death was higher by 1.9 percentage points (90% confidence interval [CI], −0.6 to 4.4) with the beta-lactam–macrolide strategy than with the beta-lactam strategy and lower by 0.6 percentage points (90% CI, −2.8 to 1.9) with the fluoroquinolone strategy than with the beta-lactam strategy. These results indicated noninferiority of the beta-lactam strategy. The median length of hospital stay was 6 days for all strategies, and the median time to starting oral treatment was 3 days (interquartile range, 0 to 4) with the fluoroquinolone strategy and 4 days (interquartile range, 3 to 5) with the other strategies.
Does beta lactam monotherapy cause a longer hospital stay?
In addition, beta-lactam monotherapy was not associated with a longer length of hospital stay or a higher incidence of complications. Funding and Disclosures. Supported by a grant (171202002) from the Netherlands Organization for Health Research and Development.
What is the best medicine for COPD?
Corticosteroids are anti-inflammatory drugs that quickly reduce inflammation in your airways. During a flare-up, you might take a corticosteroid in pill form. Prednisone is a corticosteroid that’s widely prescribed for COPD flare-ups.
What is the best way to treat COPD?
Bronchodilators. If you have COPD, you should have an action plan from your doctor. An action plan is a written statement of steps to take in the event of a flare-up. Your action plan will most often direct you to your quick-acting inhaler. The inhaler is filled with a medication called a quick-acting bronchodilator.
What is COPD in the lung?
COPD overview. COPD, or chronic obstructive pulmonary disease, is a common form of lung disease. COPD causes inflammation in your lungs, which narrows your airways. Symptoms can include shortness of breath, wheezing, tiredness, and frequent lung infections such as bronchitis.
How to prevent COPD flare ups?
In addition to avoiding your triggers, keep a healthy lifestyle to help prevent flare-ups. Follow a low-fat, varied diet, get plenty of rest, and try gentle exercise when you’re able. COPD is a chronic condition, but proper treatment and management can keep you feeling as good as possible.
Does COPD cause a flare up?
Excess mucus raises your risk of bacterial infection, and a flare-up can be a sign of bacterial infection. In fact, studies have shown that about 50 percent of mucus samples taken during COPD flare-ups test positive for bacteria.
Can COPD be controlled with medication?
You can manage COPD with medications and lifestyle changes, but sometimes symptoms worsen anyway. This increase in symptoms is called an exacerbation or flare-up. The following treatments can help restore your normal breathing during a COPD flare-up.
Does oxygen help with lung flare ups?
Oxygen therapy helps relieve the shortness of breath that occurs during a flare-up. If you have advanced lung disease , you may need oxygen therapy all the time. If not, you may only need the extra help during a flare-up. Your oxygen therapy may occur at home or in the hospital based on how severe the flare-up is.