ANATOMY AND PHYSIOLOGY

Introduction:
The respiratory system is essential for survival. It is composed of the
upper and lower respiratory tract. The upper respiratory tract includes the
nose, nasal cavity, pharynx, larynx, trachea, and the upper bronchial tree.
The lower respiratory tract consists of the smallest bronchi and the alveoli,
which make up the lungs. Together, the two tracts are responsible for
ventilation. Ventilation is the movement of air in and out of the airways. The
upper tract warms and filters inspired air so that the lower respiratory tract
can accomplish gas exchange. Gas exchange involves delivering oxygen to
the tissues through the bloodstream and expelling waste gases, such as
carbon dioxide, during expiration.

The Lower Respiratory Tract

The lower respiratory tract is composed of the lungs, which contains
the smallest bronchioles and alveolar structures needed for gas exchange.
The lungs are paired elastic structures occupying the entire thoracic cavity
except for the most central part, the mediastinum. Within the lungs tissue
receives its blood supply from the bronchial artery, which branches directly
from the right ventricle via the pulmonary artery. The delivery of this blood
to the alveoli is referred to as perfusion.
Gas exchange occurs in the alveoli. The alveoli sac holds the gas,
allowing needed oxygen to diffuse across the respiratory membrane into the
capillary while the carbon dioxide, which is more abundant in the capillary
blood, diffuses across the membrane and makes the alveolar sac to be
expired.
The respiratory membrane is made up of the capillary endothelium,
the capillary basement membrane, the interstitial space, the alveolar
basement membrane, the alveolar epithelium, and the surfactant layer. The
sac able to stay open because of the surface tension of the cells is decreased
by the lipoprotein surfactant. Absence of surfactant leads to alveolar
collapse. Surfactant is produced by the type II cells in the alveoli. These cells
have other metabolic functions, including the conversion of angiotensin I to
angeotensin II, the degradation of serotonin, and possibly the metabolism of
the various hormones.
The oxygenated blood is returned to the left atrium via the pulmonary
veins; from there it is pumped throughout the body to deliver oxygen to the
cells and pick up waste products.
A ciliated mucous membrane lines the bronchioles. The cilia carry
mucous and trapped contaminants up to the pharynx. Further protection
from pathogens is provided by the alveolar macrophages, which enter the
alveoli from blood capillaries and devour microorganism. Secretory
antibodies (IgA) which are present in the tears, saliva, and respiratory
mucous, also provide protection from many pathogens.

Illustration
Conclusion
COPD has no cure yet, and doctors don't know how to reverse the
damage to the airways and lungs. However, treatments and lifestyle changes
can help patient feel better, stay more active, and slow the progress of the
disease. As we all know, nonadherence to treatment is a significant problem
in COPD, especially in the later stages of disease, when patients have a
multitude of drugs to deal with and treatment regimens can become
confusing.
The risk of death from exacerbation of COPD is closely related to the
development of respiratory acidosis, the presence of significant
cormobidities, and the need for noninvasive and invasive positive-presence
ventilatory agent.

Recommendation
Respiratory exacerbations are characteristic of chronic obstructive
pulmonary disease (COPD) and are associated with poorer health outcomes.
The influenza virus is a common viral pathogen in COPD exacerbations.
Prevention of influenza related to exacerbations is therefore important.
International guidelines regarding seasonal influenza vaccination in COPD is
very important.
Patient with COPD need care from nurses who not only have wise
assessment and clinical management skills but who also understand how
these disorders can affect quality of life. Patient and family teaching is also
an important nursing intervention to enhance self-management.
Optimization of bronchodilator medications is the first-line therapy and
involves identifying the best medication or combinations of medications
taken on a regular schedule for a specific patient.