Case Study 3 Flashcards
A 63 year old man who is a lifelong smoker attends the chest clinic with a 2-3 year history of worsening exertion dyspnoea associated with a productive cough. He is prone to chest infections in the winter months. What is the most likely diagnosis?
COPD
Give three particularly important points of the patient’s history in confirming your diagnosis
- full respiratory and CVS history
- past medical history
- smoking history
- occupational history
What might you be looking for in the past medical history of this patient?
- whooping cough
- measles
- asthma
- TB and treatment history to exclude exacerbating drugs
What would you be looking to confirm in the smoking history of this patient?
- duration
- type
- number/day (pack years)
What would you be looking for in the occupational history of this patient?
- exposure to industrial dusts
- exposure to domestic animals
Give three essential investigations that should be carried out on this patient
- CXR
- PEFR
- Spirometry
- ECG
- ABGs
What four types of drugs can be used in the management of this man’s condition? Give an example of each
- Beta-2-agonists e.g. salbutamol/terbutaline
- Anticholinergics e.g. ipatropium bromide
- Theophylline e.g. amniophylline
- Steroids - inhaled, oral or IV
What two conditions are encompassed by COPD?
Chronic bronchitis and emphysema
What is the clinical diagnosis of chronic bronchitis based on?
Productive cough for three or more months in two or more consecutive years
What is emphysema?
Dilation and destruction of the airways distal to the terminal bronchioles
What is type I respiratory failure?
Hypoxia associated with a normal or low arterial carbon dioxide
What is type II respiratory failure?
Hypoxia associated with a raised arterial carbon dioxide
Give two interventions that can improve the prognosis of a patient with COPD
- cessation of smoking
- long term oxygen therapy
For how many hours would a patient need to wear their long term home oxygen appliance for to reduce morbidity?
15-19 hours
