Case 014: COPD

PATIENT PRESENTATION

Chief Complaint

“I’m breathing better after being in the hospital for a couple of days.”

History of Present Illness

S.B is a 68-year-old man admitted 2 days ago for a COPD exacerbation. Prior to this hospitalization he has 2 days of increasing SOB and productive cough and mild fever. In the hospital he has been treated with oxygen, nebulized albuterol/ipratropium, a prednisone taper and intravenous ceftriaxone and azithromycin. He is expected to be discharged within the next 24-48 hours.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of a COPD exacerbation does the patient have?

   Hint: See Treatment in PPP

2. What factor(s) may have precipitated this patient’s exacerbation?

   Hint: See Treatment in PPP and reference 1 below

3. As the patient nears discharge how should his medication regimen be changed?

   Hint: See Outcome Evaluation in PPP

4. What are the indications for antimicrobial therapy in a patient hospitalized with a COPD exacerbation?

   Hint: See Treatment in PPP and reference 1 below

5. What adverse effects of the patient’s likely discharge and home medications should be discussed?

   Hint: See Treatment in PPP and reference 1 below

FOLLOW-UP

You come back to see the patient the next morning, and he will be discharged in the afternoon. He says he is confused about the different inhalers and how to use them. How would you educate a patient on the use of meter-dose and dry powder inhalers?

Hint: See chapter 15 in PPP and reference 2 below

CASE SUMMARY

Global Perspective

COPD is a leading cause of morbidity and mortality globally and results in an increasing economic and social burden. While COPD is typically associated with smoking of tobacco, in many countries outdoor, occupational, and indoor air pollution (often from burning of wood and other biomass fuels) are significant risk factors. The estimated global prevalence of COPD is estimated to be close to 400 million people or over 10% of the adult population, with a higher prevalence in men versus women. While the prevalence of smiling is decreasing in developed countries, it is increasing in developing countries, and it is estimated that the annual death rate from COPD will increase from about 3 million now to over 5 million by 2060.