COPD exacerbation

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍increased ‍shortness of breathcoughsputum volumechange in sputum color

Symptoms include:

‍shortness of breath

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍increased sputum volume

‍change in sputum color

‍chest tightness

‍wheezing

‍decreased exercise tolerance

‍fatigue

‍fever, up to ‍°, over ‍ ‍hoursdays

‍orthopnea

‍paroxysmal nocturnal dyspnea

‍leg swelling, ‍rightleftsymmetrical



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍smoking

‍poor adherence with inhaler

no history of: ‍chronic obstructive pulmonary disease, ‍asthma, ‍heart disease, ‍diabetes mellitus

no use of: ‍antibiotics, ‍oral corticosteroids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍COPD exacerbation ‍likelysuspectedpossible

DDx: COPD exacerbation, asthma exacerbation, pneumonia, acute bronchitis, viral URI, heart failure, pulmonary embolism, lung cancer, tuberculosis, interstitial lung disease, pulmonary hypertension, medication noncompliance, environmental triggers, anxiety





PLAN:

Investigations:

- Chest X-ray

- Blood work: ‍CBC, ‍CRP, ‍electrolytes, ‍creatinine, ‍blood gas

- Sputum culture

- Pulmonary function tests

Treatments:

- Increase dose of rescue inhaler

- If mild increase shortness of breath, dougle dose of inhaled corticosteroids: ‍Inhaled corticosteroids (ICS)

- If moderate increase shortness of breath, add oral corticosteroids: ‍Prednisone

- If change in sputum color, add antibiotics: ‍Antibiotics

- Oxygen therapy if SpO2 < 90-92%

- Ensure proper inhalation technique and spacer use if necessary

- Smoking cessation counseling

- Immunization: pneumococcal, annual influenza, covid

Further care:

- Referral to pulmonologist

- Follow-up in ‍ ‍monthsyears

- Return sooner if symptoms not better in 72h or if symptoms worsen

- Referral to ER if severe shortness of breath, chest pain, or high fever