COPD Case Presentation

WELCOME
TO
MORNING SESSION
Academic case Presentation
Dr. Jannatul Marzia
Intern Doctor
Department of Medicine
Tairunnessa Memorial Medical College
& Hospital
Particulars of the Patient
 Name: Mrs. Nur Jahan

 Age: 60 y
 Sex: Female
 Marital status : Married
 Present and Permanent Address: Bypass, Gazipur.
 Religion: Islam
 Date & Time of Admission: 27/2/24 @ 7.45 PM
 Date and time of examination : 28/2/24 @ 10.00 AM
Chief Complaints:
1.Breathlessness for 3 days

2.Caugh with sputum for 10 years
which increased severity for 10
days
History of Present Illness:
 The patient was alright 10 years back. Since then, she has been
suffering from frequent attack of cough with profuse
expectoration of mucoid sputum. Cough is present throughout
the day and night, more marked in the morning and also on
exposure to cold and dust. It is progressively increasing day by
day. She also complains of difficulty in breathing, more
marked during moderate to severe exertion, relieved by taking
rest.
Continue
Her breathlessness is progressively increasing for 10 days.

She does not give any history of fever, swelling of the
ankle or weight loss. She is normotensive and non-
diabetic. Her bowel and bladder habits are normal. Now
she is admitted to our hospital for better management.
Continue
 History of past illness: The patient was admitted in the hospital 2 times with severe
breathlessness in the last 4 years.
 Family history: She has 4 members in her family. All the members of her family are in
good health.
 Drug history: She used to take Tab. Monas (10mg). Sometimes, she used to take
different types of inhalers.
 Personal history: She is a housewife. She smokes 8to10 cigarettes daily for last 20
years.
Continue
 Allergic History: She has no allergy to food or drugs

 Immunization History: She was partially immunized &
also takes Covid 19 vaccine.
 Socioeconomic History: She belongs to middle class
family & lives in house with good water supply & well
sanitation.
GENERAL EXAMINATION
•Appearance: Ill-looking(Pursed lip breathing )

Body Build & Nutrition: Average.
•Decubitus: Propped up position.
•Co-operation: Co-operative.
•Anaemia: Absent.
•Jaundice: Absent.
•Cyanosis: Absent.
Continue
•Clubbing: Absent.
•Koilonychia: Absent
•Leukonychia: Absent
•Oedema: Absent
•Dehydration: Absent.
GENERAL EXAMINATION
•Jugular venous pressure: Not Raised

•Neck Vein: Not engorged.
•Thyroid Gland: Not enlarged.
•Lymph Nodes: Not palpable
•Bony Tenderness: Absent
•Skin pigmentation: Normal
VITALS
•Pulse: 93 beats/min
•Blood Pressure: 130/80 mmHg
•Respiratory Rate: 28 breaths/min
•Temperature: 98°F
•SPO2: 97% without Oxygen
Systemic Examination
Respiratory system:
•Inspection:
Shape of the chest: Barrell shaped.
Respiratory rate : 28breats/min
Movement of the chest: Bilaterally restricted
Intercostal indrawing: Present
Prominence of accessory muscle of respiration: Present
Respiratory system:
•Palpation:
 Trachea was centrally placed
 Apex beat is situated in left 5th intercostal space at
midclavicular line
 Chest expansibility: Reduced
 Vocal fremitus :Reduced
Respiratory system:
•Percussion: Percussion note is resonant over both lung fields.

•Auscultation:
Breath sound was vesicular with prolonged expiration.
Vocal resonance reduced.
Rhonchi present in both lung fields.
Cardiovascular system
•Inspection: There is no visible carotid & epigastric pulsation and no

cardiac impulse were seen.
•Palpation: Apex beat was found at left 5th intercostal space just
medial to midclavicular line. There is no left parasternal heave, no thrill.
•Auscultation: 1st & 2nd heart sounds are audible at all four cardiac
area. No murmur present.
Alimentary system
Inspection:
 Shape of the abdomen was normal.
 There was no scar mark.
 No visible peristalsis.
 Umbilicus was inverted and centrally placed.
Alimentary system
Palpation:
 Abdomen was soft and non tender
 Liver and spleen are not palpable
 Kidney are not enlarged.
•Percussion: Percussion note was tympanic.

•Auscultation:
 Bowel sound was present.
Other systemic examinations
were performed and
revealed no abnormality.
Salient Feature
Mrs. Nur Jahan, 60 years old, Housewife, normotensive, nondiabetic, smoker, hailing from
Bypass ,Gazipur. Presented with frequent attack of cough with profuse expectoration of
mucoid sputum.
Cough is present throughout the day and night, more marked in the morning and also
on exposure to cold and dust. It is progressively increasing day by day.
She also complains of difficulty in breathing, more marked during moderate to severe
exertion, relieved by taking rest. Her breathlessness is progressively increasing for 10 days.
She does not give any history of fever, swelling of the ankle or weight loss.
Her bowel and bladder habits are normal.
Continue
She was admitted in the hospital 2 times with severe breathlessness in

the last 4 years. She smokes 8 to 10 cigarettes daily for last 20 years.
She used to take Tab. Monas (10mg). Sometimes, she used to take
different types of inhalers.There is no history of such illness in her
family.
Continue
On general examination
•Pulse: 93 beats/min ,Blood Pressure: 130/80 mmHg,
Respiratory Rate: 28 breaths/min, Temperature:
98°F,SPO2: 97% without Oxygen
Continue
On systemic examination:
Pursed lip breathing , Barrell shaped chest, Respiratory rate
28breats/min ,Movement of the chest: Bilaterally restricted , Intercostal
indrawing: Present, Trachea was centrally placed, Apex beat is situated in
left 5th intercostal space at midclavicular line, Chest expansibility: Reduced
, Vocal fremitus :Reduced , Percussion note is resonant , Breath sound was
vesicular with prolonged expiration , Vocal resonance reduced , Rhonchi
present in both lung fields . Other systemic examination revealed normal.
Provisional Diagnosis
Acute exacerbation of COPD.

Differential Diagnosis
Bronchial Asthma
Pulmonary Tubercolosis
Investigations
 Chest X-ray P/A view

 ECG
 CBC with ESR
 RBS
 S.Creatinine
 S.IgE
 Cardiac Troponin I
Chest X-ray
CBC:
 HB%:- 12.2 gm/dl

 Total WBC:- 6600/cumm
 MCV : 84.9fL
 HCT : 33.9 %
 Neutrophil : 64%
 Lymphocytes : 30%
 Platelet count:- 320000/cumm
S.Creatinine:0.7mg/dl
RBS: 5.0mmol/L
Total IgE:248.04 IU/ml
Cardiac Troponin I: <0.01
ECG
Confirmatory Diagnosis:
Acute exacerbation of COPD.

Treatment & Management at ward
 Diet: Normal
 Bed rest: propped up position
 O2 Inhalation:1-2L/min
 Inf: Ariton
I/V @ 7 drops/ min.
 Nebulization with windel plus + N/S (3ml) …6 hourly
 Nebulization with Budicort ……..12 hourly
 Inj. Moxaclav (1.2gm)(Amoxicillin + Clavulanic acid)
1 Vial I/V …..TDS
 Inj. Cotson (100mg)(Hydrocortisone)
Continue
 Tab. Arokast (10mg)(Montelukast)
0+0+1
 Tab. Docopa (200mg)(Doxofoilline)
1+0+1
 Tab. Dilator(10mg)(Bambuterol Hydrochloride)
0+0+1
 Tab. Rupa(10mg)(Rupatadine)
0+0+1
 Cap.Maxpro(20mg)(Esomeprazole)
1+0+1
 Syp. Ambrox (Ambroxol)
2TSF×TDS
Treatment during discharge
 Tab. Moxaclav (625 mg) (Amoxicillin + Clavulanic acid)
1+1+1…7Days
 Inh. Saltica (25/250 meg)(Salmeterol+ Fluticasone)
2 Puff x BD
 Tab. Arokast (10mg) (Montelukast)
0+0+1…….1 Month
 Tab. Docopa (200mg) (Doxofoilline)
1+0+1……..1 Month
 Tab.Rabe (20mg)(Rabeprazole)
1+0+1(B/M)…….1 month
 Syp. Ambrox
2TSFxTDS….10Days
Advice:
 Avoid smoking.
 Take medicines regularly.
 Avoid dust & dirt .
 Avoid cold food & drinks.
 Use mask .
Follow up:
 After 1 month come again with the report of chest x ray .

THANK YOU

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WELCOME

 Name: Mrs. Nur Jahan

1.Breathlessness for 3 days

Her breathlessness is progressively increasing for 10 days.

 Allergic History: She has no allergy to food or drugs

•Appearance: Ill-looking(Pursed lip breathing )

•Jugular venous pressure: Not Raised

•Percussion: Percussion note is resonant over both lung fields.

•Inspection: There is no visible carotid & epigastric pulsation and no

•Percussion: Percussion note was tympanic.

She was admitted in the hospital 2 times with severe breathlessness in

Acute exacerbation of COPD.

 Chest X-ray P/A view

 HB%:- 12.2 gm/dl

Acute exacerbation of COPD.

 After 1 month come again with the report of chest x ray .

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