Diagnosis and Treatment COPD

What is your primary diagnosis for this patient at this time (Support the decision for your diagnosis with pertinent positives and negatives from the case)?

The primary diagnosis for the presenting client is moderate to severe chronic obstructive pulmonary disease (COPD) (ICD-10-J44.9). A COPD diagnosis is given if the FEV1/FVC predicted is less than 0.7 percent (Haynes, 2018). The client reports an FEV1/FVC of 0.52, which is indicative of diagnostic airflow obstruction. The FEV1/FVC ratio of

Treatment Plan for the Primary Diagnosis

The goal of treatment in COPD is to reduce the severity and frequency of exacerbations, thus improving exercise tolerance and health status (Global Initiative for COPD, 2018). Bronchodilators (beta2- agonists, Antimuscarinic drugs, and Methylxanthines) are the recommended first-line treatments for COPD (Global Initiative for COPD, 2018). They work by increasing the FEV1, thus increasing the FEV1/FVC ratio (Global Initiative for COPD, 2018). The Global Guidelines for COPD treatment express that initial COPD treatment should begin with a Short-acting beta2-agonist (SABA), a short-acting muscarinic antagonist (SAMA), a long-acting beta2-agonist (LABA) or a long-acting muscarinic antagonist (LAMA) (Global Initiative for COPD, 2018). For patients with moderate to severe COPD and exacerbations, the GOLD Guidelines recommend combination therapy involving a LABA and an anti-inflammatory agent such as an inhaled corticosteroid (ICS) (Global Initiative for COPD, 2018). Clinical trials have shown LABA/ICS combination therapy to be more effective than either medication alone in improving lung function, reducing exacerbations and improving health status in patients moderate to severe COPD (Global Initiative for COPD, 2018). The clinician thus initiates therapy as follows:

Medication #1

Rx: Formoterol 12mcg capsule (LABA)

Sig: 2 puffs daily, 12 hours apart, inhaled via nebulizer

Disp: #90

Refills: 3

Rationale: Formoterol is a LABA with extended duration of action maintained 12 hours after installation of a single dose (Global Initiative for COPD, 2018). Its speed of action and potency make it effective for both quick relief and prolonged effect (Global Initiative for COPD, 2018).

Medication #2

Rx: Budesonide 180mcg inhaler (ICS)

Sig: 2 puffs daily

Disp: #90

Refills: 3

Rationale: Anti-inflammatory agents help to reduce inflammatory biomarkers during exacerbations and to improve symptoms of phlegm and cough (Putcha, 2018). Budesonide is preferred to other ICS because it is less lipophilic and hence, more soluble in airway mucus and more rapidly absorbed into the tissues of the airways (Putcha, 2018).

Influenza vaccine, which decrease the risk of lower respiratory tract infection, once annually

Pneumococcal polysaccharide vaccine (PPSV23), which is recommended for adults aged between 19 and 65 and helps to reduce the incidence of community-acquired pneumonia in COPD patients (Global Initiative for COPD, 2018).

Any Additional Testing Necessary for this Diagnosis

Spirometry testing is the classical diagnostic test for COPD. The classical diagnostic criterion for COPD is an FEV1/FVC ratio of

Patient Education

Disease Factors: There is a need to educate the patient that the goal of COPD treatment is to reduce the frequency and severity of exacerbations, and to improve the quality of life (Global Initiative for COPD, 2018). The long-time decline in lung function due to COPD is irreversible (Global Initiative for COPD, 2018).

Medicine Factors: The patient is to be educated that the capsules are not to be swallowed and should only be administered by the oral inhalation route using the designated inhalers (FDA, 2012). The patients is also advised to take note of adverse effects associated with the use of LABAs and ICS, including the risk of resting sinus tachycardia, pneumonia, oral candidiasis, skin bruising, and hoarse skin (Global Initiative for COPD, 2018).

Prevention: the patient is to be advised against exposing themselves to indoor and outdoor air pollutants, including gases, fumes, and occupational dusts (Global Initiative for COPD, 2018).

Referral

There is a need to refer the client to a pulmonary rehabilitation program, which uses education, exercise, and behavioral intervention to improve how people with chronic lung disease function in daily life (Global Initiative for COPD, 2018). Pulmonary rehabilitation has been shown to be the most effective therapeutic strategy for improving exercise tolerance health status, and shortness of breath among COPD patients (Global Initiative for COPD, 2018).