CHRONIC OBSTRUCTIVE

PULMONARY DISEASE Case Study

Nadeen khalaileh
201920320

Questions (Part1):
Collect Information

1.a. What subjective and objective information indicates the presence of

COPD?

• Breathing problems get worse outside (exposure to occupational and environmental

hazards)
• Having a bronchial condition that is chronic and causes COPD
• Cardiovascular disease (the coexistence of COPD and coronary artery disease occurs
frequently, likely related to shared risk factors)
• A COPD family history
• FEV1 and FEV1/FVC ratio decline
• Intolerance to exercise or a decrease in physical activity
• A background of smoking
• A persistent cough that produces sputum
• Colorado relocation (a higher elevation) increasing breathlessness

1.b. What additional information is needed to fully assess this patient’s COPD?
radiograph of chest?
• A higher total lung capacity test, a residual volume test, and a functional
reserve capacity test are additional pulmonary function examinations (FRC).
• Assessing the level of 1 antitrypsin
• Chest radiograph (CXR): Despite having a low sensitivity for COPD diagnosis,
it can be helpful during an acute exacerbation to rule out complications
including pneumonia and pneumothorax.
• ABG: Chronic PCO2 retention, low PO2 on arterial blood gas.
• Examination of the body
Assess the Information
2.a. Assess the severity of COPD based on the subjective and objective
information available
COPD stage 1 (mild) based on symptoms and FEV1 85.1%
2.b. Create a list of the patient’s drug therapy problems and prioritize them.
Include assessment of medication appropriateness, effectiveness, safety, and
patient adherence.
220 mg of naproxen oral (OTC) every 12 hours Since the combination of aspirin
and naproxen increases the risk of bleeding, PRN neck pain should be altered
(salicylates and NSAID)
Since budesonide is ineffective in treating this patient's condition, it should be
replaced with another drug. Budesonide/formoterol 80 mcg/4.5 mcg, two
inhalations twice day
50 mg of metoprolol succinate orally once per day: Since he had a MI, he must be
taking an ACE inhibitor (Enalapril), and when both medications are taken
simultaneously, blood pressure will fall. Some bronchoconstriction may be
brought on by metoprolol. It needs to be tapered before being stopped.
two times each day, 150 mg of bupropion SR (for Smoking Cessation) Since before
he smoked an average of two cigarettes per day (40 packs per year), currently he
smokes five to six cigarettes, if considerable progress has not been made by the
seventh week of therapy, success is improbable and should be terminated.
No need for clopidogrel 75 mg PO once day (only continued after 1 year of MI).
Once daily 81 milligrams of aspirin should be taken.
Continue taking rosuvastatin 20 mg PO once day
Seasonal influenza vaccine (previous year): Should be continued

2.c. What economic and psychosocial considerations are applicable to this

patient?
 • Avoid gardening season as much as possible to reduce breathing in dust,
smog, and chemicals, which irritate the lungs. When around these things,
wear a mask.
• teach his grandchildren to play indoors or modify their activities to require
less effort.
• Avoid extremely hot or cold temperatures.
• Avoid illnesses, and ask your doctor about getting a pneumonia shot.
• Quitting smoking.

Develop a Care Plan

3.a. . What are the goals of pharmacotherapy in this case?

• To prevent and control symptoms.
• To reduce the severity and number of exacerbations.
• To improve respiratory capacity for increased exercise tolerance.
• To reduce mortality ( COPD is chronic untreatable disease.
• We can only control symptoms the improve the quality of life).
3.b. What nondrug therapies might be useful for this patient?
• smoke cessation.
• O2 therapy.
• pulmonary rehabilitation program.
• patient education.
• influenza immunization.
• pneumococcal vaccine.
3.c.. What feasible pharmacotherapeutic alternatives are available for treating
COPD?
• bronchodilators
• Short acting: albuterol, levalbuterol, ipratropium promide
• Long acting: salmeterol, umeclidinium, tiotropium
• Combination of muscarinic antagonist and b2 agonist can be used.
• Methylxanthine: theophylline and aminophylline
 • Phosphodiesterase 4 inhibitor roflumilast
• A1 antitrypsin replacement therapy
• Expectorants, mucolytics, opioids

3.d. Create an individualized, patient-centered, team-based care plan to

optimize medication therapy for this patient’s COPD and other drug therapy
problems. Include specific drugs, dosage forms, doses, schedules, and durations
of therapy
After MI, all patients should begin taking ACE inhibitors and keep doing so forever
to lower mortality, limit re-infarction, and prevent heart failure.

Enalapril 2.5–5 mg at first, 10 mg twice daily as the goal dose

Umeclidinium (62.5 mcg per actuation, one inhalation each day), as he is a Category B
patient.
Albuterol (Oral inhalation, 90 mcg/actuation, 2 inhalations as needed every 4-6
hours)
Acetaminophen (1000 mg each six hours) For neck discomfort, PRN

Aspirin (81 mg PO once daily)

Rosuvastatin (20 mg PO once daily)

Bupropion If sufficient progress has not been made by the seventh week of treatment,
success is improbable, and treatment should be terminated, changed to a
different drug, or paired with a low-dose nicotine patch.
Seasonal influenza
vaccine

Implement the Care Plan

4.a. What information should be provided to the patient to enhance adherence,
ensure successful therapy, and minimize adverse effects?
• The name and the purpose of medication
• How much of the medication that should be taken, when to take it and how
long to take it
• How to administer medicines
• Prescription refill information
• What to do when a dose is missed
• Important side effects
• Precautions e.g. causes sleep do not drive
• Interaction with foods, beverages and other medicines
• How to store medicines at home

4.b. . Describe how care should be coordinated with other healthcare providers.
Particularly for managed care or health system facilities, the pharmacist should be
able to create, maintain (update), and follow procedures as a pharmacist clinician
and assess overall adherence to treatment protocols (such as drug utilization
evaluations "DUE") (e.g. hospitals).

Follow-up: Monitor and Evaluate

5.a. What clinical and laboratory parameters should be used to evaluate the
therapy for achievement of the desired therapeutic outcome and to detect and
prevent adverse effects?
Each outcome metric chosen should have a clear end point and be closely related
to the treatment goals. The intention was to alleviate his breathing difficulty. The
intervals at which data should be gathered should be defined prospectively and
rely on the outcome parameters chosen. We can get objective information about
the physiology by using some objective measurements, such as spirometry,
pulmonary function testing, and the 6-minute walk test, which assesses exercise
capacity. Subjective measurements, or patient-reported outcomes, include
symptom questionnaires like the St. George's Respiratory Questionnaire, the
COPD Assessment Test, or the CAT, among others. In those instances, we can
interview a patient and receive a score that examines their symptom load across
different dimensions and their location. Parameters for adverse effects must also
be well established and quantifiable.
5.b. Develop a plan for follow-up that includes appropriate time frames to
assess progress toward achievement of the goals of therapy.
Depending on the severity of the condition, patients with COPD should have
regular evaluations. Patients with mild, stable COPD may be followed up every six
months, whereas those with severe, frequent exacerbations and those who have
recently been hospitalized require follow-up every two weeks to every month.

Questions (Part 2)

1- Describe and compare the expectations for deterioration in pulmonary

function in patients with COPD who have quit smoking with those who continue
smoking. In particular, emphasis should be placed on expected patterns of
change in FEV1, FVC, and general health over time in years.
The most successful intervention for slowing the course of COPD, boosting
survival, and lowering morbidity is quitting smoking. This is why the first step in
treating COPD should be quitting smoking. The FEV1/FVC ratio continues to
decline in non-quitters. The severely low FEV1 readings in COPD patients may be a
result of continuous smoking, which has destroyed healthy lung parenchyma.
According to reports, the decline is two times bigger than what is seen in quitters.
A rise in FEV1 may also be reported by quitters. However, it is evident that the
patients benefitted from giving up smoking. Early quitting of smoking prevents
mortality and disability from occurring. In conclusion, people with COPD who
continue to smoke experience a faster reduction in FEV1, And inhaler therapies
did not stop this deterioration. All COPD patients who quit, however, saw a
significant improvement in FEV1.
2- Research and describe the appropriate use of inhaled corticosteroids for the
management of stable COPD. Be able to compare and contrast the benefits and
risks of this therapy.
In COPD, corticosteroids reduce capillary permeability, which reduces mucus
production; they also stop leukocytes from releasing proteolytic enzymes; and
they block prostaglandins. Patients with COPD who are at high risk of
exacerbation and who continue to experience exacerbations after taking
medication are advised to receive inhaled corticosteroid (ICS) treatment. In order
to successfully focus therapy, consensus recommendations suggest assessing
blood eosinophil levels to identify COPD patients who might benefit from long-
term ICS medication. Even if they won't reduce mortality or have an impact on
the long-term course of the illness, inhaled corticosteroids can be useful for
reducing COPD exacerbations and stopping quality of life declines. The main
drawbacks of inhaled corticosteroids for COPD include local side effects and a lack
of evidence about possible long-term harmful effects. The use of inhaled
corticosteroids increases the risk of oropharyngeal side effects, including
hoarseness and oral candidiasis, albeit the latter condition can be avoided by
thorough mouth washing following administration. Due to the lack of evidence
regarding the long-term harmful effects of these treatments, it may be wise to
proceed cautiously when administering inhaled corticosteroids to younger
patients who have less severe illnesses. However, the advantages of inhaled
corticosteroids may outweigh any potential long-term negative effects for older
patients with more serious illnesses. In both situations, it's essential to instruct
patients on the proper inhalation of corticosteroids to assist reduce the danger of
local side effects.

3- Analyze the safety surrounding the use of β-blockers in patients with COPD
versus those with asthma.

Selective β 1-blockers are frequently used for COPD and asthma instead of non-
selective ones because the latter can make breathing difficulties or asthma
attacks worse.