Name: HASHIM SYED ALI ABBAS H.

Ht no: 170312882029

Year: Pharm.D Vth Yr

INTRODUCTION TO COPD:

The World Health Organization (WHO) defines chronic obstructive

pulmonary disease (COPD) as: 'a lung disease characterised by chronic

obstruction of lung airflow that interferes with normal breathing and is not

fully reversible'. The airflow obstruction in COPD is due to damage to the

lung structure and destruction of lung tissue (emphysema). This is normally

due to smoking, but recurrent infection also contributes to the process.

COPD is also frequently associated with, and may contribute towards,

numerous co-existing diseases such as heart disease, osteoporosis and

diabetes, which influence morbidity and mortality.

SYMPTOMS OF COPD:

Common symptoms of COPD include: chronic cough, sputum production and shortness of breath. People with COPD are at increased risk of chest infections, some of which will be severe enough to require hospitalisation.

Case presentation

SUBJECTIVE DATA

I. PATIENT’S NAME :

II. AGE : 65 years

III. SEX : MALE

IV. COMPLAINTS: Fever and cough since 4days, pain in abdomen and

left side of chest, generalized body pain and weight loss. Not a k/c/o

hypertension and DM.

OBJECTIVE DATA:VITAL DATA

DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6

PULSE RATE(per min)

86 86 90 62 70 72

BLOOD PRESSURE(mm of Hg)

90/60 120/70 110/70 110/80 110/70 110/80

RESPIRATORY RATE(per min)

TEMPERATURE(degree F)

101 102 99 101 100 99

LABORATORY INVESTIGATIONS

•BOICHEMICAL INVESTIGATIONS

BUN: 14 (8 to 24 mg/dl in males)

(6 to 21 mg/dl in females)

S.Cr: 0.8 (0.9-1.3 mg/dl in males)

(0.6-1.1 mg/dl in females)

SODIUM: 130 (135-145 mEq/L)

POTASSIUM: 3.3 (3.5-5.0 mEq/L)

CHLORIDE: 84 (98-108 mmol/L)

•HAEMATOLOGICAL INVESTIGATIONS

RBC: 3.6 (4.5-5.5million/cubic mm)WBC: 12,500 (4,00,000-10,00,000per cubic mm)NEUTROPHILS: 90 (40-80%)LYMPHOCYTES: 6 (20-40%)EOSINOPHILS: 2 (1-6%)MONOCYTES: 2 (2-10%)BASOPHILS: 0 (0-2%)PLT: 1.0 (150,000-400,000 lakhs/cumm)Hb: 11.1 (1300-1700gms/dl)PCV: 33 (40-50%)MCV:91.1 (81-101)MCH:30.4 (27-32)

ASSESSMENT

FINAL DIAGNOSIS:

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Other Investigations:

• Chest X-ray: flattening of the diaphragm, increased size of the chest,

abnormal air collections.

• Haematology: normal study

• Color doppler electrocardiograph:

-Normal LV size & systolic function.

-Grade1 diastolic dysfunction.

-Mild dilated RA/RV.

Other valves normal no clot.

TREATMENT CHART :FORM DRUGS GENERIC DOSE ROUTE FREQ

INJ AUGMENTIN AMOXICILLIN& CLAVULANATE

POTASSIUM

1.2gm IV TID

INJ PAN PANTOPRAZOLE 40mg IV OD

TAB DOLO PARACETAMOL 650mg P/O BD

SYP ASCORIL ALBUTAROLSULPHATE

1tsp P/O BD

TAB Azithral AZITHROMYCIN 500mg P/O BD

NEB DUOLIN SALBUTAMOL 2 Puffs IN TID

INJ PIPTAZ PIPERACILLINTAZOBACTUM

4.5gm IV BD

SYP Ambroxol AMBROXOL 2tsp P/O BD

CST AS DAY1

(CONTINUE

SAME

TREATMEN

T)

STOPPED

DRUGS:

AUGMENTI

NE

DOLO

ASCORIL

DAY

2DAY 5DAY 4

DAY

3

CST AS

DAY4

START

DRUGS:

INJ.

PIPTAZ

(PIPERACI

LLIN 4.5gm

IV BD)

CST

CST

DAY 6

CST AS DAY5

STANDARD TREATMENT PROTOCOL FOR COPD

• ANTIBIOTICS: Antibiotic therapy is, however, vital if a patient

develops purulent sputum. If patients frequently develop acute

infective exacerbations of bronchitis they should be given a supply of

antibiotics to keep at home and start on the first sign of an

exacerbation. The usual antibiotics of choice are amoxicillin,

erythromycin, or doxycycline.

• BRONCHODILATORS: Bronchodilators in COPD are used to

reverse airflow limitation. They are used to treat the increased

breathlessness that is associated with exacerbations. Patients may

experience improvements in exercise tolerance or relief of symptoms

such as wheeze and cough.

-ANTICHOLINERGIC DRUGS: inhaled anticholinergic drugs reverse

the vagal tone and have a significant bronchodilator effect, especially

in the elderly. Short acting agents like ipratropium bromide is used.

-THEOPHYLLINES: Theophyllines are weak bronchodilators but

seem to have useful additional physiological effects in COPD such as

increased respiratory drive, improved diaphragmatic function and

improved cardiac output. Use of theophylline should only be considered

after a trial of short-acting with long-acting bronchodilators.

-HIGH-DOSE AND NEBULIZED BRONCHODILATORS:

Although most patients will benefit from standard-dose bronchodilators,

some with severe disease will benefit from higher doses. Hand-held

inhalers are still used for doses of bronchodilators up to 1mg of

salbutamol or 160microgram of ipratropium bromide. Doses above this

may be more conveniently given using a nebulizer.

•MUCOLYTICS: Mucolytics may be of benefit in stable COPD if there

is chronic cough that is productive of sputum. Benefit may be assessed,

for example with a reduction in the frequency of cough and/or sputum

production. Ex: bromhexine, ambroxol.

PHARMACIST INTERVENTIONSTHE GIVEN PRESCRIPTION IS FOUND TO BE RATIONAL

PATIENT COUNSELLING

REGARDING DISEASE

COPD is a lung disease that obstruct airflow and disturbs the

normal breathing. This is normally due to smoking and

other infections. Common symptoms include chronic cough,

sputum production & shortness of breath.

REGARDING MEDICATION

All the medicines should be taken on proper time which are

given in the prescription. Medicines should not be missed as

it can worsen the condition and may lead to other problems.

REGARDING LIFE STYLE MODIFICATIONS:

• QUITTING SMOKING AND AVOIDING OTHER IRITANTS:

Quitting smoking is the first and most essential step in treating

COPD and slowing its process

• PREVENTING UPPER RESPIRATORY INFECTIONS: Good hygiene.

Hands should be washed with soap before eating .

• DIETARY FACTORS: patients with chronic bronchitis are obese and

many with emphysema are underweight, assessment of nutritional

status is an important part of COPD treatment. Lack of vitamins A,

C, and E, and a lack of fruits and vegetables, can contribute to thedevelopment of COPD.

• PHYSICAL EXERCISE: Certain physical exercises may be helpful

like strengthening exercises for the limbs, walking, yoga and easternpractices.

• PSYCHOLOGICAL SUPPORT:

Patients with COPD are at high risk for depression and anxiety, which canimpair their outlook on life. Psychological counselling and social supports areimportant for helping people improve their emotional state, cope with dailystresses, and maintain independence and social relationships.