COPD [Publish Date]

En Alias 71 Malay Male

Presented to the hospital with shortness of breath for 2/7

SOB slowly progressed over 2 days, associated with cough with

minimal whitish sputum.
SOB is worse on exertion, not relieved by ipratropium
bromide/fenoterol hydrobromide.
He also complained of orthopnea for the past 2 days.
Active smoke of 5cigg/day, previously smokes 50-pack-year but
has reduced to 5 cigg since the past 3 years.

No diurnal variation
Wheezing
PND
Fever
Pleuritic chest pain
Recent travels
Sick contact
Wheezing
Trigger recognized such as pets or environmental factors
Leg swelling, abdominal distension
Trauma to the chest
h/o DVT

SOB when riding 1 flight of stairs.

MMRC 3
5th admissions in 2018
Gold D
Last exacerbation was 4 months ago
Admitted to 12U
Hx of intubation 1 yr 4 months ago
No LTOT
Still smoking
Started on Berodual for the past 3 years
Follow-up at KK near Sunway
At times, he purchased his own medication at the pharmacy.
Using 2-4 puff/day
Symptoms relieved by puff.
Technique shown was inaccurate.

Systemic review

No chest pain, palpitations, sweating, pnd.

No jaundice, pale stool, tea-coloured urine, abdominal pain.
No eczema, skin allergy.
No bruising tendency, thinning of skin, hair loss, central adiposity.
BO as per usual

BPH

August 2018- First episode of Acute Urinary retension.

COPD [Publish Date]

Cathetherized at a clinic for two days, then removed. Been on

diaper since June because of urinary incontinence.
Complained of straining to initiate urination.
However, no dyuria, haematuria, dribbling, poor flow.NO back
pain. No LOA,LOW

No hx of metabolic disease
NKDA

No Family of Ca and Asthma

Gov pensioner, living with son and wife in 3rd floor apt in Sunway.
SOB when riding 1 flight of stairs.

Tachypnaeic on O2 Mask Pursed-lip breathing is basically breathing in

Increased A-P diameter through the nose and out through pursed lips.
No clubbing (should have) This technique is particularly useful when your
No leg swelling (exclude cor pulmonale) shortness of breath flares up. It's also helpful
when you work out: In a recent study, people
Lungs: who used pursed-lip breathing during had
Reduced air entry bilaterally more endurance, a more controlled breathing
Prolonged expiratory phase rate, more oxygen in their blood, and less lung
hyperinflation during exerise. These findings
were published in Arpil 2014 in the European
Journal of Physical and Rehabilitation
Medicine.

When you have COPD, irritated airways and

lungs that have lost elasticity work less
efficiently when you exhale, leaving air
trapped in your lungs. This trapped air is what
leads to shortness of breath. When you exhale
with your lips pursed, there is increased
resistance in your airways, which helps them
stay open during exhalation. Pursed-lip
breathing also helps calm you down and slows
your breathing.
Prevalence of asthma 5%

COPD 6%

>50% have exacerbation

Average of 3x per year

 Eoninophil count predicts tratment responds to corticosteroids

 No role in using methylxanthines and Magnesium Sulphate in acute Exercerbation

 There is a role for pulmonary physiotherapy to increase inspiratory capacity

COPD [Publish Date]

 Inspiratory capacity reduced during exercise in COPD patientd due to air trapping

 The increased no of exacerbations increase mortality

 Give corticosteroids in all cases

 Differential dx is pleural effusion, Pneumothorax, pulmonary embolism, cardiac failure

Management
Oxygen therapy
NIV vs intubation
Assest vital signs
Taper choice of oxygen based on ABG
Aim at spO2 89-92%

Pharmacology

Bronchodilator
Corticosteroids

LABA + LAMA + ICS

Gold criteria based on MCAT/ mmRC score againts no of admissions

Exacerbations is defined as worsening of symptoms such as dyspnea, cough

COPD [Publish Date]
COPD [Publish Date]
COPD [Publish Date]