A case presentation of COPD ( Chronic Obstructive Pulmonary Disease )

1. Name: HASHIM SYED ALI ABBAS H.
Ht no: 170312882029
Year: Pharm.D Vth Yr

2. INTRODUCTION TO COPD:
The World Health Organization (WHO) defines chronic obstructive
pulmonary disease (COPD) as: 'a lung disease characterised by chronic
obstruction of lung airflow that interferes with normal breathing and is not
fully reversible'. The airflow obstruction in COPD is due to damage to the
lung structure and destruction of lung tissue (emphysema). This is normally
due to smoking, but recurrent infection also contributes to the process.
COPD is also frequently associated with, and may contribute towards,
numerous co-existing diseases such as heart disease, osteoporosis and
diabetes, which influence morbidity and mortality.

3. SYMPTOMS OF COPD:
Common symptoms of COPD include: chronic
cough, sputum production and shortness of breath.
People with COPD are at increased risk of chest
infections, some of which will be severe enough to
require hospitalisation.

4. Case presentation

5. SUBJECTIVE DATA
I. PATIENT’S NAME :
II. AGE : 65 years
III. SEX : MALE
IV. COMPLAINTS: Fever and cough since 4days, pain in abdomen and
left side of chest, generalized body pain and weight loss. Not a k/c/o
hypertension and DM.

6. OBJECTIVE DATA:
VITAL DATA
DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6
PULSE RATE
(per min)
86 86 90 62 70 72
BLOOD PRESSURE
(mm of Hg)
90/60 120/70 110/70 110/80 110/70 110/80
RESPIRATORY RATE
(per min)
TEMPERATURE
(degree F)
101 102 99 101 100 99

7. LABORATORY INVESTIGATIONS
•BOICHEMICAL INVESTIGATIONS
BUN: 14 (8 to 24 mg/dl in males)
(6 to 21 mg/dl in females)
S.Cr: 0.8 (0.9-1.3 mg/dl in males)
(0.6-1.1 mg/dl in females)
SODIUM: 130 (135-145 mEq/L)
POTASSIUM: 3.3 (3.5-5.0 mEq/L)
CHLORIDE: 84 (98-108 mmol/L)

8. •HAEMATOLOGICAL INVESTIGATIONS
RBC: 3.6 (4.5-5.5million/cubic mm)
WBC: 12,500 (4,00,000-10,00,000per cubic mm)
NEUTROPHILS: 90 (40-80%)
LYMPHOCYTES: 6 (20-40%)
EOSINOPHILS: 2 (1-6%)
MONOCYTES: 2 (2-10%)
BASOPHILS: 0 (0-2%)
PLT: 1.0 (150,000-400,000 lakhs/cumm)
Hb: 11.1 (1300-1700gms/dl)
PCV: 33 (40-50%)
MCV:91.1 (81-101)
MCH:30.4 (27-32)

9. ASSESSMENT
FINAL DIAGNOSIS:
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Other Investigations:
• Chest X-ray: flattening of the diaphragm, increased size of the chest,
abnormal air collections.
• Haematology: normal study
• Color doppler electrocardiograph:
-Normal LV size & systolic function.
-Grade1 diastolic dysfunction.
-Mild dilated RA/RV.
Other valves normal no clot.

10. TREATMENT CHART :
FORM DRUGS GENERIC DOSE ROUTE FREQ
INJ AUGMENTIN AMOXICILLIN&
CLAVULANATE
POTASSIUM
1.2gm IV TID
INJ PAN PANTOPRAZOLE 40mg IV OD
TAB DOLO PARACETAMOL 650mg P/O BD
SYP ASCORIL ALBUTAROL
SULPHATE
1tsp P/O BD
TAB Azithral AZITHROMYCIN 500mg P/O BD
NEB DUOLIN SALBUTAMOL 2 Puffs IN TID
INJ PIPTAZ PIPERACILLIN
TAZOBACTUM
4.5gm IV BD
SYP Ambroxol AMBROXOL 2tsp P/O BD

11. CST AS
DAY1
(CONTINUE
SAME
TREATMEN
T)
STOPPED
DRUGS:
AUGMENTI
NE
DOLO
ASCORIL
DAY
2
DAY 5DAY 4
DAY
3
CST AS
DAY4
START
DRUGS:
INJ.
PIPTAZ
(PIPERACI
LLIN 4.5gm
IV BD)
CST
CST
DAY 6
CST AS
DAY5

12. STANDARD TREATMENT PROTOCOLFOR COPD
• ANTIBIOTICS: Antibiotic therapy is, however, vital if a patient
develops purulent sputum. If patients frequently develop acute
infective exacerbations of bronchitis they should be given a supply of
antibiotics to keep at home and start on the first sign of an
exacerbation. The usual antibiotics of choice are amoxicillin,
erythromycin, or doxycycline.
• BRONCHODILATORS: Bronchodilators in COPD are used to
reverse airflow limitation. They are used to treat the increased
breathlessness that is associated with exacerbations. Patients may
experience improvements in exercise tolerance or relief of symptoms
such as wheeze and cough.
-ANTICHOLINERGIC DRUGS: inhaled anticholinergic drugs reverse
the vagal tone and have a significant bronchodilator effect, especially
in the elderly. Short acting agents like ipratropium bromide is used.

13. -THEOPHYLLINES: Theophyllines are weak bronchodilators but
seem to have useful additional physiological effects in COPD such as
increased respiratory drive, improved diaphragmatic function and
improved cardiac output. Use of theophylline should only be considered
after a trial of short-acting with long-acting bronchodilators.
-HIGH-DOSE AND NEBULIZED BRONCHODILATORS:
Although most patients will benefit from standard-dose bronchodilators,
some with severe disease will benefit from higher doses. Hand-held
inhalers are still used for doses of bronchodilators up to 1mg of
salbutamol or 160microgram of ipratropium bromide. Doses above this
may be more conveniently given using a nebulizer.
•MUCOLYTICS: Mucolytics may be of benefit in stable COPD if there
is chronic cough that is productive of sputum. Benefit may be assessed,
for example with a reduction in the frequency of cough and/or sputum
production. Ex: bromhexine, ambroxol.

14. PHARMACIST INTERVENTIONS
THE GIVENPRESCRIPTIONISFOUNDTOBE RATIONAL

15. PATIENT COUNSELLING
REGARDING DISEASE
COPD is a lung disease that obstruct airflow and disturbs the
normal breathing. This is normally due to smoking and
other infections. Common symptoms include chronic cough,
sputum production & shortness of breath.
REGARDING MEDICATION
All the medicines should be taken on proper time which are
given in the prescription. Medicines should not be missed as
it can worsen the condition and may lead to other problems.

16. REGARDING LIFE STYLE MODIFICATIONS:
• QUITTING SMOKING AND AVOIDING OTHER IRITANTS:
Quitting smoking is the first and most essential step in treating
COPD and slowing its process
• PREVENTING UPPER RESPIRATORY INFECTIONS: Good hygiene.
Hands should be washed with soap before eating .
• DIETARY FACTORS: patients with chronic bronchitis are obese and
many with emphysema are underweight, assessment of nutritional
status is an important part of COPD treatment. Lack of vitamins A,
C, and E, and a lack of fruits and vegetables, can contribute to th
development of COPD.
• PHYSICAL EXERCISE: Certain physical exercises may be helpful
like strengthening exercises for the limbs, walking, yoga and easter
practices.
• PSYCHOLOGICAL SUPPORT:
Patients with COPD are at high risk for depression and anxiety, which ca
impair their outlook on life. Psychological counselling and social supports ar
important for helping people improve their emotional state, cope with dail
stresses, and maintain independence and social relationships.