呼吸内科英语病历汇报

呼吸内科英语病历汇报

Title: A Case Report of Chronic Obstructive Pulmonary Disease (COPD) with Acute Exacerbation

Keywords: Chronic Obstructive Pulmonary Disease, Acute Exacerbation, Spirometry

Abstract:

This case report presents a 65-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) who presented to the emergency department with acute exacerbation. The patient had a significant smoking history and was on maintenance therapy with inhaled bronchodilators and corticosteroids. Upon admission, he exhibited symptoms of increased breathlessness, cough, and sputum production. Diagnostic evaluations, including spirometry and chest imaging, confirmed the exacerbation. The patient was treated with a combination of antibiotics, systemic corticosteroids, and nebulized bronchodilators. This case highlights the importance of early recognition and prompt management of COPD exacerbations to prevent further complications and improve patient outcomes.

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive lung condition characterized by airflow limitation that is not fully reversible. It is primarily caused by long-term exposure to irritants, most commonly cigarette smoke. COPD encompasses two main conditions: chronic bronchitis and emphysema. Patients with COPD often experience periods of acute exacerbation, which are defined as a sustained worsening of the patient's condition from their usual state that is beyond normal day-to-day variations and necessitates a change in medication. These exacerbations can lead to significant morbidity and mortality, making their timely diagnosis and treatment crucial.

Case Presentation

Patient History

The patient is a 65-year-old male with a 40-pack-year smoking history and a known diagnosis of COPD for the past 10 years. He has been on maintenance therapy with a combination of inhaled long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS). His medical history also includes hypertension, managed with angiotensin-converting enzyme (ACE) inhibitors, and hyperlipidemia, treated with statins. The patient denies any recent travel or contact with individuals with respiratory infections.

Presenting Symptoms

The patient presented to the emergency department (ED) with a three-day history of increased breathlessness, productive cough with yellowish sputum, and wheezing. He reported that his symptoms had progressively worsened over the past few days, limiting his daily activities. He denied fever, chest pain, or hemoptysis. The patient stated that he had been using his rescue inhaler more frequently but without significant relief.

Physical Examination

On physical examination, the patient appeared in mild distress due to respiratory effort. Vital signs were as follows: temperature 37.2°C, heart rate 110 beats per minute, blood pressure 145/85 mmHg, respiratory rate 24 breaths per minute, and oxygen saturation 88% on room air. Auscultation of the lungs revealed bilateral wheezes and crackles, particularly in the lower lobes. There was no evidence of cyanosis or peripheral edema.

Diagnostic Evaluations

Spirometry:

A spirometry test was performed to assess the patient's lung function. The results showed a forced expiratory volume in one second (FEV1) of 1.2 liters (30% predicted) and a forced vital capacity (FVC) of 2.5 liters (55% predicted), with an FEV1/FVC ratio of 48%. These findings are consistent with severe airflow obstruction, characteristic of advanced COPD.

A chest X-ray was obtained to rule out other causes of respiratory distress. The image showed hyperinflation of the lungs with flattened diaphragms and areas of increased bronchovascular markings, suggestive of chronic bronchitis. No evidence of pneumonia or pneumothorax was noted.

Complete Blood Count (CBC):

A complete blood count revealed a white blood cell count of 12,000 cells/µL with a neutrophil predominance, indicating an inflammatory response. Hemoglobin and hematocrit levels were within normal limits.

Arterial Blood Gas (ABG):

An arterial blood gas analysis was performed to assess the patient's acid-base status and oxygenation. The results were as follows: pH 7.35, PaO2 60 mmHg, PaCO2 50 mmHg, and HCO3- 28 mEq/L. These values indicate respiratory acidosis with hypoxemia, consistent with an acute exacerbation of COPD.

Treatment and Management

The patient was admitted to the hospital for management of his acute exacerbation of COPD. The following treatment plan was initiated:

Antibiotics:

Given the presence of increased sputum production and purulence, the patient was started on intravenous ceftriaxone, 1 gram every 12 hours, to cover common respiratory pathogens such as Haemophilus influenzae and Moraxella catarrhalis. The choice of antibiotic was based on local resistance patterns and the patient's clinical presentation.

Systemic Corticosteroids:

To reduce airway inflammation, the patient was prescribed oral prednisolone, 40 mg daily for five days. Systemic corticosteroids have been shown to shorten recovery time, improve lung function, and reduce the risk of treatment failure in patients with acute exacerbations of COPD.

Nebulized Bronchodilators:

The patient received nebulized albuterol (2.5 mg) and ipratropium bromide (0.5 mg) every four hours as needed for symptom relief. Nebulized bronchodilators help to dilate the airways and reduce airway resistance, thereby improving breathing.

Oxygen Therapy:

Supplemental oxygen was administered via nasal cannula at 2 liters per minute to maintain oxygen saturation above 90%. Care was taken to avoid hyperoxia, which can lead to carbon dioxide retention in patients with COPD.

Supportive Care:

The patient was encouraged to stay hydrated and perform deep breathing exercises to promote mucus clearance. Chest physiotherapy was also provided to assist with sputum expectoration.

Course and Outcome

Over the next few days, the patient's symptoms gradually improved. His respiratory rate decreased to 18 breaths per minute, and his oxygen saturation stabilized at 92% on room air. The frequency of his rescue inhaler use decreased, and his sputum production became less purulent. Repeat spirometry showed an improvement in FEV1 to 1.5 liters (37.5% predicted).

The patient was discharged after five days of hospitalization with instructions to continue his maintenance therapy and follow up with his primary care physician in one week. He was advised to quit smoking and to seek medical attention if he experienced any recurrence of symptoms.

Discussion

Acute exacerbations of COPD are a significant cause of morbidity and healthcare utilization. Early recognition and prompt treatment are essential to prevent further deterioration and reduce the risk of hospitalization. In this case, the combination of antibiotics, systemic corticosteroids, and nebulized bronchodilators effectively managed the patient's exacerbation and led to a favorable outcome.

The use of spirometry in the diagnostic evaluation of COPD is crucial. It helps to confirm the presence of airflow obstruction and assess the severity of the disease. In this patient, the spirometry results were consistent with severe COPD, which guided the treatment approach.

The role of smoking cessation cannot be overstated in the management of COPD. Smoking is the primary risk factor for the development and progression of COPD, and quitting smoking is the most effective intervention to slow disease progression and improve quality of life.

Conclusion

This case report highlights the importance of a comprehensive approach to managing acute exacerbations of COPD. Early diagnosis, appropriate use of antibiotics and corticosteroids, and supportive care are key components of successful treatment. Additionally, smoking cessation and regular follow-up are essential for long-term management and prevention of future exacerbations. Further research is needed to identify novel therapeutic strategies and biomarkers that can predict and prevent exacerbations in patients with COPD.

References

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4. Miravitlles M, Soler-Cataluña JJ, Calle M, et al. Management of acute exacerbations of COPD: a guide to good practice. Eur Respir Rev. 2014;23(131):102-115.

5. Anthonisen NR, Manfreda J, Warren CP, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196-204.