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Case Study in COPD ADRISH
Case Study in COPD ADRISH
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The case study focuses on evaluating and managing a 53-year-old female patient with chronic obstructive pulmonary disease (COPD). She has a history of smoking one pack per day (PPD) for 30 years, having quit 8 months ago, and has experienced two exacerbations in the past year. After a recent exacerbation, she was treated with systemic steroids and antibiotics. At present, she reports daily productive coughs and shortness of breath after walking a short distance. Her current medications include metoprolol, multivitamin, albuterol, and long-acting bronchodilators (LAMA/LABA), which she uses almost daily.<br /><br />The patient’s clinical evaluation shows moderate airflow obstruction with symptoms rated at mMRC 2 and CAT score 12, indicating Group E COPD. Spirometry and blood eosinophil count (210 cells/µL) were analyzed to confirm the diagnosis and facilitate further management decisions.<br /><br />The initial management plan for her COPD involves continuing her current LAMA/LABA regimen with the potential addition of inhaled corticosteroids (ICS) due to her exacerbation frequency and eosinophil count. The updated COPD guidance from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and medication studies support this potential strategy.<br /><br />The case also discusses recommended vaccinations for COPD patients, emphasizing influenza, RSV, and pneumonia vaccines. After starting the LAMA/LABA/ICS therapy, the patient showed symptom improvement at the 3-month follow-up.<br /><br />Upon a subsequent exacerbation, despite medication compliance, further steps included potentially stopping ICS, adding roflumilast for anti-inflammatory benefits, or considering long-term azithromycin to reduce exacerbation frequency. It also addresses the possibility of modifying the steroid regimen based on the patient's response and exacerbation patterns. <br /><br />Overall, the case underlines the importance of personalized management in COPD, considering exacerbation history, symptom severity, and eosinophil count, alongside standard spirometry measures.
Keywords
COPD
Chronic Obstructive Pulmonary Disease
exacerbation
eosinophil count
spirometry
LAMA/LABA
inhaled corticosteroids
roflumilast
azithromycin
personalized management
COPD
Chronic Obstructive Pulmonary Disease
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American College of Chest Physicians
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