PHYSICAL ASSESSMENT

Physical Assessment



Physical Assessment

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Introduction

In this study, I explored aspects of physicians' current management of patients with chronic obstructive pulmonary disease (COPD) in a small, rural community hospital. This paper briefly describes the problem, the purpose of the study.

Statement of the Problem

COPD is expected to become the third most common cause of mortality in the world (GOLD Committee, 2009). With this rising prevalence, treatment of COPD will continue to play a large role in everyday medical practice. An integral component of COPD management is drug therapy, and guidelines for the treatment of COPD continue to advocate inhaled rather than oral therapy (GOLD Committee, 2009; O' Donnell et al, 2007). Inhalation treatments come in a variety of devices that disperse medication to the patient. This wide selection of devices can be confusing to the patient and prescriber (Newman, 2005). Device selection is now recognized as a factor that is as powerful as drug selection to successful clinical outcomes with COPD (Newman, 2005). The problem is that limited information is available to assist practitioners in selecting appropriate devices to deliver medication to their patients. Even less of this information is evidence based (Dolovich et al, 2005; Everard, 2001; Newman, 2005). Understanding the current practice related to device selection can help to find ways to improve the care of people with COPD. Purpose The purpose of this study was to add to what we know about ways to improve the care of people with COPD.

Background of the Problem

Healthcare professionals are becoming increasingly aware that device selection for medication delivery is as powerful as individual drug selection to ensure successful treatment of COPD (Newman, 2005). Drug therapy for COPD can be delivered by oral, intravenous, and inhaled routes. The inhaled route is preferred for the delivery of medications for therapy for COPD because it minimizes the side effects, and the onset of action is faster than the oral route (Newman, 2005; Thorsson & Geller, 2005; Virchow, 2005). Various devices such as nebulizer, metered-dose inhalers (MDIs), and dry-powder inhalers (DPIs) are available for the delivery of bronchodilator and corticosteroids. Dolovich et al.' s (2005) recent systematic review of the literature showed no significant difference, among the various devices in any efficacy outcome, in any patient group for multiple clinical situations, including COPD exacerbations, ± and the authors concluded that various devices used for the delivery of bronchodilators and steroids can be equally efficacious' ± (p. 335).

With supporting evidence that all devices have the potential to be equally efficacious, it is left up to the individual medical practitioner to decide which device to use for specific clinical situations. The proliferation of new inhaler devices has resulted in a confusing number of choices for practitioners, and there is a lack of evidence-based guidelines to aid clinicians in making these choices for their patients (Dolovich et al, 2005). The Canadian Thoracic Society's (CTS's) recommendations for COPD management offer no guidance to clinicians in selecting drug-delivery ...