Chronic obstructive pulmonary disease (COPD) is a group of progressive lung diseases that cause the obstruction of airflow in the lungs. Breathing difficulties, wheezing sounds, and coughs are among the symptoms of COPD. Emphysema, chronic bronchitis, and non-reversible asthma are progressive lung diseases under the COPD umbrella. It is rare to notice the symptoms of COPD during its early stages. Therefore, the frequent coughs and breathing difficulties may be confused with consequences of aging. People with COPD are at a high risk of developing other diseases such as lung cancer, heart disease, and hypertension. The survey by the COPD Foundation found that 81% of patients have at least six additional chronic diseases. Pulmonary hypertension (PH) is among the most common comorbidities of COPD. This paper discusses physiological and psychological factors associated with COPD with hypertension.
PH is a lung disease marked by high blood pressure in the pulmonary arteries, which are narrowed and blocked. The pulmonary artery uses hypoxic constriction as a protective mechanism it improving the ventilation of alveoli and reducing ventilation-perfusion mismatch. In severe COPD, alveolar hypoxia becomes diffuse, causing pulmonary vasoconstriction. Prolonged hypoxia results in pulmonary vascular remodeling (Shujaat, Bajwa " Cury, 2012). Structural changes of the pulmonary artery include the proliferation of longitudinal smooth muscles in the pulmonary arteries. The changes are also associated with the irregular mass of endothelial cells and angiomatoid lesions in advanced stages of pulmonary hypertension.
Endothelial dysfunction is another physiological factor of COPD with hypertension. It is associated with the interference of the synthesis of various compounds produced by endothelial cells (Shujaat, Bajwa " Cury, 2012). Nitric oxide and prostacyclin are vasodilators which protect the artery from vascular remodeling. COPD with hypertension reduces the production of these mediators, thereby, initiating vascular remodeling. The two health problems induce inflammatory responses. They are associated with systemic inflammation shown by increased levels of interleukin-6 and C-reactive proteins (Shujaat, Bajwa " Cury, 2012).
PH affects the right side of the heart. The heart is weakened and enlarged when the pulmonary arteries are obstructed. Pulmonary hypertension is characterized by changes that may cause the death of the patient when their severity increases. Patients usually experience increased pressure in the chest, and swelling in the ankles and abdomen. The pigmentation of the lips and skin changes to a bluish color. The structural change and blocking of the pulmonary artery may result in irregular heartbeats. The severity of PH is exacerbated when the patient also has COPD. The survival chances of patients having the two diseases decrease significantly.
In COPD with hypertension, the pulmonary artery pressure increases due to the structural changes of the artery. The destruction of capillaries in severe emphysema, inflammation, and hypoxia are the conditions responsible for causing pulmonary vascular remodeling associated with the increased pressure in the artery transport blood to the lungs. When COPD is exacerbated by one level, blood pressure in the pulmonary artery rises by 20 mmHg (Brashier " Kodgule, 2012). A patient develops a full fledge pulmonary hypertension when the trend of COPD exacerbation continues. Emphysema causes increased intrathoracic pressures, which in turn causes pressure changes in the right ventricle. They eventually can an increase in the pulmonary artery wedge pressure.
While patients and caregivers address the physiological factors in COPD with hypertension, there is the need to consider the psychological effects of the health problems. Patients with COPD with hypertension experience psychological distress which can be acute or transient (Laurin et al., 2012). Psychological distress can be chronic. Anxiety and depression are common in patients with pulmonary hypertension secondary to COPD. Patients develop anxiety because of the uncertainties of the health condition. They know that their condition cannot be cured but can be managed to prolong their lives. Therefore, they are living knowing that their lives can end anytime. Depression is common among the patients with pulmonary hypertension secondary to COPD. The lack of no cure for their health problems gives them no hope for a better future. As a result, patients usually have low self-confidence, reduced adherence to medication and rehabilitation procedures and poor self-care behaviors. Depressed patients usually isolate themselves, thereby, reducing their motivation to seek help.
Cognitive behavioral therapy is the best practice care that should be incorporated in the management of hypertension secondary to COPD. Psychological factors accelerate the progression of the two conditions. CBT is an appropriate approach to the management of psychological symptoms associated hypertension secondary to COPD (Pollok et al., 2016). It involves establishing relationships between the patient and caregiver. The relationship facilitates the collection of information from the client and developing person-specific strategies for managing identified psychological problems. CBT revives the sense of self-worth of the patient. It addresses dysfunctional emotions, perception, self-destructive behaviors, and transforms self-care behaviors (Pollok et al., 2016). As a result, patients will be positive towards medication and rehabilitation programs.
Conclusion
Both pulmonary hypertension and COPD are life-threatening health problems with no cure. Therefore, patients only have to manage factors affecting their health to prolong their lives and improve the quality of their lives. The combination of the two conditions increases their severity. The well-being of patients can be enhanced when the physiological and psychological factors are managed. Cognitive behavioral therapy is an appropriate approach to managing psychological symptoms and improves the effectiveness of medication and rehabilitation interventions.
References
Laurin, C., Moullec, G., Bacon, S. L., " Lavoie, K. L. (2012). Impact of anxiety and depression on chronic obstructive pulmonary disease exacerbation risk. American journal of respiratory and critical care medicine, 185(9), 918-923.
Shujaat, A., Bajwa, A. A., " Cury, J. D. (2012). Pulmonary hypertension secondary to COPD. Pulmonary medicine, 2012.
Brashier, B. B., " Kodgule, R. (2012). Risk factors and pathophysiology of chronic obstructive pulmonary disease (COPD). J Assoc Physicians India, 60(Suppl), 17-21.
Pollok, J., van Agteren, J. E., Carson, K. V., Esterman, A. J., Smith, B. J., " Licinio, J. (2016). Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease. The Cochrane Library.
