Question

Case Scenario

Mr. W is an 80-year-old retired truck driver admitted to medical ICU for exacerbation of his COPD. He lives his wife, who is 78 years old. Mr. W continues to smoke one to two packs of cigarettes per day, as he has done since the age of 15.Over the past week, Mrs. W has noticed a decrease in Mr. W’s activity level and attention span. He has a productive cough of thick tenacious sputum, averaging 1 cup per day. Over the past week the sputum has become yellow. His appetite has decreased, and he has difficulty sleeping at night, often awakening and gasping for breath. Mr. W is having increasing difficulty in bathing and dressing.Physical examination reveals a thin man with weight of 138 lbs. He had a barrel chest and his accessory muscles of respiration to breathe. Auscultation of the chest reveals diminished breath sounds with scattered coarse crackles bilaterally and no wheezes, Mr. W’s

blood pressure is 138/68 mm Hg, his pulse is 92 beats /min. and his respiratory rate is 35 breaths / min. His oral temperature is 38.3C (101F).Laboratory tests show ABG measurement to be pH of 7.40, PaCo2 of 41 mmHg, PaO2 of 55 mmHg, SaO2 of 90% and bicarbonate (HC03) of 28. Mr. W has a white cell count of 12,000. Sputum cultures reveal Haemophilus influenza. A diagnosis of H. influenza pneumonia is made.Because of increasing shortness of breath and decreasing oxygenation, Mr. W is intubated and placed on mechanical ventilation according to the couple’s wishes. Intravenous antibiotic therapy is started, and bronchodilator therapy is initiated to reduce airway resistance and promote pulmonary hygiene. Mr. W remained on mechanical ventilation for 6 days until he is successfully weaned and transferred to the medical division.

1. What are the risk factors for COPD

2. What are the strategies for symptom management for older adults with COPD

3. Read and summarize an article updates regarding COPD.(website)

Answer 1

1. Risk factors of COPD include:

-cigarette smoking

-genetic factors-alpha 1 anti trypsin deficiency

-age: there is increased chance of getting COPD on oldage.

-gender: it is more common in men than women.

-medical conditions: there is increased risk of COPD in people who have history of frequent childhood lung infection.

-exposure to environmental pollution

-people who have exposure to dust,fumes and chemicals.

2 .Strategies for symptom management in older people with your COPD

-give up smoking

-eat healthy foods

-exercise

-use oxygen properly

-avoid infections

-study techniques that can bring up the mucus

-retrain your breathing

-take medications correctly

-take rest

-clear airways

-see doctor regularly

3. Article update regarding COPD

Summary:

In spite of the magnitude of the problem and significant progress in the pathophysiology and clinical aspect of COPD, mechanism underlying the COPD development remain poorly understood and so far nolo therapy has been shown to prevent long term decline in lung function.

Although COPD therapies target common mediating symptoms in most patients, distinct mechanism may underlie unique natural history and clinical phenotypes in individual or group of patients. Future therapies would require a transition from population-based thinking about a disease towards precision medicine approach on the basis of knowledge of pathophysiological pattern and disease driving mechanism in each patient and every patient. This can be achieved through use of patient-derived organotypic models of COPD like airway and lung organoids where disease mechanism can be identified ,reconstructed in tissue and patient-specific way.