COPD Patient Question

[cubsfan16]

Hi all! I was sitting here after a NOC shift thinking about a patient I had last night.

It was a patient with chronic COPD who basically had a three-hour long coughing fit during my shift. I ended up giving Respiratory's PRN albuterol neb and a dose of an antitussive, but I was wondering if there were any other interventions you knew/thought could be helpful for a patient in this situation.

I tried repositioning, encouraging to use a vibration PEEP device (I don't know the official name for that), and brought some cold water. She also had cough drops at the bedside. It was such a miserable night for this patient....

Thanks, in advance, for sharing your knowledge with a newbie.

[Okami_CCRN, BSN, RN]

Unfortunately it happens, especially in cases of exacerbation. The good thing is he/she was able to expectorate whatever was causing irritation. Sometimes, chest physiotherapy and vibration help break up some of the mucous and the patient can clear it out.

Many times in nursing we look at coughing as a bad thing, but in reality it's pretty good, it allows harmful things to be expelled and helps expand the lungs.

[canoehead, BSN, RN]

I'd be tempted to try saline in a nebulizer mask, or O2 with mist.

[vanilla bean]

I tried repositioning, encouraging to use a vibration PEEP device (I don't know the official name for that), and brought some cold water.

It can be difficult to determine the cause of extended bouts of coughing, and strategies would vary based on that. Difficulty mobilizing secretions or excessive secretions? CPT, flutter valve, hydration, encouraging deep breathing and coughing exercises could be the way to go. Coughing due to bronchospasm or airway irritation? Nebulizer treatments, purse-lip breathing or PEP therapy, antitussives and cough drops may be the way to go.

Bear in mind that a "vibration" device (such as a flutter valve) is helpful in mobilizing secretions and often elicits coughing (which may or may not alleviate the problem). Also, cold water can often be irritating and stimulate a cough reflex; tepid water may be better depending on the situation.

[HouTx, BSN, MSN, EdD]

I have been an asthmatic for quite a while... lucky enough to have it managed by a wonderful pulmonologist. A few years ago, while recovering from bronchitis, I began to have episodes of extensive coughing - extreme SOB with all the trimmings. I was exhausted and absolutely miserable. It was so exhausting and horribly painful from the resulting pleurisy. The cough was not productive. Cough reflex was triggered by bronchiole irritation... which caused more coughing... more irritation - yada yada yada.

At that point, my wonderful doc prescribed a bit of lidocaine in my usual nebulizer treatments. It worked like a charm. We had to do some trial and error to discover just the right amounts... enough to numb up bronchioles without too much effect on oral tissues. My nebulizer supplies now include a stock of lido along with the normal albuterol - just in case.

It works for me. You may want to suggest it if you're ever involved in a similar situation in the future.