Acute Respiratory Case Study" a Cute Exacerbation in Copd"

Evidence based case study in management of acute Exacerbations of COPD.

Introduction:

Chronic pulmonary diseases have become increasingly one of the most common chronic lung diseases and a major cause of morbidity and mortality in modern world. It is characterized by airflow limitation that is not fully reversible.

 Chronic Obstructive Disease is a leading cause of the death in the worldwide (Calverley et al, 2003). The condition can result in loss of work quality and quality of the life can be significantly effected (Barnes, 1999). In UK 27,478 men and woman die because of the chronic obstructive lung diseases and most of the death ( more than 90%) was in  the age of above 60 years old(British Thoracic Society. 2006).

Rehabilitation for patients with chronic lung diseases is well established and widely accepted as means of enhancing standard therapy in order to improve symptoms and maximise the patients function (Siafakas et al, 1995; Ries, 1990; Casaburi, 1993; Fishman, 1996). In 1974, the American College of Chest Physicians (ACCP) focused in there definition of Pulmonary rehabilitation on three important features and they suggested that Successful pulmonary rehabilitation depends on three importance features, Individuality of each case, Multidisciplinary team approach and attention to physiopathology and psychopathology of each case.

One of the main problems with COPD patient is the increase in the pulmonary secretions leading to increase in shortness of breath. These two factors affect the patient’s function and quality of life.  For exacerbation, Physiotherapy is often required to help clear secretions and reduce WOB, including non-invasive ventilation to prevent intubation (Alexandera, 2001).

There are various techniques, which can be used in physiotherapy to improve patient’s condition. The research suggests that the postural drainage is beneficial in clearing  the chest from secretions (Clarke,1989;Faling,1986), respiratory muscle relaxation manoeuvre is effective for improving the pulmonary function of pulmonary emphysema patients (Fujimoto et al, 1996), relaxation can help reduce dyspnoea and anxiety in chronic obstructive pulmonary disease (COPD) patients (Louie, 2004).

Case description 🙁 case history, physical examination, and intervention)

Patient is a 67-years-old woman with acute exacerbation in Chronic Obstructive Pulmonary Disease (COPD). She complained of increased shortness of breath with loose, non-productive cough. A febrile on auscultation, bilateral rales, rhonchus, and expiratory wheezing. Patient said she is on bronchodilators and low-dose steroid. Patient said she has been suffering from this problem since 10yrs and has been on medication since. She does not do any exercises and her general practitioner who she usually sees has never mentioned about seeing any physiotherapist. Recently during this episode of acute exacerbation, she was advised by the hospital doctor to see a physiotherapist.

The strategy in this case study used was the problem-solving model, which included following six steps;

Step 1: Patient assessment,

Step 2: defining the problem,

step3: determining the goals,

step4: identifying appropriate techniques,

Step 5: applying the techniques,

step6: re-evaluation of the patients situation(Donna,1987).     

Evaluation and assessment:

Accurate assessment is the key player of physiotherapy and forms the bases of rational practice. A Problem based assessment leads to reasoning in the pulmonary rehabilitation. As result, a thoughtful evaluation will guide to both effectiveness and efficiency  because time will be saved by avoiding unnecessary treatment (Physiotherapy in Respiratory Care An evidence-based approach to respiratory and cardiac management).

Ward reports and medical notes of the patient were evaluated to know about;

·         The past and present relevant history.

·          social history , accommodation

·         Conditions required precautions in relation to certain treatments e.g. light-headedness ,bleeding disorders or swallowing disorders

·         Recent cardiopulmonary  resuscitation to examine the X-ray in case of gastric aspiration or fracture

·         Checking for possibly of bony metastases, long-standing steroid therapy that this leads to risk of osteoporosis and checking for the history of radiotherapy over the chest. These all findings contraindicate percussion or vibration over the ribs.  

·         The patient’s experience increased shortness of breath and the assessment indicate airway secretion.

A part of the patient evaluation was subjective assessment and that was by listening to patient’s problem in her own words. Following symptoms were checked:

Respiratory symptoms by looking for the how long the symptoms been troublesome.

·         Frequency, duration, and the severity.

·         Any pain, chest pain, musculoskeletal pain or cardiac pain.

·         Checking functional limitations including the daily living.

By:

About the Author:

1989-1993 BSc. in Physiotherapy and Rehabilitation, Istanbul/ Turkey.
2002-2005 PgDep. in Pain, Queen Margrate University, Edinburgh/ United Kingdom.

Living With COPD

One of the most common diseases that affects the aging population of California is COPD. COPD ( chronic obstructive pulmonary disease), is a progressive disease that makes it hard to breathe. “Progressive” means the disease gets worse over time. There is no cure, doctors try to treat the symptoms and relieve the patient’s discomfort. COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness, and other symptoms.

To understand COPD, you need to be able to understand how the lungs work. The air that you breathe goes down your windpipe into tubes in your lungs called bronchial tubes, or airways. The airways are shaped like an upside-down tree with many branches. At the end of the branches are tiny air sacs called alveoli. The airways and air sacs are elastic. When you breathe in, each air sac fills up with air like a small balloon. When you breathe out, the air sac deflates and the air goes out.

In COPD, less air flows in and out of the airways because of one of the following reasons:

? The airways and air sacs lose their elastic quality.

? The walls between many of the air sacs are destroyed.

By:

About the Author:

Gregg Camp, of Propertyinsantacruz.com is a local realtor who sells Santa Cruz homes. He works in the Santa Cruz real estate market and specializes in Rio Del Mar beach homes

Emphysema, COPD & Other Conditions Beaten: 10 Advantages of Alternative Medicine & Natural Remedies

10 ADVANTAGES OF ALTERNATIVE MEDICINE AND NATURAL REMEDIES (One man beat emphysema and COPD in six weeks … over 20 years ago.)

Fact: Emphysema, COPD, cancer, arthritis, and other diseases and adverse health conditions have in many cases been beaten. But why aren’t these countless successes acknowledged by mainstream medicine?

PREFACE

Alternative medicine is kind of an umbrella title for a number of different health or healing philosophies and approaches to medicine, health and healing. Included in alternative medicine are homeopathy, naturopathy, chiropractic care, acupuncture, and natural remedies.

Many diseases and health conditions (i.e., emphysema, COPD, cancer, arthritis) have actually been beaten by alternative medicine and natural remedies. However, mainstream medicine has for years tended to not acknowledge these countless successes, apparently because they go against its established philosophies, methodologies, and are generally far less profitable than their mainstream treatments.

From my research and experience, and that of many highly qualified sources, many safe and effective alternative treatments and remedies have been ignored or even scoffed at for years by mainstream medical authorities and professionals. Mainstream medicine has labeled some alternative treatments as “unsafe,” “unproven”, etc. However, consider how many once “approved” mainstream pharmaceutical drugs, prescribed to millions of patients, have been recalled due to harm or death to patients? Consider the numerous potential side effects they list in their ads for their drugs still on the market. (Talk about “unsafe”! Yet, they can label alternative medicine and natural remedies “unsafe”?!)

Alternative medical, health and healing “testimonials” have also often been called “anecdotes” or “anecdotal evidence;” sometimes, as in a court room, such can be called “hearsay.” Some anecdotal evidence does not qualify as scientific evidence because its nature prevents it from being investigated using the scientific method. I’m not discounting the scientific method at all; it certainly has its place, and it is one of the single greatest strategies and reasons for humanity’s greatest advances in science, technology and medicine in the last two centuries.

There is truly “hearsay” and there is “anecdotal evidence.” Applying these labels too broadly, however, can shade or hide the reality of truly valuable and valid research and results. This terminology or labeling can be accurate (i.e., illogical conclusions), desirable and necessary in many situations. “Goat yogurt mixed with bananas and peanuts prolongs life. I heard of a man who ate this almost every day of his life, and he lived to be 112.” This would be a simplistic example of hearsay or anecdotal evidence; the conclusion is unreliable and does not follow the evidence. Such cases may hold some truth, but, by their nature, using the scientific method is not possible.

However, with many successful alternative treatments and natural remedies, I am asserting that there is often a much higher level of correlation linking them to health or healing, even though the scientific method may not be applicable. (Mainstream medical authorities have in the past tended to discount claims or research that wasn’t conducted with the scientific methodology). (Many celebrities, professional athletes, politicians, and other wealthy people are seekers and strong supporters of alternative medicine, natural remedies, etc. Such high performance people need, want and demand high performance supplements, practices and treatments for their minds and bodies. Why shouldn’t you and your family have the same? )

Objectivity is foundational to the value and integrity of the scientific method; however, in the area of medicine and healing, the subjective, human realities of the patient (i.e., belief, expectation, attitude, commitment, family or environmental support, etc.) have abundantly been demonstrated to play major roles in healing. But such real factors and dimensions cannot easily be incorporated by the scientific method; therefore, other methods of measurement, research and investigation are necessary.

Again, the scientific method is highly necessary and deserves glorious credit. But scientists, researchers, doctors, etc., need to have the wisdom to know when it is needed or applicable; they, and we, need to have the wisdom and integrity to not discount or discredit evidence simply because it has not or cannot be investigated by the scientific method.

With the human, subjective variables being very real, medicine, health and healing can be somewhat more complicated than, say, the aerodynamics of flight, or other areas of technology. It seems that to simply label evidence that doesn’t fit the strict western scientific methodology, simply because scientists can’t fully explain or predict a claim, or that its nature prevents such strategy, would be closed minded. Some factors, variables or dimensions of the human experience are simply broader than the scientific methodology allows.

As can be seen as you investigate alternative medicine—great results have been realized from alternative medicine, natural remedies, etc.; such results are undeniable.

Mainstream medicine places a high value upon being able to explain “why” a tested treatment works; if they can’t explain it or it isn’t predictable by their standards, they tend to discount or discredit the substance, treatment or practice. Yes, it is worthy to want to know why something works or doesn’t work. However, wisdom from positive results would seem to say, “Use it … as you continue to investigate the “why” of it.” (Again, consider the countless dangers and deaths that have resulted from mainstream “approved” drugs, treatments and practices … many of which the public seems to be little aware.)

The bottom line is—the alternative treatments and natural remedies I support and use have demonstrated a much higher degree of value and validity than simple “hearsay” or “anecdotal evidence.” A real “truth seeker” will not let fear, bias, ego or an agenda interfere with gaining truth and facts.    

In recent years millions of common people have been awakened to the value and validity of alternative medicine and natural remedies; now, even mainstream practitioners are opening their minds to them. Here are a few examples. For years, chiropractic care was basically scoffed at; but now chiropractic care is so widely embraced that many insurance companies cover it and countless people have benefited from it. For years, alternative doctors and health practitioners asserted that good nutrition and cleansing the body of toxins were crucial to good health and healing; yet mainstream medicine tended to downplay their importance. Now, after years of alternative medicine making progress, an increasing number of mainstream practitioners are open to these truths and even practice them personally themselves. This is good news! These mainstream medical professionals are to be appreciated for being forward-thinking!

A third example is that, for years, alternative professionals asserted that anti-biotics were way over prescribed by mainstream doctors. Now, in recent years, mainstream sources have come to acknowledge this, as some harmful microbes have become immune to the over prescribed anti-biotics. This has even been report on in mainstream media. Once again, alternative medicine revealed and proclaimed truth that is now being received. I am not attempting to discount or diminish the value and validity of mainstream medicine. It definitely has its place. And I definitely acknowledge and appreciate the truly dedicated mainstream medical professionals who both practice and advance beneficial methods of medical innovations. In my opinion, there is no better place to go for injuries or trauma than a mainstream medical hospital!

I’m just saying that, when it comes to general health and healing of diseases and conditions like emphysema, cancer, COPD, arthritis, etc., both mainstream and alternative treatments should be openly and fairly considered. This seems to be “common sense” wisdom. When you begin to look into the successes of alternative medicine, it will soon become apparent that the countless successes and testimonials cannot be denied. Five, ten or twenty success testimonials from a single source could be overlooked. However, a broader view will reveal that there are countless successes, from many diverse and highly credible sources of alternative medicine and natural remedies. Many such successes are from late stage patients who mainstream medicine had exhausted their limited treatments on, and sent them home to prepare to die. Yet, alternative medicine is credited with a good percentage of restoring the health of such late-stage patients, or at least extending their lives and allowing them to experience a higher quality of life in their final days (as compared to what they likely would have had under mainstream treatment or hospitalization).

At some point in one’s investigation of the subject, it becomes apparent that to discount or deny these many diverse successes would be ignorant and closed minded. One man, Jim, was told by his mainstream doctor that there was nothing else he could do for him, and that he would die in about six months from his emphysema and COPD.

By:

About the Author:

The simple treatment Jim used can be found in an e-book, entitled, How I Beat Emphysema and COPD in Six Weeks!
View the YouTube Video

BIO:
I am a father of five children and have been a school teacher. I have been reading, researching, experimenting with, and benfiting from alternative medicine and natural remedies for over 20 years. My family, friends and acquaintances have experienced many excellent results. If you purchase a copy of the e-book, you will also get as free bonuses, eight powerful natural remedies we have used for years and that everyone needs to know. Thank you for your time and best wishes to you and yours! Al

Building confidence increases short-term exercise gains in COPD patients

( American Thoracic Society ) Patients with chronic obstructive pulmonary disease are more likely to increase physical activity on a day-to-day basis when exercises classes are combined with a confidence-building program, according to researchers from Michigan and Illinois. However, those improvements are only short-term and patients return to their original levels of activity once the …

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