PG 2025: Pulmonary Literature Review and Interactive Complex Case Presentations (PG)-MARCINIUK COPD PG YIR 2025 Case Studies Uploaded

MARCINIUK COPD PG YIR 2025 Case Studies Uploaded

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This 2025 pulmonary literature review by Dr. Darcy D. Marciniuk presents detailed case studies focusing on chronic obstructive pulmonary disease (COPD) management, illustrating patient-centered clinical decision-making.<br /><br />Case #1 features Vicky, a 72-year-old female with moderate COPD and chronic bronchitis symptoms. Despite quitting smoking seven years ago, she experiences shortness of breath after minimal exertion and frequent exacerbations treated with antibiotics and steroids. Initial treatment involved a combination of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist (LABA) therapy plus as-needed salbutamol. Upon assessment, elevated symptoms (CAT score 27) and moderate airflow limitation were noted. The clinical team escalated inhaled therapy to a triple combination of inhaled corticosteroid (ICS)/LAMA/LABA, leading to reduced exacerbations and improved quality of life (CAT score dropped to 19). Ongoing management includes pulmonary rehabilitation and disease management support. Subsequent considerations included biologic therapies (dupilumab or mepolizumab) for her eosinophilic phenotype, maintenance azithromycin or roflumilast, and novel agents like ensifentrine, all aimed at reducing exacerbation risks and symptoms.<br /><br />Case #2 involves Clara, a 62-year-old female with severe COPD and concomitant cardiomyopathy (left ventricular ejection fraction 30%) causing significant exercise limitation. Despite maximal inhaled therapy including triple therapy and frequent short-acting bronchodilator use, she has severe functional impairment (CAT 34, 6MWD 80m). Cardiopulmonary exercise testing revealed limitations due to both pulmonary and cardiac factors, including blunted heart rate response from pacemaker settings and flow limitation. After pacemaker adjustment, modest improvements in exercise capacity and oxygen pulse were observed, highlighting the integral role of cardiovascular function in COPD exercise tolerance. Management emphasized comprehensive symptom evaluation, optimization of bronchodilation, pulmonary rehabilitation, and assistive devices.<br /><br />Overall, these case studies demonstrate the complexity of managing COPD patients with frequent exacerbations or significant comorbidities. A personalized, multi-modal approach involving pharmacotherapy escalation, rehabilitation, and assessment of cardiac function is critical for optimizing outcomes. Emerging therapies targeting inflammation and muscle function offer additional options for select phenotypes.

Keywords

COPD management

chronic obstructive pulmonary disease

COPD

case studies

patient-centered care

inhaled corticosteroids

triple therapy

pulmonary rehabilitation

biologic therapies

cardiopulmonary exercise testing

comorbidities in COPD