45-year-old woman presents with a chief complaint of the 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. The patient has a history of COPD with a chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals a flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields. Purchase the answer to view it

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation that is not fully reversible (Global Initiative for Chronic Obstructive Lung Disease (GOLD), 2021). It is a common condition worldwide and is a significant cause of morbidity and mortality, particularly in elderly individuals (Rabe et al., 2007). Patients with COPD often experience chronic cough, shortness of breath, and sputum production.

This case presents a 45-year-old woman with a history of COPD who is experiencing an exacerbation of her symptoms. She reports worsening shortness of breath, cough with thick green sputum production, and fevers, suggesting a possible infection. This case highlights the importance of recognizing and managing exacerbations in patients with COPD.

Clinical Presentation

The patient, a 45-year-old woman with a history of COPD, presents with a chief complaint of a 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. She reports that her usual chronic cough has worsened and is now interfering with her sleep. She further describes that the sputum is thicker and harder for her to expectorate.

On physical examination, auscultation of the lung fields reveals hyperresonance and coarse rales and rhonchi throughout all lung fields. These findings suggest the presence of increased air trapping and inflammation in the lungs, consistent with an exacerbation of COPD.

Diagnostic Assessment

To further evaluate the patient, diagnostic imaging and tests can be performed. A chest X-ray (CXR) can be obtained to assess the patient’s lung anatomy and identify any abnormalities. In this case, the CXR reveals a flattened diaphragm and increased anteroposterior (AP) diameter. These findings are consistent with hyperinflation of the lungs, which is a characteristic feature of COPD.

Additionally, sputum culture and sensitivity testing can be performed to identify the presence of infection and guide antibiotic therapy. The patient’s symptoms of cough with green sputum and fevers raise suspicion for a bacterial respiratory tract infection, which commonly occurs in COPD exacerbations.

Management

The management of a COPD exacerbation includes both non-pharmacological and pharmacological interventions. Non-pharmacological interventions aim to optimize lung function, relieve symptoms, and prevent complications. These interventions include smoking cessation, oxygen therapy, chest physiotherapy, and pulmonary rehabilitation (GOLD, 2021).

First and foremost, smoking cessation is essential for patients with COPD as it is the most effective intervention to slow the progression of the disease. The patient should be counseled on the benefits of quitting smoking and provided with appropriate resources and support.

Oxygen therapy may be necessary in patients with severe exacerbations and hypoxemia. It helps improve oxygenation and alleviate hypoxemia, which can be detrimental to the heart and other vital organs. Oxygen saturation should be monitored, and supplemental oxygen should be administered to maintain saturation above 90% (GOLD, 2021).

Chest physiotherapy, including techniques such as percussion, postural drainage, and breathing exercises, can help mobilize secretions and improve airway clearance in patients with excessive sputum production. These techniques can be performed by a respiratory therapist or trained healthcare professional.

Pulmonary rehabilitation, which includes exercise training, education, and psychosocial support, has been shown to improve exercise capacity, quality of life, and reduce exacerbation frequency (GOLD, 2021). It should be considered for all patients with COPD, particularly those with recurrent exacerbations.

Pharmacological treatment is an essential component of managing COPD exacerbations. The goals of pharmacotherapy are to relieve symptoms, improve lung function, and prevent complications. The mainstay of treatment is bronchodilators, including short-acting beta-agonists (SABAs) and anticholinergic medications.

SABAs, such as albuterol, provide rapid relief of bronchospasm and can be administered via inhalation. These bronchodilators act by relaxing the smooth muscles of the airways, improving airflow, and reducing shortness of breath. Anticholinergic medications, such as ipratropium bromide, also act to relax the smooth muscles of the airways but may have a longer duration of action compared to SABAs.

In this patient, the use of both SABAs and anticholinergic medications may be appropriate given the severity of her symptoms. These medications can be administered via inhalation using a metered-dose inhaler (MDI) with a spacer or a nebulizer.

In addition to bronchodilators, systemic corticosteroids can be considered in patients with moderate to severe exacerbations. These medications help reduce airway inflammation and improve symptoms. Oral prednisone is the preferred corticosteroid, and the recommended duration of treatment is typically 5 to 10 days (GOLD, 2021).

Conclusion

COPD exacerbations can significantly impact the quality of life of patients. Prompt recognition and management are crucial to minimize symptoms, prevent complications, and reduce hospitalizations. Non-pharmacological interventions such as smoking cessation, oxygen therapy, chest physiotherapy, and pulmonary rehabilitation play important roles in managing exacerbations. In addition, pharmacological treatment with bronchodilators and corticosteroids provides symptomatic relief and helps improve lung function. Overall, a multidisciplinary approach is essential in the management of COPD exacerbations to provide comprehensive care to patients.