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sixty--year-old man wth COPD


sixty--year-old man wth COPD


حالة سريرية

الوصف الكامل Background
A 60-year-old man comes to your office with worsening shortness of breath over the last 5 months. He has had 3 episodes of bronchitis over the last 12 months. He now has a mild nonproductive cough. He denies any fever, chills, productive cough, blood in sputum, chest pain, or difficulty breathing while lying down. His medications include ipratropium inhalers, baby aspirin, and amlodipine. He was hospitalized twice in the last 5 years due to his COPD. He has been smoking 1 pack per day for the last 40 years. Vital signs are: BP: 130/85 mm Hg, RR: 30/min, PR: 100/min, T: 99 F (37.2C). Physical exam shows a thin white man in respiratory distress with increased anteroposterior chest diameter, diffuse expiratory wheeze and loud S2. Chest X-ray shows hyperinflation of bilateral lung fields with diaphragm flattening and small heart size. Which of the following could decrease mortality in this patient?

A. Albuterol MDI
B. Beclomethasone MDI
C. Theophylline
D. Methyl prednisone IV
E. Antibiotics
F. Smoking cessation

and when we used the others for the copd><><><><>?><?><?

المرجع

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mbs2380's picture
by
بعد التخرج

Quote:
Which of the following could decrease mortality in this patient?

F. Smoking cessation

Green Wave's picture
Green Wave

Quote:
and when we used the others for the copd><><><><>?><?><?

And in which Situations we use the other drugs?>?>?>?>?

mbs2380's picture
mbs2380
بعد التخرج

Now in the acute exacerbation of a COPD : i'd use the following :
Albuterol MDI a good bronchodilator , better results with ipratropium inhaler , + the Methyl prednisone IV &
Antibiotics even if there is no evidence of an infection for the antibiotics ..they'll benefit in both cases ..
Beclomethasone MDI no benefit as an acute case .. better to give the IV or the Oral ..ie.the systemic ones ..and the pt will stay on them for 2 weeks ..

Theophylline no benefit in the acute case ..but if the pt on it ..don't change the dose ..coz it'd worsen the case

that wut i have for A COPD in an acute presentation , i'd say another talking if it is a chronic one

Green Wave's picture
Green Wave

Ya ,u r right............

I opened this thread to focus on the drugs used in tretment of COPD.........

This 60 year old patient who presents with long history of Chronic Obstructive Pulmonary Disease (COPD), most likely has an emphysema type rather than chronic bronchitis because of the absence of productive cough for 2-3 months in consecutive years. His 40 pack-year smoking history is the most likely cause of his lung problem. Ten to fifteen percent of smokers develop COPD, while 80-90 % of COPD patients are smokers.
Anticholinergic drugs (Ipratropium bromide) are the first line medications in COPD. These agents are given via metered dose inhalations (MDI) and control airway caliber and tone. Anticholinergic agents can be used synergistically with beta-2 agonist in patients with COPD.
Beta-2 agonists like albuterol (Option A) are used as second-line drugs after anticholinergic agents. Inhaled steroids like beclomethasone MDI (Option B) are not useful in COPD patients, unlike in asthmatic patients, where inhaled steroids are the cornerstone of therapy.
Aminophylline or oral Theophylline (Option C) is used after beta-2 agonists and anticholinergic agents, as 3rd or 4th line agent. They can increase the diaphragmatic contraction and help breathing.
Systemic steroids (Option D) are the first line therapy of the acute exacerbation of COPD but are relatively ineffective for chronic maintenance therapy.
Antibiotics therapy (Option E) should be used empirically for acute exacerbation of COPD and should cover Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis.
Despite the above treatments, the only two modalities that can decrease mortality in patients with COPD are home oxygen therapy and smoking cessation (Option F).

mbs2380's picture
mbs2380
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i have a question here....
why Beta-2 agonists are not used as a first line????
why the first line is Anticholinergic drugs??

Vince Carter

Quote:
i have a question here....
why Beta-2 agonists are not used as a first line????
why the first line is Anticholinergic drugs

according to uptodate:

A long-acting beta agonist or a long-acting anticholinergic is acceptable. In general, we prefer a long-acting anticholinergic over a long-acting beta agonist because most of the effects of the currently available once daily anticholinergic appear to be superior to the twice daily beta agonists that are available for use

.b's picture
.b
بعد التخرج

Quote:
have a question here....
why Beta-2 agonists are not used as a first line????
why the first line is Anticholinergic drugs

Thanx Bishr,,

and also I have another explanation: many pts wth COPD would also have cardiac problems,and the prefered drug for COPD wth cardiac problems is anticholinergic drug instead of the beta agonist........

mbs2380's picture
mbs2380
بعد التخرج


a

Quote:
nd also I have another explanation: many pts wth COPD would also have cardiac problems,and the prefered drug for COPD wth cardiac problems is anticholinergic drug instead of the beta agonist........

بسام.....معلم....Eye-wink
الله يحميك....

i was waiting for ur answer....i know u will answer it....

Vince Carter

For the Antibiotics you can use Amoxicillin, TMP-SMX, Doxy, Clarithromycine, Antipneumococcal floroquinolones "all are reasonable and no single Abx proven to be superior"
its use will increase the PEFR and increase the chance of clinical resolution which means improve the morbidity but not the mortality.

Reference: JAMA 1995;273:957

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Hot sauce
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