Steps taken to curb the spread of COPD

The current assignment discusses regarding the long term condition of CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) and its effect in the Leicester and Leicestershire region of UK.  COPD is a chronic disorder which needs long term management goals. It can threaten the normal life process of an individual and a community by directly affecting their ability to breathe. COPD is a misnomer and covers wide spectrum of lung disorders including chronic bronchitis and emphysema.

In order to curb the menace of COPD and regulate the spread of the disease within the population, a number of major steps had been taken and implemented by the community based health services. Some of these are in the form of joint strategic needs assessment program. The goal is to find out the plausible reasons for the wide spread occurrence of the disease within the population. Some of these are delivered in the form of community health education programmes. From the UK policy perspective specialist community nurses have been placed at the forefront of giving care services for the treatment and management of the condition of the patients suffering from COPD. The government of UK drives some of these healthcare programs with the sole motive of making the patients more efficient in self managing their own conditions over the long term. As supported by Murphy (2018), the directive implemented by the UK government states that optimum level of care and support services for the management of COPD should be administered by primary healthcare agencies in collaboration with multi speciality healthcare agencies. As commented by Young et al. (2015), the multi agencies working helps in getting approved standards of care for the appropriate management of the conditions of COPD. Additionally, an integrated health care structure helps in getting easy and quick referrals for intensive care patients. The standards for the COPD management have been divided into eight different quality statements.

In order to understand the pathophysiology of COPD it is necessary to understand the structure of the lungs. On inhaling air moves down the trachea through the two tubes called bronchi. The bronchi further branch into bronchioles and alveoli. The alveoli are supplied with capillaries and rich tiny blood vessels. It is at the site of the alveoli that the gaseous exchange takes place depending upon the partial pressure of oxygen and carbon dioxide. Oxygen moves from the lungs to the blood stream through the capillaries and carbon dioxide moves out and vice versa depending upon the partial pressure of the gases which facilitates diffusion.

Pathophysiology of COPD

In this respect, two different conditions of the lungs have been discussed over here which is emphysema and bronchitis.  In Emphysema the fibres that make up the walls of the alveoli are damaged making them less elastic (thorax.bmj.com 2018). It further hinders the normal inhalation and exhalation process causing the patient to develop dependency upon external source of oxygen. As commented by Dritsaki  et al. (2016), COPD is identified by poorly reversible airflow obstruction.

On the other hand, the bronchioles become inflamed in bronchitis producing excessive amount of mucus. As commented by Lakhanpaul  et al. (2017), exposure to chemicals and second hand smoke in poorly ventilated buildings can further aggravate the lungs disorder or diseases. The bronchitis is often initiated as an immune response upon exposure to noxious gases and particles.  As commented by Young et al. (2015), hypersensitivity to some of these chemicals is expressed in the form of mucous hyper secretion, tissue destruction and disruption of normal defence mechanisms. Apart from inflammation there are two other processes which are involved in the pathogenesis of COPD, which are imbalance between proteases and antiproteases and imbalance between oxidants and anti-oxidants. On complete blood profiling of the COPD patients increased number of neutrophils, macrophages and T-lymphocytes are seen. Oxidative stress can lead to inactivation of antiproteases and stimulates mucous production. It can also activate gene expression of pro-inflammatory mediators by enhancing the activation of transcription factor such as nuclear factor κB (Young et al. 2015). 

The demography of the population plays a pivotal role in the pathophysiology and the progression of a disease.  In this regard, the effect of COPD within the population of two different geographical regions has been taken into consideration which is the Leicester and Leicestershire community. As commented by Steiner  et al. (2015), the demographical characteristics of a population such as the age, gender and economical conditions of a population further govern their susceptibility of being affected by a disease. Some of the ethnic minority groups are more prone to being susceptible to certain patterns of infections and diseases. Some of the societal factors which contribute to the development of the condition of COPD are -unhealthy diet, physical inactivity, advancing age, low socio-economic status, genetic pre-disposition etc. The Leicester community show relatively low rate of detection of COPD. The figures and data are alarming which exhibits high rates of the presence of COPD within the Leicester population. In March 2015, there were 5473 patients recorded with COPD (2018). However, further studies revealed that the rates could be actually as high as 4.5% in males, 35 in females, over 10% in minority groups (Blackmore et al. 2017). Deaths from COPD accounts to almost 13% within the Leicester community which is higher than the national average of 11% (nhs.uk  2018). Further investigation has suggested that the rate of prevalence of COPD was higher in the males than in the females. This could be attributed to a number of factors such as age, physiological condition of the patient.  As commented by Steiner  et al. (2015), the men have higher disposition of being affected by smoking and drinking habits which deteriorates and makes their condition of COPD even worse. Figures and evidences have shown that 14% of emergency hospital administrations are due to respiratory diseases which are equivalent to 4,700 hospital admissions (leicestercityccg.nhs.uk 2018). As supported by Mitchell  et al. (2016), unscheduled care contributed to over 48% of the healthcare costs. Some of the community wide factors have been identified over here which are high rates of smoking tobacco. The Leicester community has developed Stop Smoking services for its population helping 2000 people quit smoking by year 2014-2015 (nhs.uk  2018). The focus should be shifted upon the ascertainment and management of COPD within the population. As supported by Garner  et al. (2017), the conformation is made by spirometry delivered either by accredited practices or delivered through acute healthcare centres. The disease progression is usually managed within the community by the primary and secondary providers. As mentioned by Krishna  et al. (2016), 8% of the males settled within the community have depicted symptoms of acute bronchitis. The comprehensive nursing care model focuses upon comprehensive assessment of the present health condition of a patient.  This mode of care focuses upon patient education and providing optimum support to the family of the patient. In this respect, a number of efforts were undertaken in Leicester to identify potentially susceptible people. These were mainly the ones who had inclination towards smoking and drinking habits. As commented by Bhamra  et al. (2017), health education and dissemination of sufficient knowledge regarding the handling and management of COPD have been found to be effective.

Effect of COPD in Leicester and Leicestershire community

The rates of COPD occurrence have been discussed with regards to the England based Leicestershire community. As commented by Woodruff  et al. (2015), COPD have been mainly seen to affect people over the age of 40. It is the sixth most common cause of death in England leading to nearly 30,000 deaths a year (Mitchell et al. 2016). As supported by Houchen-Wolloff  et al. (2018), smoking has been seen to damage the tissue of the lungs leading to the tissues and losing their elasticity. This further affects the rate of normal gaseous exchange of the lungs. Reports and evidences have shown that North West Leicestershire have highest prevalence of COPD compared to Rutland or Leicester region (leicestercityccg.nhs.uk). Further study had suggested that the areas with the greatest proportion of unmet need for COPD are Oadby and Wingston with a oercentage as high as 58% (nhs.uk  2018). The area has also recorded lowest rates of hospital administration due to COPD which could be due to the lack of sufficient knowledge present within the population regarding the health effects of COPD.

The community based care structures need to take into consideration a number of ethical standards during the delivery of the health support services to the patient population. Some of these are maintaining the diversity and equality of the individual community. As commented by Lange  et al. (2015), maintaining a good communication between the patients and the physicians or nurses looking after the health of the patients within  a primary or secondary health care setting have been found to be instrumental in this effect. The community based care structures need to ensure that the treatment methods are culturally appropriate and are delivered with due respect to the cultural and emotional sentiments of the population. It should be provided in an equal and just manner to people with emotional and sensory disabilities and also to the ones who can speak little or no English. Therefore, the role of the local of community based nurses is pivotal over here.

COPD is long term condition which needs proper care and management. This could be further explained with the help of a number of policies and programs such as the Care Act, 2014, as per which   the right to choice in availing particular mode of treatment by the patient needs to be respected (Pascoe et al. 2015). The availability of the support and care services are further dependent upon the number of trained healthcare professionals  present  at the community level. Some of the community based services which had been implemented by the UK government over here are N.E. Lincolnshire carer’s support service and provides support services across North East Lincolnshire which has the highest abundance of COPD (statistics.blf.org.uk 2018). It aims at providing specialist advice and information, holistic therapies, counselling support to the population. It has been seen that fear and anxiety can further aggravate the symptoms of COPD. One such community based program which had been implemented over here is the provision of care emergency alert card. The aim was to support the carers in emergency situation, where the carer can activate the alert in emergency situations. Once the carer is absent or unable to take care of the patient, they can nominate someone else their place to take care of the patient for the while (Garner et al. 2017). 

Community-Based Care Structures for COPD

As commented by Johnson-Warrington  et al. (2016), the social inequalities can arise due to the gap in provision of the healthcare services. The   inequalities within the social structure mainly arise due to the difference in the earning patterns of the individual and community. Additionally, the move of privatisation supported by NHS England has further aggravated the health inequalities present within the population. A few have been in the favour of the move for privatisation whereas the majority has boycotted the move. Under the new directive, 80 % of the healthcare costs in emergency and trauma care will be provided by NHs whereas the rest will have to be borne by the patient themselves (Sewell et al. 2017).  This was done in order to improve the healthcare infrastructure of the government based hospitals and healthcare agencies. The social exclusion and disparities in health could be reduced by equal treatment of people from all socio economic backgrounds (evidence.nhs.uk 2018).

The current assignment focuses on the prevalence of COPD in certain geographical regions in England and the management of the long term conditions of the individual patients and communities as a whole. On retrospection and conducting a detailed research it has been found that the Leicestershire community had recorded the lowest hospital administration rate for COPD compared to the other parts of England (statistics.blf.org.uk 2018). It could be due to the lack of awareness within the population regarding COPD along with unequal distribution of healthcare services. Some of the major reasons which were highlighted for the abundance of disease within the population are low economy, poor standards of health, addiction to drugs and alcohol. Detailed inspection shows that majority of the lung diseases are due to emphysema (Clark et al. 2015). Hence, substance addiction might be a problem within the population. In this respect, the health needs of the population needs to be accessed for designing of effective COPD management strategies. The demographics study of the Leicester region states that population above the age group of 65 is set to increase in the next couple of years (Elliott et al. 2017). Hence, the chances and the occurrences of COPD are also expected to increase. In this case almost half of the population are from minority and ethnic backgrounds. Some of them have been included from Somali, Middle Eastern, African and eastern European backgrounds. Most of them profess different beliefs and approaches, which affects their health accessibility issues. As commented by Bourne  et al. (2017), owing to a number of orthodox beliefs and mentalities some of them are hesitant to approach the health care channels.  Reports and evidence have shown that respiratory diseases accounts to almost 13% of the disease burden of the population (Apps et al. 2015). Leicester has been marked as the 21^st most deprived local area (nhs.uk  2018). 44 % of the locals residing in the area have been tagged to be living as below the poverty line (statistics.blf.org.uk 2018). 

Conclusion

In the Leicester community the rate of improvement of life expectancy is low compared to nationally. The figures are equally depresive when focussing upon the Leicestershire community as 2% of the population live in areas classified as below the poverty line (bmcpulmmed.biomedcentral.com 2018). In order to analyse the health needs of the community of Leicestershire a joint strategic assessment had been implemented, which aimed at improving the quality of life for the people living in the area. Some of the objectives for such program were to give the children and the adults the best quality of life by supporting them at each and every step of their sick or allied health condition (Wright et al. 2015). As commented by Blackmore  et al. (2017),  studies and detailed analysis has shown that  majority of the women and the children living in  the poor  and the downtrodden areas were affected by lung disorder owing to high rates of passive smoking. Community wide health education programs need to be implemented for providing the community with better self management programs (nice.org.uk 2018). 

In this respect, Maslow’s theory of needs hierarchy could be used for understanding the health requirements of the community as a whole. The Maslow’s hierarchy of needs could be divided into several domains which are –self actualization,  need for self esteem, belongingness and need for love,  safety needs and physiological needs etc.  As majority of the people residing in the Leicester and the Leicestershire community belong to ethnic and minority community. Therefore, the health and well being of the community needs to be taken into consideration. As commented by Woodruff  et al. (2015), due to   poor living standards and low education most of the people living in the Leicester, Leicestershire region fail to grab a sound paying job and are not able to satisfy their potential limit.  As argued by Pascoe  et al. (2015), the  lack of support and social exclusion  also results in a  larger section of the youth get involved in unsocial activities which are theft, inclination to drugs and substance abuse.  There is a lack of accomplishment within the community at a large. Therefore, some  of the policies which had been implemented by the federal and state level government in this regard is the social inclusion strategy, 2017-2017, which takes  community development as the prime objective by giving sufficient amount of  importance  on the  preservation of the culture, safety protection , housing development, health care, education and training (nhs.uk  2018). The implementation of the program would help in satisfying the psychological needs as depicted by Maslow’s social hierarchy of needs. For example, recognising the unique culture of a community though their rituals and beliefs and making them a part of the society at large can generate love and belongingness for a region. In order to make living safe for the community some of the programs such as Safer Melton had been introduced as NFS target programs which could help in reducing the rate of crime within the community (Hartley et al. 2016). In this respect, the community wide education also serves as an important component of the healthcare program as it will help the population adjust better to some of the basic requirements such as air, water, fresh food, etc.   A basic level of health understanding can help in controlling the rate of the occurrence of COPD within the population.

Figure : Maslow’s hierarchy of needs

(Source : Duran et al. 2017)

Conclusion 

The current assignment focuses on the concept of community healthcare needs and the assessment of the same within a specific population. For the current assignment, the prevalence of COPD within the Leicester and the Leicestershire community had been taken into consideration. The rates of COPD are particularly large in the community owing to lack of awareness and insufficient management. On further analysis, it was found out that majority of the people living within the community were affected by low economy and poor standards of health. The low economy ensured that could not get sufficient care in times of need. Moreover, due to lack of health education greater disposition towards alcohol and drugs were found within the population. Therefore, there was a need to provide the population with an effective health education program along with additional level of support from multi agency channels.

However, in my opinion a number of challenges could be offered in this regard. Some of which are different social and cultural beliefs within the population which can affect the health view and lifestyle approaches. As a health care worker one needs to be respectful towards the health beliefs and advocacies possessed by others.  However, insufficient number of emergency and trauma care services where seen to be present in the Leicester as well as the Leicestershire region. Hence, there was a lack of the government policies and programs which resulted in inadequate health services being met out to the population. Therefore, to bridge the gap optimum amount of social inclusion was required within the community with the help of sufficient health education programs, campaigns or activities. In my opinion providing free health visits to some of these regions could along with providing them with free immunization programs could also help in balancing the vast health requirements of the population. 

References 

Apps, L.D., Harrison, S.L., Johnson-Warrington, V.L., Hudson, N., Young, H.M.L. and Singh, S.J., 2015. Important, misunderstood, and challenging: a qualitative study of nurses and allied health professionals’ perceptions of implementing self-management for patients with COPD, pp. 56-85.

Bhamra, S.K., Slater, A., Howard, C., Johnson, M. and Heinrich, M., 2017. The Use of Traditional Herbal Medicines Amongst South Asian Diasporic Communities in the UK. Phytotherapy Research, 31(11), pp.1786-1794.

Blackmore, C., Johnson-Warrington, V.L., Williams, J.E., Apps, L.D., Young, H.M., Bourne, C.L. and Singh, S.J., 2017. Development of a training program to support health care professionals to deliver the sPaCe for COPD self-management program. International journal of chronic obstructive pulmonary disease, 12, p.1669.

bmcpulmmed.biomedcentral.com 2018, bmcpulmmed.biomedcentral.com, Available at : https://bmcpulmmed.biomedcentral.com/articles/10.1186/1471-2466-12-48 [Accessed on 16 Mar. 2018]

Bourne, C.L., Kanabar, P., Mitchell, K., Schreder, S., Houchen-Wolloff, L., Bankart, M.J.G., Apps, L., Hewitt, S., Harvey-Dunstan, T. and Singh, S.J., 2017. A Self-Management Programme of Activity Coping and Education-SPACE for COPD (C)-in primary care: The protocol for a pragmatic trial. BMJ open, 7(7), p. 463.

Clark, T.W., Medina, M.J., Batham, S., Curran, M.D., Parmar, S. and Nicholson, K.G., 2015. C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD. European Respiratory Journal, 45(1), pp.76-86.

Dritsaki, M., Johnson-Warrington, V., Mitchell, K., Singh, S. and Rees, K., 2016. An economic evaluation of a self-management programme of activity, coping and education for patients with chronic obstructive pulmonary disease. Chronic respiratory disease, 13(1), pp.48-56.

Duran, G., 2017. Self-Efficacy Levels of Individuals with Chronic Obstructive Pulmonary Disease and Investýgation of Caregiver Burden. International Journal of Caring Sciences, 10(2), p.921.

Elliott, R.A., Tanajewski, L., Gkountouras, G., Avery, A.J., Barber, N., Mehta, R., Boyd, M.J., Latif, A., Chuter, A. and Waring, J., 2017. Cost Effectiveness of Support for People Starting a New Medication for a Long-Term Condition Through Community Pharmacies: An Economic Evaluation of the New Medicine Service (NMS) Compared with Normal Practice. PharmacoEconomics, 35(12), pp.1237-1255.

evidence.nhs.uk 2018, evidence.nhs.uk, Available at : https://www.evidence.nhs.uk/Search?om=[{%22ain%22:[%22Clinical%22]},{%22ety%22:[%22Policy%20and%20Strategy%22]}]&ps=50&q=NSF+copd&sp=on [Accessed on 18 Mar. 2018]

Garner, A., Hodson, M., Ketsetzis, G., Pulle, L., Yorke, J. and Bhowmik, A., 2017. an analysis of the economic and patient outcome impact of an integrated COPD service in east london. International journal of chronic obstructive pulmonary disease, 12, p.1653.

Hartley, R.A., Barker, B.L., Newby, C., Pakkal, M., Baldi, S., Kajekar, R., Kay, R., Laurencin, M., Marshall, R.P., Sousa, A.R. and Parmar, H., 2016. Relationship between lung function and quantitative computed tomographic parameters of airway remodeling, air trapping, and emphysema in patients with asthma and chronic obstructive pulmonary disease: A single-center study. Journal of Allergy and Clinical Immunology, 137(5), pp.1413-1422.

Houchen-Wolloff, L., Williams, J.E., Green, R.H., Woltmann, G., Steiner, M.C., Sewell, L., Morgan, M.D. and Singh, S.J., 2018. survival following pulmonary rehabilitation in patients with COPD: the effect of program completion and change in incremental shuttle walking test distance. International journal of chronic obstructive pulmonary disease, 13, p.37.

Johnson-Warrington, V., Rees, K., Gelder, C., Morgan, M.D. and Singh, S.J., 2016. Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial. International journal of chronic obstructive pulmonary disease, 11, p.1161.

Krishna, M.T., Huber, P.A.J., Nasser, S.M., Ewan, P.W. and Clark, A.T., 2016. Prescription of adrenaline auto?injectors–A National Survey of UK Allergy Specialists. Clinical & Experimental Allergy, 46(1), pp.172-177.

Lakhanpaul, M., Culley, L., Robertson, N., Bird, D., Hudson, N., Johal, N., McFeeters, M., Angell, E., Hamlyn-Williams, C., Abbas, N. and Manikam, L., 2017. A qualitative study to identify parents’ perceptions of and barriers to asthma management in children from South Asian and White British families. BMC pulmonary medicine, 17(1), p.126.

Lange, P., Celli, B., Agustí, A., Boje Jensen, G., Divo, M., Faner, R., Guerra, S., Marott, J.L., Martinez, F.D., Martinez-Camblor, P. and Meek, P., 2015. Lung-function trajectories leading to chronic obstructive pulmonary disease. New England Journal of Medicine, 373(2), pp.111-122.

leicestercityccg.nhs.uk 2018, leicestercityccg.nhs.uk, Available at : https://www.leicestercityccg.nhs.uk/about-us/our-priorities/chronic-obstructive-pulmonary-disease-copd/ [Accessed on 12 Mar. 2018]

Mitchell, K.E., Johnson, V., Houchen?Wolloff, L., Sewell, L., Morgan, M.D., Steiner, M.C. and Singh, S.J., 2016. Agreement between adherences to four physical activity recommendations in patients with COPD: does the incremental shuttle walk test predict adherence?. The clinical respiratory journal, pp. 105-215.

Murphy, A., 2018. Knowing the differences between COPD and asthma is vital to good practice. Stroke, 13, p.57.

nhs.uk  2018, nhs.uk , Available at : https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/ [Accessed on 10 Mar. 2018]

nice.org.uk 2018, nice.org.uk, Available at : https://www.nice.org.uk/guidance/CG101 [Accessed on 17 Mar. 2018]

Pascoe, S., Locantore, N., Dransfield, M.T., Barnes, N.C. and Pavord, I.D., 2015. Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. The lancet Respiratory medicine, 3(6), pp.435-442.

Sewell, L., Schreder, S., Steiner, M. and Singh, S.J., 2017. A strategy to implement a chronic obstructive pulmonary disease discharge care bundle on a large scale. Future Hospital Journal, 4(3), pp.198-201.

statistics.blf.org.uk 2018, statistics.blf.org.uk, Available at : https://statistics.blf.org.uk/copd [Accessed on 11 Mar. 2018]

Steiner, M.C., Evans, R.A., Greening, N.J., Free, R.C., Woltmann, G., Toms, N. and Morgan, M.D., 2015. Comprehensive respiratory assessment in advanced COPD: a ‘campus to clinic’translational framework. Thorax, pp.15.

thorax.bmj.com 2018, thorax.bmj.com, Availabele at : https://thorax.bmj.com/content/early/2011/10/18/thoraxjnl-2011-200768.short [Accessed on 15 Mar. 2018]

Woodruff, P.G., Agusti, A., Roche, N., Singh, D. and Martinez, F.J., 2015. Current concepts in targeting chronic obstructive pulmonary disease pharmacotherapy: making progress towards personalised management. The Lancet, 385(9979), pp.1789-1798.

Wright, D., Twigg, M., Barton, G., Thornley, T. and Kerr, C., 2015. An evaluation of a multi?site community pharmacy–based chronic obstructive pulmonary disease support service. International Journal of Pharmacy Practice, 23(1), pp.36-43.

Young, H.M., Apps, L.D., Harrison, S.L., Johnson-Warrington, V.L., Hudson, N. and Singh, S.J., 2015. Important, misunderstood, and challenging: a qualitative study of nurses’ and allied health professionals’ perceptions of implementing self-management for patients with COPD. International journal of chronic obstructive pulmonary disease, 10, p.1043.