Primary impression:

Chronic obstructive pulmonary disease

Primary impression: Chronic obstructive pulmonary disease

Basis:
• Easy fatigability
• Dyspnea after doing activities (sweeping, lifting
heavy objects, and walking)
• Weight loss
• (+) 2 pillow orthopnea
• (+) paroxysmal nocturnal dyspnea
• Risk factor: Smoking (40 packs yr)
Primary impression: Chronic obstructive pulmonary disease

Basis:
• Vital signs: BP: 140/80, RR: 28cpm, PR: 104bpm
• Chest x-ray: increased anterior posterior diameter,
increased retrosternal airspace, and flattened
diaphragms on posteroanterior chest radiograph
• PE: barrel chest, prolonged expiration,
hyperresonance on percussion of both lung fields, (+)
wheezing and occasional crackles on both lung fields,
decreased breath sound on the entire lung field
Differential Diagnosis
Rule in: Rule out:
Congestive Dyspnea after doing
activities
Edema (legs,ankles,
feet)
Heart failure    
(+) 2 pillow orthopnea Chest pain
   
(+) paroxysmal weakness
nocturnal dyspnea
 
(+) wheezing and
occasional crackles on
both lung fields
 
Risk factor:
Hypertension
Differential Diagnosis
Rule in: Rule out:
Lung cancer Dyspnea
 
Chest pain
 
Wheezing hemoptysis
   
easy fatigability
 
weight loss
 
hoarseness
 
risk factor: smoking
(40 pack yrs)
Pathophysiology
Diagnostic work up:
Pulmonary function test (spirometry)
Arterial blood gases and oximetry
Chest radiography
Treatment
Pharmacotherapy
1. Smoking cessation

All patients with COPD should be strongly urged

to quit and educated about the benefits of
quitting. An emerging body of evidence
demonstrates that combining
pharmacotherapy with traditional supportive
approaches considerably enhances the
chances of successful smoking cessation such
as bupropion, nicotine replacement therapy,
varenicline
2. Bronchodilators

Used for symptomatic benefit in patients with

COPD. The inhaled route is preferred for
medication delivery as the incidence of side
effects is lower.
3. Beta agonist
Long-acting inhaled β agonists, such as
salmeterol, have benefits comparable to
ipratropium bromide.
addition of a β agonist to inhaled anticholinergic
therapy has been demonstrated to provide
incremental benefit.
4. Anticholinergic Agents

Ipratropium bromide - improves symptoms and

produces acute improvement in FEV1.
Tiotropium - a long-acting anticholinergic, has
been shown to improve symptoms and reduce
exacerbations.
5. Theophylline

modest improvements in expiratory flow rates

and vital capacity and a slight improvement in
arterial oxygen and carbon dioxide levels in
patients with moderate to severe COPD
6. Oxygen

• Supplemental O2 is the only pharmacologic

therapy demonstrated to unequivocally
decrease mortality rates in patients with COPD
• Commonly prescribed for patients with
exertional hypoxemia or nocturnal hypoxemia.
Non Pharmacologic therapies
1. Pulmonary rehabilitation
2. Lung volume reduction surgery
3. Lung transplantation