Case presentation on copd

exacerbation

presented by-

SANA RAFEEQ
170715882024

Under the guidance of-

SARA SHIREEN
Department Of Pharmacy Practice
Deccan school of pharmacy
 INTRODUCTION TO COPD EXACERBATION

• COPD Exacerbation-It is a disease that is characterised by

airflow limitation that is not fully reversible and is associated
with an abnormal inflammatory response of the lungs to
noxious particles or gases.
• COPD is described as either chronic bronchitis or emphysema.
• Chronic bronchitis:Chronic or recurrent excess mucus
secretion with cough.
• Emphysema:Abnormal,permanent enlargement of airspaces.
• Patients with COPD suffer acute worsening of disease referred
to as acute exacerbations.These exacerbations can be
spontaneous but often precipitated by infection and lead to
respiratory failure with hypoxaemia and retention of carbon
-dioxide.
SIGNS AND SYMPTOMS: Shortness of breath, especially during physical activities
•Wheezing
•Chest tightness
•A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenis
•Blueness of the lips or fingernail beds (cyanosis)
•Frequent respiratory infections
•Lack of energy
•Unintended weight loss (in later stages)
•Swelling in ankles, feet or legs
RISK FACTORS:
•Exposure to tobacco smoke.
•People with asthma who smoke. 
•Occupational exposure to dusts and chemicals.
•Exposure to fumes from burning fuel.
•Age.
•Genetics.(alpha 1-antitrypsin deficiency)
COMPLICATIONS:
•Respiratory infections.
•Heart problems.
•Lung cancer.
•High blood pressure in lung arteries.
•Depression.
 SUBJECTIVE

• A 50 years old male patient came to the pulmonology department with chief
complaints of shortness of breath, cough with expectoration, and also with 2-3
episodes of hemoptysis since 2 days and swelling of feet.

PAST MEDICAL HISTORY:

• Hypertension ,Diabetes mellitus since 1 yr.
Not on regular medications

PERSONAL HISTORY:
• Smoker.
 OBJECTIVE
BLOOD FINDINGS NORMAL VALUE
COMPONENTS.
Neutrophils 48.9% 50-80%
Monocytes 11.9% 2-10%

Total bilirubin 2.0 mg/dl 0.2-0.8 mg/dl

Direct bilirubin 1.0 mg/dl Upto 0.2 mg/dl

CT-HRCT CHEST PLAIN

Para septal emphysema noted surrounding the mediastinum
Lungs shows Hyperinflation with Accentuation of
bronchovascular marking
Mild cardiomegaly (for cardiac evaluation)
2D ECHO-Dilated LV
Moderate LV dysfunction
Mild MR
MICROBIOLOGY REPORT:
Gram staining shows few gram negative Bacilli
 FINAL DIAGNOSIS: COPD with acute exacerbatio
ASSESSMENT
•Problem1: shortness of breath
•Medication : Nebs Duolin
(salbutamol/ipratropium bromide)(100/20mcg)
Budecort(budesonide) (0.25mg/ml)
•Problem2:Diabetes mellitus
•Medication :HAI(human actrapid insulin) acc to
GRBS /TID
•Problem3: LV dysfunction
•Medication :Lanoxin (digioxin)(0.25mg/ OD)
•Problem:4 Chest pain
•Medication: Sorbitrate(isosorbide dinitrate)
(5mg/TID)
• Problem 5:edema,hypertention
• Medication: Tab Dytorplus
(spironolactone+torsemide) 20mg/BD
• Problem 6: gastro oesophageal reflux
• Medication :Tab PAN(pantoprazole) (40mg/OD)
• Problem 7:platelet aggregation(mild MR)
• Medication: Tab Clopitab-A(clopidogrel+aspirin)
• Problem 8: Bacterial Infection
• Medication: Tab Augmentin
(amoxicillin/clavulanate)625mg/BD
BRAND GENERIC DOSE FREQUE Rou DAY 1 DAY 2 DAY DAY DAY
NAME NAME NCY te 3 4 5

PAN Pantoprazol 40 mg OD Oral     

e
Hydrocort Hydrocortis 100m BD IV     
one g

Hepain Heparin 5000U TID S/C     

sodium

Lasix Furosemide 20mg BD IV     

Duolin Salbutamol , 100/20 BD NAS     

ipratropium mcg AL
bromide
Budesonid Budesonide 0.25
e mg/ml BD

Augmenti Amoxicillin/ 625m BD Oral     .

n Clavulanate g

Clopitab A Clopidogrel 150mg OD Oral     

BRAND GENERIC DOSE FREQUE Rou DAY 1 DAY 2 DAY DAY DAY
NAME NAME NCY te 3 4 5

Lanoxin Digoxin 0.25 OD Oral     

mg
HAI Human Acc to TID IV     
actrapid GRBS
insulin
Dytorplus Spironolacto 20mg BD Oral     
ne+Torsemi
de
Sorbitrate Isosorbide 5mg TID oral x x   
dinitrate
 DAY NOTES
Vitals Data Day 1 Day 2 Day 3 Day 4
Blood pressure 130/80 100/70 120/90 120/70
Pulse rate 94 92 84 74
Respiratory rate 24 22 20 20
Temperature 98.6 F 98.5 F 98.6 F 98.0 F
DAY 1
C/O: SOB since 15 days, cough with expectoration and hemoptysis since
2 days [2-3 episodes / day ] fever, swelling of feet.
Day 2
C/O : cough, no haemoptysis, SOB decreased
Day3
C/O: mild chest pain
Day 4
No fresh complaints, SOB decreased.
O/E: C/C/C
Day 5
Patient is better and responding to the treatment and all the vitals are
stable.
PATIENT IS DISCHARGED
 PLAN
DISCHARGE MEDICATION

Drug name Generic name Dose Frequency ROA

Sorbitrate Isosorbide dinitrate 5mg TID Oral

Lanoxin Digoxin 0.25mg OD Oral

Pan Pantoprazole 40mg OD Oral

Clopitab-A Clopidogrel 150mg OD Oral

Lasix Furosemide 20mg BD Oral

 PATIENT COUNSELLING
REGARDING DISEASE
COPD is the lung disease that obstructs the airflow and
disturbs the normal breathing. This is normally due to
smoking and other infections. Common symptoms include
chronic cough, sputum production and shortness of breath.
REGARDING MEDICATION
Take tab.pan atleast 30 min before food.
All the medicine should be taken on proper time and the
dose should not be missed.
The patient is explained about the importance of medication
adherence for the effective treatment of the disease and
help to reduce and relief symptoms.
 LIFE STYLE MODIFICATIONS
•Smoking cessations.
•Avoid exposure to Allergens , chemicals, Infections etc.
•Seek out clean air ,Stay well hydrated.
•Avoid excess salt and sugar intake.
•Talk to a doctor for effective breathing techniques,Exercise
regularly.
•Eat healthy foods.(eg:fruits,vegetables,whole grain,fish etc)
•Avoid smoke and air pollution, Monitor your lung health
steadily.
•Patient is advised to participate in pulmonary rehabilation
programs which includes exercise training to improve a
person’s emotional and physical condition. It also promotes
“health-enhancing behaviours”.  
 PHARMACIST INTERVENTION
• The following drug interactions are found:
• Pantoprazole+Digoxin-pantoprazole will increase the
level or effect of digoxin by increasing gastric pH.
Patients taking digoxin should be monitored
appropriately.
• Furosemide+Digoxin- furosemide will increase the
effect of digoxin.Hypokalemia increases digoxin
effects.
• Heparin+Clopidogrel- either increases effects of the
other by pharmacodynamic synergism.Monitor
closely.Enhanced risk of hemorrhage is seen.