Question

A 150 lb., 63-year-old man is experiencing exertional dyspnea, shortness of breath, mild cyanosis, and marked slowing of forced expiration. He is chronically fatigued from the action of breathing and appears to have a "barrel chest." In addition, he has been a smoker for 40 years. The doctor describes his condition as a "progressive disease that directly affects the site of gas exchange in his lungs."

What treatments would you recommend for this patient?

Answer 1

His features Exertional Dyspnea,Shortness of Breath,Mild Cyanosis, marked slowing of forced expiration ,Fatigue,Barrel chest and history of smoking for 40 years are all suggestive of Chronic Obstructuive Pulmonary disease -Most Probably Emphysema.

Emphysema is the Permanent Enlargement of AirSpaces distal to Terminal Bronchioles accompanied by destruction of their Walls.

Treatment -

1.Cessation of Smoking-Continuation of Smoking causes more complications.

2.Bronchodialators-

Inhaled bronchodialators are preferred-

a) beta-2 agonists-salbutamol

b) anticholinergics- ipratropium, tiotropium

Oral Bronchodialator-Theophylline

In mild cases-Short acting bronchodialators

In severe Cases-Long acting Bronchodialators.

3.Glucocorticoids-Glucocorticoids are used to Prevent Exacerbation of COPD

4.Pulmonary Rehabilitation-Exercises,Educating about the disease,Nutritional Counselling

5.Oxygen Therapy-

Long Term Domiciliary Oxygen Therapy(LTOT)

This is Indicated when PaO2 < 55 mm Hg

Aim:Increase PaO2 > 60 mm Hg

Surgical Intervention-

1.LVRS(Lung volume Reduction Surgery)-

In severe Upperlobe Emphysema,Peripheral Emphysematous Lung tissue is Removed.

2.Lung Transplantation-In Sweriously Advanced Disease