COPD Patient Assessment

COPD is a multidimensional illness, with a few systemic signs and relationship with various comorbid maladies. The undoubtedly connect amongst COPD and these extrapulmonary conditions is an overflow of provocative arbiters from the lung, as systemic irritation is related with skeletal muscle squandering and cachexia and also with cardiovascular, metabolic, and bone illnesses. More research is expected to comprehend the connections between these illnesses and to scan for regular treatable segments. It appears to be likely that medications, for example, statins, that are as of now used to oversee cardiovascular and metabolic ailments may likewise give an advantage in COPD patients, in spite of the fact that it is critical that randomized fake treatment controlled trials be led to affirm this probability. It is critical to consider how the presence of a comorbid infection may influence the administration of the patient who additionally

Presently, experiencing a cough, fatigue, fever of 100°F, and increased shortness of breath with activity for the past 5 days. Patient reports productive, “cough is a large amount of thick, tan sputum occurring day, and night, worse at night when lying on my back”. In the mornings John K has a thick, productive cough of “whitish sputum” for the last 18 months. Admits to sleeping with two pillows at night for comfort. John K, has difficulty breathing with climbing one flight of stairs and intercourse. In evaluating John K, presented sitting in tripod position with active mild respiratory distress, physically fatigued, oxygen saturation of 92% room air, respirations 24 (shallow), and temperature 99.8°F. Further physical findings identify early finger nail clubbing, moderate use of the abdominal muscles as evidence in compensating to breath, bilateral tympany on percussion, diffuse coarse crackles and few scattered end expiratory wheezes throughout bilateral lung fields. Electrolyte lab values within normal limits (no evidence of infection), ruling out pneumonia and chronic bronchitis. Chest x ray results COPD confirmed, ruling out pneumonia and chronic bronchitis. Sputum sample results normal flora congruent to COPD with no evidence to bacteria growth or pathogens identified, ruling out pneumonia and chronic bronchitis. Diagnostic

History of Present Illness: Mr. Perkins is a very pleasant 50-year-old man who was referred for ongoing dyspnea on exertion. He states that his symptoms began about a year ago and at that time, he had extensive cardiac evaluation, which reveals significant mitral valve regurgitation for which he has mitral valve repair. Since that time, however, he states that his level of cardiovascular fitness has not returned to his previous baseline. He is here today for formal evaluation. It should be noted that he did have a right heart catheterization performed that showed normal LV function with normal right heart pressures in September 2014. It should also be noted that he was not anemic at that time. He also has exercise stress testing performed perioperatively, which demonstrated limited exercise treadmill test secondary to marked accelerated hypertensive blood pressure in response to exercise. He states that he normally works out on a regular basis. He has been working out actively for a while doing cross fit and doing plank holds and other strenuous activities. He also has membership to Planet Fitness where he does run on the treadmill, as well. He once again states that his cardiovascular endurance is not quite where he feels it should be. He denies any associated wheeze with his symptoms. He has no chest pain. He does note a chronic morning bout of productive sputum that has persisted for one year as well. He denies this as being a

Chronic obstructive pulmonary disease (COPD) is a lung disorder characterized by a small airway obstruction and reduction in expiratory flow rate (Arcangelo & Peterson, 2013). It affects over ten percent of the United States’ population, is the 4th leading cause of death, and costs over $37 billion annually to treat (Arcangelo & Peterson, 2013). In 2013, 2.8% of every 100,000 diagnosed with COPD, died from chronic bronchitis or emphysema related causes (CDC, 2014). Common risk factors for the development of COPD include smoking, air pollution, chronic respiratory infections, and hyperresponsive airways due to asthma (Arcangelo & Peterson, 2013). Unfortunately, early signs and symptoms of COPD are practically nonexistent. Once a patient starts exhibiting symptoms, the disease has progressed significantly (Arcangelo & Peterson, 2013). Pulmonary function tests are essential to diagnose COPD. Forced vital capacity, or the maximum amount of air exhaled with force, indicates lung size (Arcangelo & Peterson, 2013). Forced expiratory volume (FEV1) measures the maximum amount of air expired in one second (Arcangelo & Peterson, 2013). FEV1 and symptoms exhibited are used to stage COPD (Arcangelo & Peterson, 2013). COPD is staged at five levels of severity (Refer to Appendix for severity scale). The severity of COPD is defined by FEV 1 %, or the maximal amount of air forcefully exhaled in one second using spirometry (Timmins, et.al., 2012). Emphysema and chronic

The following report is a case study of an 86 year old male suffering respiratory distress as a result of chronic obstructive pulmonary disease (COPD).

On January, 31st, Patient F.F. arrived to the emergency room in the hospital with her brother due to an increased temperature for ‘the past 3 days,’ fatigue, and was ‘unable to catch [her] breath.’ A focused assessment revealed crackles and wheezes in the lower lobes of the lungs. The patient was leaning over in a tripod position and breathing heavily between words. The patient’s heart sounds were normal with a regular S1 and S2. The patient denied having chest pain and edema was not present. The patient reported having a productive cough with green sputum for the past 3 days. Vital signs were taken and the patient’s oxygen saturation was 88%. The doctor ordered 2 liters of oxygen by nasal cannula for the patient with a continuous

Patients present with shortness of breath, cough, sputum production, airflow limitation, wheezing, chest tightness, dyspnea during exertion, fatigue, dizziness, elevated shoulders, overuse of accessory breathing

Patient TM is a 61-year-old female patient with PMH of COPD, Hypertension, asthma and type II Diabetic who presents to the clinic with a complaint of Shortness of breath for the past 2 Days. The patient states that the SOB was sudden in onset and progressive. It was 8/10 in severity. Occurs with minimal activity. The patient states that he has been using his rescue inhalers but is not getting any relief. The patient states she has severe exacerbations of COPD around once or twice a year. She states that she is coughing up a small amount of clear sputum with no foul smell. Denies fever. Denies chest pain no palpitations. The patient TM is a chronic smoker. She has three pack years history of

Mucoactive drugs usually unstated corollary in modern textbooks in the sections on treatment of exacerbations of COPD [1,56,57]. However, from the perspective of the pathophysiology of COPD development of exacerbations these drugs in this situation may have its point of application. Increased production of bronchial secretion is an important part of the pathogenesis of COPD exacerbations [58]. Excess secret airway when COPD can be due to either its excessive production of goblet cells due to stimulation of neutrophil elastase and / or free radicals, or lack of impaired mucociliary clearance [59]. That is increased bronchial inflammation causes to increased amounts (Hypersecretion) and changing the composition and biophysical properties (Dyscrinia) airway secretion [60]. In your turn, Dyscrinia Hypersecretion and lead to the development of airway obstruction [61]; reduces the area of epithelial thickening due to inflammation of airway Lumen [62]; the high content of mucus in the Lumen of to the respiratory tract disrupts their surface tension, That is predisposing factor to Developed expiratory collapse [63]. Exacerbations of COPD are a leading cause of hospital admission. Some patients have recurrent admissions, often several a year. Others have a largely stable disease with infrequent exacerbations. Reasons for the difference are unclear, but both pathological and psychosocial factors may be involved

Keith Orton, 61 year old male, has been diagnosed with chronic obstructive pulmonary disease (COPD), a not fully reversible lung disease characterised by post bronchodilator limitation of expiratory airflow by comparison with lung volumes , interfering with normal breathing. COPD is used as an umbrella term to describe progressive lung diseases including emphysema and chronic bronchitis. Disorders such as tracheal tumour, cystic fibrosis, obliterative bronchiolitis and respiratory bronchiolitis interstitial lung disease, that can restrict expiratory airflow are excluded from the COPD definition. However, these disorders may be present in a patient diagnosed with COPD, but whether they are associated is unknown.

The patient presents for routine follow up. States overall he has done not okay. He has been seen and evaluated for his chronic hoarseness telling that he needed to rest his vocal chords. States that it may be getting a little better if he has quit singing for several weeks. The patient states that he still continues to be quite short of breath. States that he feel he does have COPD from his tobacco use. States that he does have a lot of drainage and coughing early morning with sputum production. He has denied any dizziness, syncope, chest pain, or other difficulties. Appetite is well. Bowel and bladder function is without difficulties. He has also continued on his verapamil, lisinopril, aspirin, and daily

On examination, he was saturating at 96% on room air. His lung fields revealed reduced air entry but no significant wheeze or

Knowlton has had insidious progression of dyspnea on exertion over the course of one to two years. His pulmonary function tests do demonstrate a restrictive ventilatory defect with significant decrement to his DLCO. He has a very significant smoking history. However by imaging, the is no evidence of any emphysematous disease. Additionally, there is no evidence of obstruction on his pulmonary function tests. The differential diagnosis for restrictive ventilatory defects are quite broad to include intrinsic lung disease versus neuromuscular weakness verus non-muscular diseases of the upper thorax to include kyphoscoliosis. It should be noted that Mr. Knowlton does have a fair amount of stooped posture and kyphosis on examination, however this should not contribute to the level of decreased DLCO noted on his pulmonary function tests. At this time, it would be reasonable to interrogate the lung parenchyma with high resolution CT scanning given the pulmonary function tests

Does not have a pulmonary embolism. Severe dyspnoea, RR 28 breaths per minute, SaO2 of 91% and diagnosed with COPD. Is constantly tired.

According to the clinical presentation of this patient the definitive diagnosis is COPD which is chronic bronchitis. According to Buttaro (2013), symptoms of chronic bronchitis include a cough that persists for most days of the month, for at least three months and at least two years in a row.