Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is defined as a “preventable and treatable disease state characterized by airflow limitation that is not fully reversible” (ATS/ERS, 2005). According to this definition the term COPD “encompasses chronic obstructive bronchitis, which is clinically characterized by obstruction of small airways, and emphysema, which is hallmarked by enlargement of airspaces, destruction of lung tissue, reduced lung elasticity and closure of small airways” (Barnes, 2000). Also included under the category of COPD is chronic bronchitis. Chronic bronchitis is clinically defined as the presence of a cough and sputum daily for at least three months for two consecutive years, and requires that other causes for cough have been excluded (ATS/ERS, 2005; Barnes, 2000). A major feature of this form of COPD is mucus hypersecretion, which may or may not be accompanied by airway obstruction (Barnes, 2000; Vestbo, Prescott, & Lange, 1996). Most cases of COPD can be attributed to smoking and the diagnosis is often made in the fifth decade or later (ATS/ERS, 2005)
The most common symptom reported by COPD patients is dyspnea, also commonly termed “breathlessness” or “shortness of breath” (Mahler & Baird, 2005). Dyspnea is a subjective term that describes a sensation of uncomfortable breathing that varies in intensity
(ATS/ERS, 2005). The mechanisms of dyspnea are complex and incorporates physiological, psychological, psychosocial and environmental factors that may be manifested by the
individual as secondary behavioral and physical responses (ATS/ERS, 2005).
Advancing age is associated with declining physical activity. In the case of the adults
and older adults (generally age 65 or older) with COPD, the individual gradually reduces physical activity in an effort to reduce dyspnea associated with activity (Mahler & Baird, 2005, 1993). The fall in physical activity contributes to an overall reduction in physical functioning in COPD patients (Reardon, Lareau, & Zuwallack, 2006) and setting into motion a downward cycle of disability, declining function and worsening dyspnea (Carrieri-Kohlman, 2003). It is also recognized that as one ages, their confidence for remaining physically active can gradually decline (Bandura, 1997). This type of confidence is called “self-efficacy” and reflects the individuals’ self-assurance in being able to complete or accomplish a specific task (Bandura, 1997). Aging is associated with some gradual decline in physical activity and this decline can negatively impact one’s self-efficacy or confidence that they can carry out a specific physical activity task (Bandura, 1997).
When evaluating the older adult with COPD, it is important to recognize that the pathophysiological changes associated with COPD are superimposed on expected age-related
changes in the pulmonary system. There is ample evidence that the lung undergoes numerous changes as part of the normal aging process, which results in a gradual decline in respiratory function. The three most important age-related changes in the respiratory system are 1) decreased compliance (increased stiffness) of the chest wall; 2) a loss of respiratory muscle strength; and 3) increased compliance of lung tissues (Zeleznik, 2003). These age-related changes in the lung influence airway function, lung volumes, flows and gas exchange. Expected age-related decline in pulmonary function, coupled with pathophysiological changes associated with COPD, results in a “double- edged sword” for the older adult with COPD.
Chronic obstructive pulmonary disease is a highly prevalent chronic illness in adults.
According to World Health Organization (WHO) estimates, 80 million people worldwide
have moderate to severe COPD (WHO, 2007). United States (U.S.) Centers for Disease Control (CDC) data collected through 2000 estimates that between 10 and 24 million Americans have COPD (CDC, 2007). Current data indicates that moderate COPD is found in 6.9% of the general U. S. population aged 25-75 years (ATS/ERS, 2005).
Chronic obstructive pulmonary disease is associated with considerable mortality,
morbidity and expense. In the U.S., COPD is the fourth leading cause of death among individuals aged 65 or older; only cardiovascular disease, cancer and stroke rank higher
(CDC, 2006). In 2002 alone, U. S. healthcare expenditures associated with COPD costs totaled $32.1 billion, with $18.1 billion attributed to medical services and $14.4 billion associated with the indirect costs of morbidity and premature mortality (NHLBI, 2002). Medicare expenditures for beneficiaries with COPD were 2.5 times higher than expenditures for all other patients (NHLBI, 2002). The predicted 25% increase in the American older adult population in the coming decades is projected to boost medical expenditures by 25% as well (CDC, 2006).
In summary, the age-related physiological decline in lung function, superimposed with pathophysiological changes associated with COPD are considerable. It is well recognized that declining physical activity leads to disability and morbidity and that aging and chronic illness can gradually erode self-efficacy for subsequent physical activity and subsequent physical activity. Therefore therapeutic interventions that are designed to increase physical activity, instill confidence in being able to be physically active, are particularly important for the older adult with COPD.
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