copd therapeutics case

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Etiology

1. Exposure totobaccosmokewhetheractive orpassive.(Environmental)

2. AirwayHyperresponsiveness

3. Impaire lun!

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Exposure to TobaccoSmoke

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Pathology of C P!

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"uscles of #reathing

ne of thesigns of lungfunctionde$ciency is theuse ofaccessorymuscles inbreathing. Thisis manifestedby the buldgingappearance of

the cla%iclehead& andsternal head.

This occurs dueto air trapping

in the lungsthus the body

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ClinicalPresentation

1. "ymptoms# $ou!h%

sputum% yspnea.2. History o& exposure tosmoke or other ha'ar ous&umes.

3. Abnormal ecline inactivity ue to

exacerbation uponexertion.. "pirometry# E* 1# *$ ratio

+ ,- %/ostbroncho ilator E* 1 +0-

. re uent respiratoryin&ections.

. 4ow 56I ($hronic $7/8),. 5arrel $hest# 8ue to

hyperin9ation o& lun!s.0. /urse lip breathin!# to

help expiration.

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C P! ' (sthma& there is adiference

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Pulmonary )unction Test*Spirometry

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Therapeutic Strategy

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Stepwise Treatment of C P!

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#ronchodilators

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#ronchodilators

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Corticosteroids

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Corticosteroids

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Patient PresentationThomas -ones

• Chief complaint*=Why can’t I just take prednisone every

day? It always works when I get admittedto the hospital .>

• istory of Present+llness*

A!e# % unstable $7/8• Past "edical istory*$7/8 ? 12 years% H

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Patient Presentation• )amily istory*6other# 8ie &rom emphysema at a!e 02.

ather# History o& $oronary Artery8isease.• Social istory*History o& smokin!# 3 /ackCDear. uit 3months a!o% occasional relapse. $laims to

have not smoke &or a week.Alcohol consumption# 2 beers aily.4ives with au!hter.

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Patient Presentation

Current"edication/. "etaprolol

tartrate - m!

5I80. Salmeterol -mc! 5I8

1. Tiotropium 10mc! aily

2. 3isinopril 2- m!

aily4. Esomeprazole 2-m! aily

5. (lbuterol 1F2puGs /B@

6. (sprin 01 m!

aily

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Patient Presentation•

7e%iew of systems*"75% @onFpro uctive cou!h% ati!ue%Exercise intolerance.• Physical examination*6il respiratory istress &rom walkin!

own the hallway.*ital si!ns# 5/ 130C00% / 0 % BB 2 % <3,. $ Jt : k!% Ht K11

4un!s#

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3ab results

+nterpretation of 3ab 7esults*$reatinine clearance L 88.65 m39min : Stage ++ C;!Hemo!lobin is low. (@ormal# 13. F1,. )Hematocrit is low. (@ormal# 30.0F - )Albumin is low. (@ormal# 3. F )

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Pulmonary function tests

$onclusion# /atients pulmonary &unction was

enhance a&ter the a ition o& tiotropium

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!rug

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=oals of Therapy

/. Pre%ention ofhospitalization& orreduction of hospital stay.

0. Pre%ention of acute

respiratory failure& ordeath.1. 7esolution of symptoms.2. 7eturn to a baseline

clinical status and >ualityof life.

4. Pre%ention of de%elopmentof Cor Palmonale

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? o n <P h a r m a c o lo g ic a l

/ . S m o k in g c e s s a t io n

0 . @ e ig h t r e d u c tio n A y p e r t e n s io n '

= E7 ! B1 . +m m u n iz a t io n AP r e %e n t i

o n o f

e x a c e r b a t io n b y in f e c t io nB

2 . ( lc o h o l c e s s a t io n A= E7 !B

4 . P u lm o n a r y r e h a b ili t a t io n AEx e r c is e B5 . 3o w f a t d ie t AC( ! B

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Cindy s Plan

P h a r m a c o lo g ic a l

/ . " e t a p r o lo l t a r t r a t e - m ! 5 I8

0 . S a lm e t e r o l - m c! 5 I8

1 . T io t r o p iu m 1 0 m c! a ily

2 . 3o s a r t a n - m !

4 . Es o m e p r a z o le 2 - m! a ily

5 .( lb u t e r o l 1 F2 p u Gs / B

@

6 . ( s p r in 0 1 m ! a ily 8 . 7 o f u m ila s t - - m c

! a ily

D. # u p r o p io n 1 - m ! a ily &or 3 a ys

t h e n t wice

a ily

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ais s

Plan ? o n < P h a r m a c o l o g i c a l

/ . S m o k i n g C e

s s a t i o n#

5 u p ro p io n

0. t h e r

E n % i r o n m e n t a

l

T r i g g e r s * E x po s u re

s t o

occ u p a t io na l u s t s a n

& u m e s .

1 . P u l m o n a r y

7 e h a b i l i t a t i o n

* i n c l u e

e xe rc i s e t ra i n i n !

% b rea t h i n !

e xe rc i s e s % o p t i m a l m

e ica l

t re a t m e n t% p s yc ho s oc ia l

s u p po r t % a n hea

l t h

e u ca t io n . 6 i n i m

u m 2

m o n t h s .

2 . 3 i f e s t y l

e c h a n g e s *

e c rea s e 5 6 I t o 1 0 .

F 2 ( . : %

a lco h o l ic i n t a ke t o a i l y t o

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ais s

Plan P h a r m a c o l o g i c a l / . " e t

a p r o l o l t a r t r a t

e

- m ! po 5 I 8

0 . T e l m i s a r t a n

( - m !

a i l y 1 . T i o t

r o p i u m 1 0 m c!

ca p s u le

2 . S a l m e t e r o l9

) l u t i c a s o n e co m

b i ne

i n ha le r

- C 2 - mc! 2

p u G s t w ice a i l y

4 . 3 a n s o p r a z o l

e

5 . # u p r o p i o n

1 - m !

a i l y &o r 3 a y s t h

e n

t w ice a i l y

6 . ( l b u t e r o l p r n

r i n 0 1 m !

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Patient Education

The patient shouldbe educated in theproper use of "!+ sto ensure themaximal e,ciency of

his regimen.

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"onitoring

• /ulmonary &unction test shoul berepeate a&ter 1 month to assessimprovement.

• 5loo !ases shoul be monitore &orthe evelopment o& hypoxia.

• Hypertension# measure bloopressure an pulse a&ter 1 month.

• $oronary artery isease# measurecholesterol an tri!lyceri es a&ter 1month.

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)ollow up

• 8yspnea score an uality o& li&eshoul be measure perio ically.

• uality o& li&e uestionnaire#1. $hronic Bespiratory uestionnaire

($B )2. "t. eor!eMsBespiratory

uestionnaire (" B )

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"tay healthy% stayalive.