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Pulmonary Literature Review and Complex Case Prese ...
Complex Cases COPD MARCINIUK
Complex Cases COPD MARCINIUK
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Pdf Summary
The literature review presented by Dr. Darcy D. Marciniuk focuses on two case studies involving patients with severe Chronic Obstructive Pulmonary Disease (COPD).<br /><br />**Case 1 - Vicky:**<br />Vicky, a 72-year-old female, exhibits severe COPD symptoms and frequent exacerbations, requiring antibiotics and prednisone. Despite quitting smoking seven years ago, she experiences chronic bronchitis and shortness of breath. Initially treated with a LAMA/LABA combination and as-needed salbutamol, her therapy was augmented to include ICS, which reduced exacerbations and improved her CAT score from 27 to 19, indicating better symptom control. This intervention was supported by daily walking and pulmonary rehabilitation, part of a comprehensive disease management program. The next management steps aimed to maintain current therapy and reassess in six months, with considerations on the need for azithromycin based on risks such as cardiac arrhythmia.<br /><br />**Case 2 - Clara:**<br />Clara, a 62-year-old retired nurse with a history of smoking and COPD, also suffers from non-ischemic cardiomyopathy. Despite using ICS/LAMA/LABA treatments and experiencing no previous exacerbations, she struggles with increasing shortness of breath due to the combined effects of COPD and cardiac issues. Through investigation, including post-bronchodilator pulmonary function, she shows significant limitation in exercise capacity. The approach taken involved optimizing bronchodilation, ensuring proper inhaler use, and incorporating pulmonary rehabilitation with potential use of supplemental oxygen. Exercise measurements indicated both pulmonary and cardiovascular limitations in her exercise performance. Adjustments to her pacemaker improved her exercise capacity, highlighting how integrated cardiac and respiratory management can aid individuals with complex co-morbid conditions.<br /><br />The document emphasizes the importance of holistic care for COPD patients, factoring in multiple possible interventions and ongoing assessments to optimize patient outcomes, even with severe COPD and concurrent health issues.
Keywords
COPD
Chronic Obstructive Pulmonary Disease
pulmonary rehabilitation
ICS/LAMA/LABA treatment
exacerbations
disease management
cardiac arrhythmia
exercise capacity
integrated care
holistic care
COPD
Chronic Obstructive Pulmonary Disease
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