Nurse Practitioners Offer Vital Support to COPD and Pulmonary Hypertension Patients
By Heather Kays
Nurse practitioners (NPs) offer vital support and invaluable care to patients with the serious conditions, Chronic obstructive pulmonary disease (COPD) and Pulmonary Hypertension. The specialized care and attention provided by NPs to patients of COPD and Pulmonary Hypertension makes a big difference in the effects of these conditions as well as quality of life for the patients.
“COPD is a leading cause of morbidity and mortality worldwide that induces an economic and social burden that is both substantial and increasing,” according to the 2020 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report. “COPD is the result of a complex interplay of long-term cumulative exposure to noxious gases and particles, combined with a variety of host factors including genetics, airway hyper-responsiveness and poor lung growth during childhood. Often, the prevalence of COPD is directly related to the prevalence of tobacco smoking, although in many countries outdoor, occupational and indoor air pollution (resulting from the burning of wood and other biomass fuels) are major COPD risk factors. The prevalence and burden of COPD are projected to increase over the coming decades due to continued exposure to COPD risk factors and aging of the world’s population, as longevity increases more people will express the long-term effects of exposure to COPD risk factors.”
November is COPD Awareness Month. COPD is a common chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.
Although COPD is a progressive disease that does worsen over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions. NPs play a significant role in helping COPD patients to get their condition under control and improving their quality of life.
COPD symptoms often don't appear until significant lung damage has occurred, and they usually worsen over time, particularly if smoking exposure continues.
The signs and symptoms of COPD may include:
- Shortness of breath, especially during physical activities
- Wheezing
- Chest tightness
- A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish
- Frequent respiratory infections
- Lack of energy
- Unintended weight loss (in later stages)
- Swelling in ankles, feet or legs
According to the Mayo Clinic, people with COPD are also likely to experience episodes called exacerbations, during which their symptoms become worse than the usual day-to-day variation and persist for at least several days. Only some chronic smokers develop clinically apparent COPD, although many smokers with long smoking histories may develop reduced lung function. Some smokers develop less common lung conditions. They may be misdiagnosed as having COPD until a more thorough evaluation is performed.
AANP offers a variety of tools and resources to help NPs who treat patients with COPD.
NPs are essential to the early diagnosis and treatment of COPD. Whether facing a patient at risk for developing COPD or adjusting treatment for a patient with poorly controlled COPD symptoms, NPs in clinical practice must start this important conversation. AANP, in conjunction with expert NP faculty Susan Corbridge and Corinne Young, have developed this useful tool to help NPs discuss timely diagnosis, implement appropriate treatment according to current GOLD guidelines and adjust therapy for patients who are at increased risk due to infections, exacerbation or inadequate care.
Pulmonary Hypertension is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart.
In one form of pulmonary hypertension, called pulmonary arterial hypertension (PAH), blood vessels in the lungs are narrowed, blocked, or destroyed. The damage slows blood flow through the lungs, and blood pressure in the lung arteries rises, according to the Mayo Clinic. Then, the heart must work harder to pump blood through the lungs. The extra effort eventually causes the heart muscle to weaken and fail. In some people, pulmonary hypertension slowly gets worse and can be life-threatening. Although there's no cure for some types of pulmonary hypertension, treatment can help reduce symptoms and improve quality of life. Again, this is where NPs play a vital role in helping patients to manage symptoms and improve their quality of life.
The signs and symptoms of pulmonary hypertension develop slowly. A patient may not notice them for months or even years. Symptoms get worse as the disease progresses.
Pulmonary hypertension signs and symptoms include:
- Shortness of breath (dyspnea), initially while exercising and eventually while at rest
- Fatigue
- Dizziness or fainting spells (syncope)
- Chest pressure or pain
- Swelling (edema) in the ankles, legs and eventually the abdomen (ascites)
- Bluish color to the lips and skin (cyanosis)
- Fast pulse or pounding heartbeat (palpitations)
The typical heart has two upper chambers (atria) and two lower chambers (ventricles). Each time blood passes through the heart, the lower right chamber (right ventricle) pumps blood to the lungs through a large blood vessel (pulmonary artery). In the lungs, the blood releases carbon dioxide and picks up oxygen. The blood typically flows easily through blood vessels in the lungs (pulmonary arteries, capillaries and veins) to the left side of the heart.
However, changes in the cells that line the pulmonary arteries can cause the walls of the arteries to become stiff, swollen and thick. These changes may slow down or block blood flow through the lungs, causing pulmonary hypertension.
Pulmonary hypertension is more often diagnosed in people ages 30 to 60, according to the Mayo Clinic. Growing older can increase the risk of developing PAH. However, idiopathic PAH is more common in younger adults. Other risk factors include a family history of the condition, being overweight, blood-clotting disorders or a family history of blood clots in the lungs, exposure to asbestos, congenital heart disease, living at a high altitude, use of certain weight-loss drugs, use of illegal drugs such as cocaine and use of selective serotonin reuptake inhibitors (SSRIs) used to treat depression and anxiety.
According to the Mayo Clinic, potential complications of pulmonary hypertension include:
- Right-sided heart enlargement and heart failure (cor pulmonale). In cor pulmonale, the heart's right ventricle becomes enlarged and must pump harder than usual to move blood through narrowed or blocked pulmonary arteries.
As a result, the heart walls thicken, and the right ventricle expands to increase the amount of blood it can hold. But these changes create more strain on the heart, and eventually the right ventricle fails.
- Blood clots. Having pulmonary hypertension increases the risk of blood clots in the small arteries in the lungs.
- Arrhythmia. Pulmonary hypertension can cause irregular heartbeats (arrhythmias), which can lead to a pounding heartbeat (palpitations), dizziness or fainting. Certain arrhythmias can be life-threatening.
- Bleeding in the lungs. Pulmonary hypertension can lead to life-threatening bleeding into the lungs and coughing up blood (hemoptysis).
- Pregnancy complications. Pulmonary hypertension can be life-threatening for developing babies.
- Designed to support NPs in primary care — who play a crucial role in the management of patients with PAH, a rare, complex disease — this tool explains the clinical presentations of PAH, provides an overview of treatment options, and identifies when patients should be referred to pulmonary hypertension (PH) centers.
According to experts at Global Initiative for Chronic Obstructive Lung Disease (GLOBE), NPs can help their patients prevent COPD.
“Identification and reduction of exposure to risk factors is important in the treatment and prevention of COPD,” according to the 2020 Global Initiative for Chronic Obstructive Lung Disease (GLOBE) Report. “Cigarette smoking is the most commonly encountered and easily identifiable risk factor for COPD, and smoking cessation should be continually encouraged for all individuals who smoke. Reduction of total personal exposure to occupational dusts, fumes, and gases, and to indoor and outdoor air pollutants, should also be addressed.”
Other Resources
COPD:
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