CASE LEARNING OBJECTIVES
Identify the signs and symptoms of a COPD exacerbation
List the treatment goals for a patient with COPD
Design an appropriate treatment regimen for a patient with a COPD exacerbation
Develop a monitoring plan to assess the effectiveness and adverse effects of pharmacotherapy for COPD
Formulate an appropriate education plan for a patient with COPD
"My breathing just isn't getting better. I'm so tired and out of breath, I couldn't even read a book to my grandson yesterday."
History of Present Illness
Samuel Smarthe is a 67-year-old male who presents to the emergency department with complaints of increasing SOB over the past 4–5 days. He was seen by his primary care physician 3 days ago and was given a prescription for prednisone and told to increase his rescue inhaler use as needed. He comes to the ED this evening because his SOB has continued to worsen and he is increasingly tired and weak. In the last year, he has been hospitalized five times for similar symptoms, most recently 5 weeks ago. He has been using inhalers for his COPD for the past 11 years. About 6 months ago, his ICS dose was increased. He is supposed to use O2 at home, but he admits to being nonadherent with this.
COPD diagnosed 12 years ago
Chronic atrial fibrillation × 5 years
Hyperlipidemia diagnosed at age 45
Osteoarthritis (OA) × 10 years
Father died at age 70 of lung cancer. Mother died at age 35 in a motor vehicle accident. He has one brother with CAD and an "irregular heartbeat," who is alive.
The patient is married and lives with his wife of 45 years, his youngest daughter, and his 3-year-old grandson. He has two other children who live out of state. He is a retired steel-mill worker, and he and his wife care for their grandson during the day while his daughter is at work.
Smokes ½ ppd of cigarettes; he cut back about 6 months ago from 1½ ppd for 47 years. No alcohol or illicit drug use.
Allergies/Intolerances/Adverse Drug Events
Medications (Prior to Admission)
Warfarin 7.5 mg PO on Mondays and Fridays, 5 mg PO on all other days
Prednisone 30 mg PO daily × 10 d (started 3 ...