Chronic obstructive pulmonary diseases (COPD) is a slowly progressing diseases that leads to difficulty in breathing. Loss of elasticity in airways and air sac, chronic inflammation and thickening of airway and air sac and excessive deposition of mucus, have been identified as the reasons for COPD. (American Lung Association,2015)
COPD is initially identified by the patient signs and symptoms. Patients with COPD experience chronic cough, difficulty in breathing, frequent respiratory infection, cyanosis, fatigue, produce excessive phlegm or sputum and have wheezing. Signs and symptoms can vary from patients to patients. Some people show symptoms only during advanced stages of diseases. Early diagnosis is the key to successfully treating COPD. By using stethoscope, a doctor can hear abnormal sounds from the patient’s chest. Patients who are suspected for COPD, can be referred for pulmonary function test.
Pulmonary function test measures the capacity to breathe in and breathe air, out of the lungs. The following test are done to measure lung function:
a. Spirometry: Spirometry helps to diagnose COPD, even before symptoms develop. In this, a technician asks the patients to take a deep breath and then, to blow out the air through mouth into a tube connected to spirometer. The test is repeated after inhaling medication or surgery. An improvement in the volume of air inhaled can be seen after treatment. It give the measure of air flow into and out of the lungs.
b. Arterial blood gas testing, measures the level of oxygen, carbon dioxide, acids and bases in your blood.
c. Exercise tolerance test, measures heart and lung function before, during and after exercise.
d. Oximetry test, measures oxygen saturation levels during rest and exercise.
Apart from pulmonary function test, other tests like X-rays, CT scan, bronchoscopy, mucus culture, bone scan and pH probe study are used in determining the cause for COPD.
The diseases is managed by modification in lifestyle and by using medication. Oxygen therapy is used in severe cases. Pulmonary rehabilitation is given to patients, to help them manage the diseases. In rare cases surgery may be required.
Smoking is an important predisposing factor for COPD. Air pollution, fumes and dust can also predispose to COPD. The diseases has higher prevalence in elderly than young adults. Patient can be referred to a deaddiction center, to help them give up smoking. Good nutrition has an important role in preventing this diseases. (Nationaljewish.org, 2015).
Explain the diagnosis for the patient in the case study you selected:
In the given case, patient had dyspnea, history of smoking and severe impairment in lung function test. She is a confirmed case of COPD. Though bronchodilators, steroid and antibiotics may give temporary relief, a lung transplant is required in extreme lung damage. Cessation of smoking will be required to prevent further detoriation in her condition. After lung transplant, spirometry reading showed a significant improvement of breathing. The FEV% improved from <25% before surgery to more than 50% after surgery.
Describe treatment and management option based on patient diagnosis:
Managing the diseases by early intervention and cessation of smoking could have prevented surgery in the given case. Lung transplant is an extreme method of extending lifespan in patients with advanced stage COPD. Detecting COPD at an earlier stage, is a key to successful treatment. Steroid, NPPV and oxygen can be used in the patient to provide comfort till suitable lung donor is available.
References:
American Lung Association,. (2015). Symptoms, Diagnosis and Treatment - American Lung Association. Retrieved 18 June 2015, from http://www.lung.org/lung-disease/copd/about- copd/symptoms-diagnosis-treatment.html?referrer=https://www.google.co.in/
Nationaljewish.org,. (2015). Diagnosis of Chronic Obstructive Pulmonary Disease. Retrieved 18 June 2015, from http://www.nationaljewish.org/healthinfo/conditions/copd-chronic- obstructive-pulmonary-disease/diagnosis
