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

master's thesis

• Title (croatian): Obrada i liječenje bolesnika s kroničnom opstruktivnom plućnom bolesti u odjelu hitne medicine
• Author: Filip Pajnić
• Mentor: Vesna Degoricija (mentor)
• Committee member: Vesna Degoricija (predsjednik povjerenstva)
• Committee member: Marko Jakopović (član povjerenstva)
• Committee member: Marija Gomerčić Palčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Emergency Medicine

Abstract

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 limitation 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.

Abstract (croatian)

Kronična opstruktivna plućna bolest je progresivna, ali predvidljiva i potencijalno zaliječiva plućna bolest od koje boluje oko 32 milijuna ljudi u SAD-u i po učestalosti predstavlja četvrti uzrok smrtnosti u općoj populaciji u toj zemlji. Bolesnici sa simptomima zaduhe, povećanom produkcijom sputuma, kroničnim kašljem i s dugotrajnom izloženošću rizičnim faktorima pobuđuju sumnju na ovu bolest i zahtjevaju obradu i liječenje. Abnormalan kronični upalni odgovor uzrokuje postojanu opstrukciju protoka zraka koja je praćena sa znakovima kroničnog bronhitisa i emfizema i čini glavna obilježja ove bolesti.
Osim plućna, bolest sustavno zahvaća i ostale organske sustave u tijelu: kardiovaskularni sustav, skeletne mišiće i metaboličke cikluse što ju čini višesustavnom bolesti koja ozbiljno narušava kvalitetu života u bolesnika koji boluju od nje. Drugi komorbiditeti koji se često javljaju u bolesnika koji boluju od KOPB-a su karcinom pluća i bronha i depresija. Bolest je snažno povezana sa životnim stilom i okolišnim čimbenicima. Duhanski dim, zagađenje zraka, izlaganje otrovnim plinovima i genetski čimbenici su najčešći uzroci u razvitka ove bolesti. Rano prepoznavanje, dijagnoza, promjene životnih navika i liječenje su ključni čimbenici u smanjenju mortaliteta, komplikacija i hospitalizacija. S obzirom na kompleksnost same bolesti i prisutnosti komorbiditeta, ovim bolesnicima stanje se često može akutno pogoršati. Najčešći izazovi koji se susreću u zavodima za hitnu medicinu su akutna egzacerbacija KOPB-a koja je često potaknuta bakterijskom infekcijom koja brzo pogoršava plućnu funkciju i svijest vodeći do zatajenja disanja i smrti. Gore spomenute činjenice su razlozi zbog kojeg kategorizacija bolesnika s KOPB-om, kombinirana s procjenom stanja bolesti, izračunom rizika od akutne egzacerbacije, terapijskim smjernicama i točnim istraživačkim studijama su od iznimne važnosti. Pravilna trijaža bolesnika u zavodima za hitnu medicinu je imperativ prilikom odluke o hospitalizaciji ili eventualnom izvanbolničkom zbrinjavanju.
Multidisciplinarni pristup bolesti je vitalan kao i rane intervencije koje smanjuju rizik od egzacerbacija te komorbiditeti koji snažno doprinose ukupnoj težini ove bolesti.

• Keywords: COPD; dyspnea; comorbidities; acute exacerbation
• Keywords (croatian): KOPB; zaduha; komorbiditeti; akutna egzacerbacija
• Language: english
• URN:NBN: urn:nbn:hr:105:928695
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-07-20 08:27:59