engleski

Management of chronic obstructive pulmonary disease patients in the emergency department setting

Chronic obstructive pulmonary disease is a progressive but preventable and treatable lung disease affecting at least 32 million people in the USA and predicted to be the 4th leading cause of death in the USA. People with a history of dyspnea, increased sputum production, chronic cough with a longstanding past of risk factors should raise the suspicion of the disease. An abnormal chronic inflammatory response leading to persisting airflow restriction concomitant with signs of chronic bronchitis and emphysema are the hallmarks of the disease. Except for its pulmonary components, the disease systemically affects many systems of our bodies as the cardiovascular system, skeletal muscles, and metabolic cycles making it a multifaceted disease heavily affecting the quality of life in patients. Other comorbidities that are often seen are lung cancer and depression. The disease is strongly associated with lifestyle and environmental living conditions. Tobacco smoke, air pollution, occupational exposures to toxic gases and genetic factors are the most common causes of developing the disease. Early recognition, diagnosis, lifestyle changes, and treatment are crucial for improving mortality and decreasing complications and hospitalizations. Because of the complexity of the diseases and many comorbid factors these patients can acutely worsen. The challenge facing emergency departments are acute exacerbations of COPD which are common and usually triggered by bacterial infections rapidly deteriorating lung function and consciousness leading to respiratory failure and death. This is the reason why categorization of COPD patients, a combined assessment of the disease, acute exacerbation risk calculations, treatment guidelines, and accurate investigative studies are of immense importance. Proper triage of the patient at the ED is imperative to decide if hospitalization of the patient is necessary or if out-patient treatment and management is sufficient. A multidisciplinary approach to the disease is vital and early interventions lower the risk of exacerbations and comorbidities that strongly contributes to the overall severity of the disease.

COPD ; dyspnea ; comorbidities ; acute exacerbation

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