COPD
Patient presentation:
T.A., a 50 year old male, was brought to the clinic by his wife due to progressive SOB over the past 4 weeks associated with a productive cough. T.A. stated that he had been very healthy all of his life, except for periodic colds which typically lasted for a similar number of weeks, but never went to the doctor for check-ups. During this episode, however, the persistent cough, fatigue and SOB became a problem for him as it interfered with his job as a gardener. He has continually smoked approximately one pack a day since his late teenage years.
Differential diagnosis:
Pneumonia, bronchial asthma, bronchiectasis, pleural effusion, COPD and CHF.
Diagnosis:
Vital signs: temperature 99.0F, respirations 24, heart rate 90, blood pressure 150/70, saturation 88% on room air.
On physical examination T.A. had rapid shallow breathing; prolonged expiration; a “barrel shaped chest”; occasional wheezing with some rhonchi; diminished breath sounds bilaterally at the bases; peripheral cyanosis; and digital clubbing.
Laboratory testing was obtained which revealed results WNL except for a mild elevation in hemoglobin and a HCO3 of 30. ABG’s were also obtained and showed a pH of 7.34, PaO2 of 60 mmHg and PaCO2 of 50 mmHg. A chest radiograph was taken at the clinic which portrayed increased interstitial markings. Based on the clinical picture and diagnostic findings the patient was diagnosed with COPD, and admitted to the hospital for further evaluation and initiation of treatment.
Treatment & Outcome:
Once admitted to the hospital, the patient was placed on oxygen therapy titrated to maintain oxygen saturation between 90-94% via nasal cannula. Respiratory treatments: ipratropium bromide 500 mcg by nebulizer every 4 hours as needed, and albuterol 2.5 mg every 1-4 hours as needed were initiated. Broad-spectrum antibiotics were administered after blood cultures were obtained. Pulmonary function tests revealed decreased FVC, decreased FEV1, and decreased FEV1/FVC. After a couple of days, the acute symptomatology subsided. Prior to discharge a strong emphasis on smoking cessation, instructions on bronchodilator use, pulmonary rehabilitation, and recognition of signs and symptoms for when to seek medical attention was made. Finally, flu and pneumonia vaccines were administered to prevent causes of acute bronchitis and exacerbations of COPD. T.A.’s prognosis is good; the degree of pulmonary dysfunction is a direct predictor of survival. This patient has a mild to moderate COPD that may be managed well if he ceases to smoke, maintains an adequate body mass index and uses supplemental oxygen adequately (if indicated).