copd therapeutics case
TRANSCRIPT
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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.