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Chronic Obstructive Pulmonary Disease

Abby Dalling

Brigham Young University Idaho

Nursing 322

Sister Jamison

February 24, 2017


February 24, 2017

Ms. Bloomfield
220 Corporation Way
Idaho Falls, ID 83425

Dear Ms. Bloomfield,

I hope this letter can answer some of the question that you have about you diagnosis of early
mild COPD (Chronic Obstructive Pulmonary Disease). First, I want to help you understand what
COPD is. I think the easiest way to explain it is your airway is limited and it usually gets worse
over time (Lewis & Buchner, 2017, p.557).

There are many things that can cause COPD. The underlying thing that all of the causes have in
common is airway obstruction. I will list some of the causes here:
Chronic bronchitis, which includes cough and sputum for three months on two
consecutive years, can eventually lead to COPD (Lewis & Buchner, 2017, p.557).
Emphysema is also often present with COPD and is the destruction of the alveoli in the
lungs (Lewis & Buchner, 2017, p.557).
Cigarette smoke and other irritants contribute to a lot of peoples COPD. It is also
believed that there is a genetic component to the development of COPD because only
about 20 to 30 percent of people who smoke develop COPD (Mayo Clinic, 2016).
Alpha 1- Antitrypsin deficiency is an autosomal recessive disorder that can also cause
someone to be more likely to develop COPD (Lewis & Buchner, 2017, p.558).

As you can see there are many things that cause someone to be more likely to develop COPD.
There is a high incidence of COPD in the United States. It is estimated that approximately 12.7
million adults over age 18 have COPD. It is the third leading cause of death in the United States
with more than 133,000 deaths each year. It is suspected that the number of people with COPD is
underestimated because many people do not seek medical help until the disease is in the
advanced stages (Lewis & Buchner, 2017, p.557).

There are risk factors for COPD and knowing some of these may be helpful to you so you can
avoid as many as possible. I will list some of the risk factors here:
Long term exposure to tobacco smoke is the most significant risk factor. The more years
you have smoked and the more packs you have smoked both increase a person risk for
developing COPD.
Working or living in a place that exposes you to dust, fumes and/or chemicals on a
regular basis can irritate your lungs and puts you at a higher risk for developing COPD.
As your age increases the signs and symptoms of COPD begin to manifest themselves
more and more (Mayo Clinic, 2016).

Now that I have told you more about COPD in general I want to talk about you and your
diagnosis specifically. You are only 38 years old. Your COPD is still mild and I feel fortunate
that we have caught it this early. There is much that can be done to help you managing your
disease. You have stated to me many of the impacts COPD has already had in your life. You have
mentioned your persistent cough and more shortness of breath when you exercise. These are
things that can be difficult to deal with and over time may become more severe and debilitating
without intervention. You may not be able to fully regain the lung function that is lost. However,
there are things that you can do to prevent losing more of your lung functioning and decrease the
symptoms of your COPD (Lewis & Buchner, 2017, p.562).

The most important thing for us to focus on to help you is smoking cessation. You have stated to
me that you are already working on this goal and decreased to 10 cigarettes a day instead of a
pack. I am glad that you are motivated to quit because this will be the main thing that will keep
your COPD from getting worse. I realize how difficult stopping smoking can be and that it will
take some time but if we work together it is definitely something we can accomplish.

You also mentioned being exposed to smoke of the nearby wildfires and how it makes your
cough worse. I would recommend trying to avoid this as much as possible. Anything that makes
your cough worse is generally something that should be avoided. You also mentioned the
shortness of breath with exercise. I want to make it clear that regular physical exercise is very
important. That being said, you should not try to do more than your body can handle. I can help
you develop an exercise plan that will work best for you. We will determine where you are at
with your endurance and make a plan bases upon that.

Another thing that I noticed is your hypertension and the medications you are taking. There are
no contraindications but if you begin to have any new symptoms please let me know.

You mentioned that you are wondering what else can help you. I have some ideas for health
promotion activities that can be beneficial to you. I will list some here:
I suggest making sure that you get vaccinated yearly for influenza. You are more
susceptible to get pneumonia because you have COPD so it is important to avoid sickness
(Board, 2013).
Having a healthy diet is essential with COPD. This will help keep you healthy and be less
likely to develop another sickness that can worsen your COPD (Lewis & Buchner, 2017,
As I mentioned earlier, regular physical exercise will help you to be able to perform more
of your daily activities.
Disease prevention is something that you can think about as well. We do not want your COPD to
advance further. We want to slow it down as much as we can and the most important thing that
you can do to make that happen is stop smoking. We have smoking cessation classes available if
you are interested in that. It has been proven that once people with COPD are able to stop
smoking their disease progression turns to that of a non-smoker. The sooner you are able to stop
the better (Lewis & Buchner, 2017, p.562).

From what I understand, the times that you have the most trouble with your COPD is when you
are around irritants or engaged in physical activity. These episodes can be handled in different

ways and we can explore the options and find what works best for you. If you feel that you
would like medication I can prescribe you an albuterol inhaler for the times of shortness of
breath. If you want to wait and not take medication yet there are other options. For example, we
will teach you breathing techniques such as pursed lip breathing and diaphragmatic breathing.

There are many treatment options available to you. Oxygen therapy is something that can be very
beneficial. There are many methods of administering oxygen therapy and many are things that
you can do yourself. Oxygen therapy allows you to get the oxygen you need when you are
having difficulty breathing. Another option for treatment is breathing retraining. I mentioned a
few of the methods above but this would include learning pursed lip breathing and diaphragmatic
breathing. Airway clearance techniques can also be very effective is there is a lot of sputum
being produced (Madell, 2016).

I hope that this letter has brought you some peace of mind and has helped you to understand
COPD more clearly. My purpose as your health care provider is to help you have the best quality
of life possible. I want you to know that anytime you have a problem or question you can contact
me. I am excited about the progress you have already made with smoking cessation. Thank your
for you cooperation and willingness.


Abby Dalling, M.D.

2494 N. 2375 E.
Hamer, ID 83425


Board, H. P. (2013). Chronic obstructive pulmonary disease (COPD). Retrieved 2/24, 2017, from


Lewis, S., & Buchner, L. (2017). In Kwong J. (Ed.), Medical-surgical nursing, assessment and

management of clinical problems (10th ed.). United States of America: Elsevier.

Madell, R. (2016). COPD: Treatment options. Retrieved 2/24, 2017, from


Mayo Clinic. (2016). Copd. Retrieved 2/24, 2017, from http://www.mayoclinic.org/diseases-