Can daily use of macrolides decrease the onset of COPD exacerbations
Introduction
The fourth leading cause of death in the United States is Chronic Obstructive Pulmonary Disease ("Chronic obstructive pulmonary," 2010). Many patients living with COPD suffer chronic exacerbations which lead to a decreased quality of life and undesired outcomes. Treatment of COPD exacerbations is controversial. Some experts believe that the use of antibiotics during exacerbations help eradicate infectious agents while others believe continual use of antibiotics lead to microbial resistance. The purpose of this paper is to critique current research to identify if a significant relationship exists between daily macrolide use and a decrease in the onset of COPD exacerbations. This evidence will help support or refute the judgment to use daily macrolides to delay the onset of exacerbations in the management of COPD patients as a nurse practitioner.
Current Guidelines
The GOLD standards defines COPD as “a common preventable and treatable disease that is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs” ("Global strategy for," 2013, p. 2). Causes of COPD include long term exposure to noxious particles or gases, such as cigarette smoking, or having a hereditary deficiency of a1-antitrypsin ("Global strategy for," 2013). The chronic inflammation associated with COPD is due to “parenchymal tissue destruction (resulting in emphysema), and disrupts normal repair and defense mechanisms (resulting in small airway fibrosis)” ("Global strategy for," 2013, p. 2). These changes over time causes increased bacteri...
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Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
Standard principles of care is the optimal service provided from the centre to improve prognosis for patients with CF. It uses multi-disciplinary approach with frequent clinical visits, physiotherapy to improve lung function and nutritional therapy that prevents malnutrition of pancreatic insufficiency and manages CF-related diabetes (Colomboa and Littlewood 2011, Cystic Fibrosis Trust 2011, Kerem et al. 2005)
Chronic obstructive pulmonary disease is a lung disease that affects millions of United States citizens. It is the third leading cause of death because there is no cure for the disease. The best way to fight COPD is to make sure that people that have high risk factors, such as smoking and AATD get tested immediately to slow down the process of the disease.
To effectively manage COPD it is essential for patients to monitor themselves by writing a list of dates and times when experiencing symptoms and reactions to treatments. (Lung Chicago Managing COPD, 2016). Understanding a patient’s personal disease characteristics will help in determining treatment to prevent exacerbations. To maintain stable condition of the disease, COPD patients need to understand and reduce risk factors. Counseling programs such as smoking cessations need to be available for COPD patients as part of their treatment. Pharmacotherapy for the disease is also used to reduce its symptoms and difficulties on
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Pneumonia is an inflammatory response that results in an excess amount of fluid in the interstitial spaces, the alveoli, and the bronchioles. It is caused by the inhalation of organisms or irritants that move into the alveoli when the immune system is not strong enough to combat it. Once these organisms or irritants enter the lungs, they reach the alveoli where they begin to multiply. This multiplication of these organisms results in white blood cells traveling into the area subsequently causing local capillaries to become edematous, leaky, and to create exudate. The combination of this results in thickening of the alveolar wall due to fluid collection within and around the alveoli. Impaired gas exchange, which is the ...
DiClemente (2013) stated, “Although no evaluation is perfect, evaluation research can have a high degree of rigor” (DiClemente, Salazar, & Crosby, 2013, pp. 298). The result of a high degree of rigor can lead to the utilization by program planners and policy experts which would in turn could impact public health policy and promotion practice (DiClemente et al., 2013). This is obtained by a step by step, all equally important, process in what is known as the “Nine Step Stairway to Effective Evaluation”.
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Bronchiectasis is a chronic disease of the lungs where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection (Nhs.uk.2014). The extent of the disease can vary greatly- may be one section of an airway that is widened and abnormal or many airways- usually somewhere between these extremes. Widened parts of the airways are damaged and inflamed, which causes excess mucus to form which is less easily cleared. Furthermore, these parts of the airways are weaker and more liable to collapse inwards which may affect airflow through the affected airways- severity depends on how many of the airways are affected (Patient.co.uk. 2014). Patients with bronchiectasis have chronic cough and excess sputum production, and infections due to bacteria develop in them- this results in the loss of lung function (O’Donnell 2008).
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“At its core evidence based ‘anything’ is concerned with using valid and relevant information in decision making” “high quality research is the most important source of valid information”. Psychological Association (2006, p. 273) defines EBP as "the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. " When caring for patients it is fundamentally important to have a good selection of up to date evidence Based Practice clinical articles to support research strategies, this allows professionals to assemble the most recent and accurate information known which enables them to make decisions tailored to the individual’s plan of care. It is essential to have clinical expertise and have the involvement of the individual patient, they must have full engagement and incorporation in order to have the accurate evaluation.... ... middle of paper ...
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That was an attention-grabbing, yet disconcerting article. Pneumococcal diseases is an infection caused by Streptococcus pneumonia bacteria also known as "pneumococcus." It an infection of the lungs. It can cause pneumonia. This sickness can lead into additional medical issues such as: sinus or ear infection, meningitis, or blood infection. The symptoms of pneumococcal disease vary on the part of the body that it is affected. Warning sign can include fever, cough, shortness of breath, irritability, chest pain, stiff neck, confusion, sensitivity to light, joint soreness, chills, ear pain and insomnia. Additionally, in severe cases it can produce hearing loss, brain damage, and death. (http://www.niaid.nih.gov/topics/pneumonia/Pages/Default.aspx)
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