Exercise 6 Responses

1. Considering the patients who were employed, the frequency of the COPD patients with severe airflow limitation included 7 patients representing 14% of the severe patients.
2. Based on the total COPD patients (N = 91), the percentage of patients who were retired was 61% while that was on sick leave was 15% (Eckerblad et al. 2014).
3. The total sample for the study by Ecerblad et al. (2014) was 91 COPD patients. Out of this sample size, 14 patients were still employed representing 15% of the COPD patients. Ideally, employed patients in the moderate group were 7 and those in the severe group were 7 totaling 14 patients (7 + 7 = 14). Therefore, the total percentage = 14 / 91 * 100 = 15.38%. Rounding to nearest whole percentage gives 15%.
4. Out of the 91 COPD patients, 97% of them have a smoking history described as the patients still smoking and former smokers in both the severe and moderate groups. Ideally, the frequency of patients who were still smoking was 13 and 12 for the moderate and severe groups, respectively making a total of 25 patients (13 + 12 = 25). The former smokers in the two groups were 28 and 35 respectively with a total of 63 patients. Therefore, the total patients with smoking history were 88 (63 + 25 = 88). Therefore, the percentage was given as 88 / 91 * 100 = 96.7% rounded to 97% as a whole percentage (Eckerblad et al. 2014). Since the study assessed the symptoms of COPD between moderate and severe groups, smoking history is a clinically important factor to consider in this study. According to Decramer et al. (2012) smoking tobacco is the most common cause of COPD and this leads to the conclusion that smoking played a role in differentiating the two groups – determining the severity of the disease.
5. According to the National Cancer Institute (2018) a pack year of smoking measures the quantity an individual has smoked over a long time. It is achieved by multiplying the number of years the person has smoked with the number of packs of cigar smoked in a day. Basically, one pack year is equivalent to smoking for 1 year a pack per day or 2 packs daily for half a year. Based on the study by (Eckerblad et al. 2014) there was no significant difference in pack smoking years between the severe and moderate COPD groups. The p-value was given as 0.177 which was greater than 0.05 ( p > 0.05) indicating that there was no statistical evidence that the two groups had different pack years of smoking.
6. The four most psychological symptoms that Eckerblad et al (2014) reported were sleep difficulties, feeling irritable, worrying, and feeling sad. Accordingly, 52% of the patients experienced difficulties in sleeping, 33% experienced worrying, and 28% experienced irritable feeling, while 22% experienced sad feeling. Further, the study reported that there were insignificant differences (no significant differences) between the two groups for these psychological symptoms.
7. Based on the 91 patients who participated in the study, there were 45 patients in total using the short-acting β₂-agonists and this represented 49% of the participants. This is calculated as follows: patients from moderate group were 13 while from the severe group were 32.

Total patients using short-acting β₂-agonists = 13 + 32 = 45

Frequency is 45 patients

Percentage = 45/91*100 = 49.45% rounded as 49% to the nearest whole percentage.

• Based on the findings of the study, there was significant difference between the patients using short-acting β₂-agonists for the moderate and severe groups. Ideally, the P-value was 0.001 (P < 0.05). In many nursing procedures, the alpha is set at 5% and this shows that a statistical difference in the usage of short-acting β₂-agonists between the two groups.
• Based on the study, the percentage of the patients both in the moderate and severe airflow limitation using short-acting β₂-agonists was 49% as calculated in part 7. However, this percentage was expected since most COPD patients prefer the Long-acting β₂-agonists (LABAs) than the short-acting β₂-agonists (SABAs). Ideally, the SABAs such as albuterol (salbutamol) have an action period of around 4 to 6 hours while the LABAs have an action period of around 12 hours and this makes them spare high dosages of SABAs in favor of the LABAs (Cazzola et al. 2005). In the study, this is evident since 82% of the patients preferred LABAs as compared to 49% using SABAs.
• Considering the overall study, the findings are reliable and from a trusted source – the Heart & Lung peer-reviewed journal. Despite the fact that the study is more descriptive, it disseminates information of the COPD risk factors and how they influence the symptoms of the disease and this can be utilized in clinical and nursing practice in comparing symptoms of different patients to group them as moderate or severe – a key aspect that would facilitate quality healthcare delivery plan for these distinct COPD patient groups. Further, the study results are meaningful, practical, and evidence-based in describing moderate or severe COPD symptoms in a nursing environment which helps practitioners give the most effective treatment.  

References

Cazzola M, Matera MG, Lötvall J (July 2005). “Ultra-long-acting beta 2-agonists in development for asthma and chronic obstructive pulmonary disease”. Expert Opin Investig Drugs. 14           (7): 775–83.

Decramer M, Janssens W, Miravitlles M (April 2012). “Chronic obstructive pulmonary disease”.   Lancet. 379 (9823): 1341–51.

Eckerblad, J., Tödt, K., Jakobsson, P., Unosson, M., Skargren, E., Kentsson, M., & Theander, K. (2014). Symptom burden in stable COPD patients with moderate to severe airflow             limitation. Heart & Lung, 43(4), p. 353. National Cancer Institute (2018). NCI Dictionary of Cancer Terms. Accessed from             https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=306510