Health Promotion for COPD Management

Introduction

In this essay, an area regarding adult nursing is to be focussed and based on the field the current purpose of the essay is to discuss the health promotion and management of chronic obstructive pulmonary disease (COPD) among adults with smoking addiction. The topic of COPD for adults with smoking addiction is chosen because as per statistical reports in the UK, COPD is one of the common lung diseases after asthma among the population involved in smoking. This is evident as 25,000 deaths regarding COPD occurs each year in the UK out of which 90% occurs among the people involved in smoking (gov.uk, 2015). For this purpose, initially, a literature review along with rationale for the topic is to be presented to inform concept regarding COPD among adults with smoking addiction. The methodology to be used in gathering data regarding the essay is to be mentioned. Further, the thematic analysis of information regarding the topic is to be performed and based on the facts areas of improvement for tackling COPD among adult smokers are to be discussed.

Literature Review

The chronic obstructive pulmonary disease (COPD) is a disease of the lung which causes restricted airflow leading to interfere with normal inhaling and exhaling efficiency of the individuals (Soriano et al. 2017). One of the early sign of COPD is shortness of breath that is followed by unusual and extensive coughing. The symptom is severely faced among smokers experiencing COPD because harmful substances in the smoke cause irritation in the inner lining of the lungs which often leads to swelling of the air passages. It leads to create difficult in letting air in and out of the lungs, as a result, making individuals to forced breathing and coughing to ensure breathing (Martinez, 2016). In contrast, the study Koo et al. (2018) informs that smokers with COPD are found to produce increased amount of sputum along with coughing as a result of damage to their lungs due to the disease. This is because inhaled harmful smoke from tobacco among smokers is seen to damage the cilia present in the inner lining of the lungs which function in moving mucus. The lack of their effective functioning leads to leads the mucus to accumulate in the bronchioles and cause irritates of the airways making individuals with COPD to cough out sputum. The other symptoms related to COPD among individuals who are smokers as well as non-smokers are chest tightness, fatigue, unintended weight loss, wheezing and others (Cook et al. 2019). The presence of COPD affects the individuals to face hindrance in performing their everyday activities like walking, washing, managing household chores and others. This is because shortness of breath interferes with the physical efficiency of the individuals in performing actions (Globe et al. 2016). The existing literature provided data regarding the concept of COPD and its causes among adults with smoking addiction. However, it has failed to highlight the extent of prevalent COPD is among the adults who are smokers. Moreover, there is gap regarding the effect of COPD on individuals or adults involved in smoking addiction making it unable to determine the severity of the disease. There is lack of information about the strategies to be used in managing and preventing COPD among adults involved in smoking. Thus, to fulfil the gap existing essay is being developed to gather relevant information and fulfil the gaps.

Rationale of the Topic

In the United Kingdom (UK), it is mentioned that till 2019 nearly 1.2 million people among which mostly are smokers are diagnosed with COPD as long-term condition (hse.gov.uk, 2019). The British Lung Foundation has mentioned that 2% of the population and 4.5% of people over the age of 40 years are affected by COPD as per reports in the UK. It is informed that in the last decade in the UK there is 27% increase in the COPD incidence in the country (NICE, 2019). According to WHO, the global prevalence of COPD among adults is 251 million as seen in 2016 (WHO, 2020). This indicates that there is high prevalence of COPD among adults in the UK who are mostly smokers making it a key health issue to be focussed to lower its prevalence. The rise of COPD has become an issue because it is seen to cause increased financial burden on the NHS to manage the condition. This is evident as the NHS England has to spend £57,000 in offering treatment regarding the COPD among the adults who are smokers as well as non-smokers in 2019 which is going to increase to £1,875,000 in 2022-23. The increased cost is going to offset £426,000 as saving in 2019-20 to £852,000 in 2022/23 creating a net impact on raising the budget to gather extra amount of £1,023, 000 in 2022-23 (NICE, 2019). Thus, it indicates that finances to be spent for COPD management in the UK would be beyond the savings to be made by NHS indicating they have to arrange increased finances each year for proper health control regarding disease.

The COPD among the adult smokers has currently become an issue as it has led to cause 30,000 deaths each year which is nearly the double of the average in Europe (ash.org.uk, 2019). In the world, as in 2015, it is reported that 3.17 million deaths have occurred and most of them are among the adults involved in active smoking (WHO, 2020). Thus, it indicates that COPD among the adults with smoking addiction is negatively affecting the individuals leading them to develop the fatal condition. Therefore, effective discussion regarding COPD among adults with smoking addiction is to be done so that effective actions can be taken to reduce the overall disease burden and mortality rate of COPD in coming years that would benefit to lower financial burden on NHS.

Methodology

Literature Search and Keywords

The literature search in the study is to be done by using the electronic database. This is because it allows avoiding errors and enhances consistency in gathering data (Thielen et al. 2016). It is helpful to improve gathering of relevant and stable data regarding the study of focus so that enriched findings can be presented. The advantage of electronic database used in gathering information is that it ensures wide amount of data from various resources over the world regarding the topic to be collected without hindrance (Tricco et al. 2016). It ensured augmented data to be presented that increase the validity and reliability of the study. The use of electronic database resolves the geographic barriers to be faced in collecting facts and figures regarding the topic which are experienced during manual search (Thielen et al. 2016). Thus, this nature of literature search ensures quality data to be gathered for executing the study. The electronic databases which are used for the study are CINHAL. The Cumulative Index to Nursing and Allied Health Literature (CINHAL) database is to be used as offers opportunity to the researcher to search for information regarding the selected nursing topic from more than 3,075 nursing and related journals. Moreover, it is regarded to be one of the most widely used electronic databases for researching information by experienced nurses, students and health professionals regarding clinical topic (ebscohost.com, 2019). Thus, the improved value of the site led towards its use in formulating the study. The CINHAL database is used in the essay for gathering 10 key peer-reviewed journals related to the topic. The search terms in the study are essential as assist to narrow the focus and search of the researcher to collect and target relevant studies related to the topic (ebscohost.com, 2019). The key search terms used in the study are “COPD”, “adult smokers”, “smoking addiction”, “smoking cessation”, “challenges in COPD” and others.

Inclusion and Exclusion criteria

The inclusion characteristics are referred to the aspects which are to be present in the study for its enhanced execution. The exclusion characteristics are determined as the aspects which are not to be present in the study as it would lead to develop error and hinder the quality of the results to be presented in the study (Atkinson and Cipriani, 2018). The inclusion characteristics for the study is primary quantitative and qualitative studies published not before 2013, articles written in English, articles contains information for health promotion of adult smokers with COPD, fully accessible and academically valid content. The exclusion characteristics for the study are secondary qualitative journals which are published before 2013, journals that are not fully accessible, contains information regarding pulmonary health issues other than COPD for adult smokers, not written in English and non-academic content are present. The studies within the last 7 years are selected and others are excluded so that most current and relevant information regarding health promotion and prevention of COPD among adult smokers are presented in the study. This is because backdated information creates error in the study by presenting invalid facts that are scientifically rejected through further research. The articles which contain information regarding adult smokers with COPD is selected as it would help to provide appropriate data for the study that can be applicable in reaching the purpose of the study. The articles presented in the English language is to be included as it the universal language that is mostly understood by all, in turn, making the readers, as well as researcher, understand the content and the way they are to be presented in the study. The primary articles and journals are selected in the study because they provided information which directly addresses the topic of focus leading less time to be spent in formulating the study. The primary articles also provide detailed statistical data that can be compared by the researcher to easily determine the results of the study. The journals which are fully accessible are included and others excluded so that wide information by analysing the detailed data in the study can be determined to be critically presented by the research. The academic articles are to be used in the study as they provide validated scientific evidence which leads to disseminate breakthrough of knowledge regarding the study topic.

Critical Analysis Tool

The Critical Appraisal Skills Programme (CASP) tool is used in the study for critically analysing the retrieved literature. The CASP tool is designed for assisting the researchers to follow set of question to evaluate the study for making sense of the medical and clinical intervention mentioning in existing studies (Room et al. 2017). The benefit of using CASP tool is that it allows effective evidence to be gathered regarding the topic to use it in performing evidence-based practice in the health and social care field (Cheema et al. 2019). It indicates that use of CASP tool is beneficial in the study as it would lead to identify most effective evidence for management and prevention of COPD among the adult smokers. This, in turn, allows the evidence-based practice to be performed and effective service improvement to be suggested for better positive health promotion regarding the health issue. (Refer to Appendix 1and 2)

Thematic Analysis and PRISMA Tool

Thematic Analysis is referred to the process of analysing qualitative data to understand its patterns, ideas reflection and topics explored to differentiate them to be presented under common themes (Braun et al. 2019). In this study, the thematic analysis is used to present the critically reviewed data developed with the help of the CASP tool. For this purpose, three key themes are developed to present the findings. The PRISMA Tool mainly focuses to report reviews regarding trails and experiments by considering minimum set of items (Tricco et al. 2018). The PRISMA tool is used to mention the way relevant literature is compiled in the study. (Appendix 3)

Thematic Analysis

Theme 1: Pharmacological and therapeutic intervention for promoting positive health regarding COPD among adult with smoking addiction

The pharmacological and therapeutic intervention for smoking cessation is the effective steps taken in controlling COPD among adults with smoking as tobacco smoking is considered the key issue which influences the disease. This is evident from the study of Liu et al. (2015) where it is mentioned that out of 1,454 respondents who are involved in active smoking nearly 25.6% of them are diagnosed with COPD and others with symptoms of COPD (11.2% breathlessness, 25% productive cough). Thus, the study of Gratziou et al. (2014) is analysed which mentions that smoking cessation lower COPD relapse which is evident as researchers mention that 37.7% of the COPD smokers who are involved in smoking cessation program in the study expressed long-term continuous abstinence rate (CAR). The CAR is the percentage of sample who remain absent from studies from week 9. The study mentioned that long-term CAR indicated the patients have recovered from smoking addiction and had improved COPD condition without relapse in the issue as result of smoking cessation. The study by Ianosi et al. (2018) informed that adults of 40-49 years who were active smokers are included to experiment with the impact of use of varenicline for their smoking cessation and COPD condition. The COPD Assessment Test (CAT) score for the adult smokers after 12 weeks with administration of varenicline indicated 9.89 points compared to 27.7 points before the intervention. The lower score indicated that symptoms of COPD are reduced and smoking cessation among the adult smokers is reached. Thus, it informs that varenicline has better ability to mimic the effect of nicotine due to which results to lower the urge to smoke and relives the system regarding withdrawal of tobacco. In contrast, the study by Chen et al. (2014) mentioned that individual counselling in smoking cessation is effective for improving condition with COPD among adult smokers. This evident from the results where comparison to intervention and control group mentioned that through individual counselling 40.5% of the participants reported smoking cessation compared to 18.6% without the intervention who are active smokers and facing COPD. The results are developed as individual counselling led to greater self-awareness, education of boundaries, understanding of health scenario among adult smokers making them develop intention to stop smoking for enhanced condition regarding COPD. In the study by Kadam et al. (2020), t is mentioned that Senega 30C as complementary intervention for chronic smokers to resolve symptoms regarding COPD. This is evident as no notable change in FEV1 scores was seen among the chronic smokers with COPD in the study. Thus, it cannot be used as complementary medication to manage COPD in adult smokers.

Theme 2: Barriers to health promotion regarding COPD among adult with smoking addiction

There are challenges faced in health promotion and management of COPD by physicians and patients who are adult smokers. In the study by Van Eerd et al. (2017), 21 focus group discussions are performed between general healthcare practitioners and pulmonologists who are involved in treatment of COPD patient those are adult smokers. The study mentioned that physician’s frustration to manage COPD among the adult who smokes irrespective of their guidance leads to hindered COPD health promotion. This is because frustration leads the physicians to avoid concentrating on their activity to ensure smoking cessation. Moreover, unskilled physicians who deliver hindered smoking cessation assistance to adult smokers are unable to lower prevalence of the disease among adult smokers (Van Eerd et al. 2017). This is because intervention by unskilled physicians remains ineffective to influence adult smokers to quit smoking, in turn, making them suffer more intricately from COPD. In contrast, the study by Yadav et al. (2020) mentions that lack of proper mentoring of health of adults smokers with COPD has acted as barrier towards better health promotion regarding the disease. This is because without monitoring by social network changes in healthcare required and attainment of smoking cessation which would improve COPD condition in adult smokers is not established.

Theme 3: Dietary intervention for health promotion regarding COPD among adults with smoking addiction

The dietary supplements are found to offer physical strength among adult smokers with COPD to enhance their condition and develop well-being. The study by Kaluza et al. (2017) revealed that a potential inverse association of fruit and vegetable consumption among smokers regarding COPD was seen compared to non-smokers (p-interaction=0.02). Nearly 8% less risk of COPD in current adult smokers in the study was revealed in relation to consumption of fruit and vegetables for each day. This indicates that high consumption of vegetables and fruits are related with lower COPD risk among smokers. In comparison, the study by Fischer et al. (2018) mentioned that intake of the Mediterranean diet that consists of increased antioxidants, nutrients, vitamins and others act as protection to lower risk of COPD among smokers. This is evident from the study where high Mediterranean diet scores are related to less risk of developing COPD among smokers (odds ratio [OR] 0.73). However, in the study by Park e al. (2016), it is mentioned that intake of increased dietary vitamin C acts to protect the risk of COPD among mild and severe adult smokers. This is evident as 76.7% risk for COPD is found to be lowered for people affected by COPD and those are mild and severe smokers compared to heavy smokers. This indicates that dietary intervention to tackle COPD risk could be implemented to lower the prevalence of disease among smokers.

Service Improvement

The NICE guidelines mention that group therapy is to be provided to COPD patients for smoking cessation. This is to influence the smokers through discussion and meeting similar people with the help of psychiatric counsellor to develop smoking cessation attitude (NICE, 2018). However, based on the review, individual therapy is to be promoted for adult smokers with COPD in enhancing their condition. This is because individual therapy allows a person-centred approach towards meeting the needs and demands of adult smokers with COPD which make them feel value and zeal out of satisfaction of their needs to quit smoking in turn showing better health regarding COPD (Stegberg et al. 2018). The NHS informs that varenicline or bupropion to be used for smoking cessation for COPD adults in improving their health (NHS, 2018). However, as per the review varenicline is to be used as the pharmacological intervention for adults smokers with COPD in making them quit smoking and enhance their condition regarding the disease. The service improvement to be made for health improvement of adult smokers with COPD is that they are to be recommended to well-trained dieticians to ensure effective dietary supplement like fruits, vegetables and others are provided to them. This is because the review effective diet can enhance the energy of adult smokers with COPD to cope with the condition as well as avoided relapse of the disease (Park e al. 2016). In respect to smoking cessation, service improvements are to be made to ensure experienced healthcare professionals are included to provide smoking cessation program to adults smokers with COPD. This is to ensure positive response and right delivery of cessation intervention to adult smokers to effectively quit smoking and improve their condition regarding COPD. Further, continued monitoring of the health of adults smokers with COPD is to be attained to offer them adequate support in immediate manner to cope with smoking addiction and enhancement of health.

Conclusion

The above discussion informs that COPD among adult smokers is mostly prevalent and it has resulted in negatively affecting their health and efficiency to live. In this respect, information for health promotion of adult smokers with COPD is determined by using data collected through electronic data. The data revealed that effective smoking cessation, use of vitamin C and fruits along with vegetables as dietary supplement and varenicline as the pharmacological intervention is able to lower COPD prevalence among adult smokers. On the basis of the review, service improvement to be made such as monitoring of the health of adults smokers with COPD, recruitment of dieticians, using trained professionals to deliver successful smoking cessation program and others.

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