Title COPD | AEBA | BRONCHIECTASIS ✅

COPD TOPIC : COPD LONG CASE HISTORY TAKING 1. 4C a. Complaint: worsening shortness of breath. Evaluate further using MRC dyspnoea scale. - Describe as sense of increased effort to breathe, chest heaviness, air hunger or gasping. Other symptoms to explore: - Chest tightness - Fatigue - Activity limitation - Chronic cough with/without sputum - Initially cough may be intermittent, but subsequently my be present every day, throughout the day - Wheezing - Weight loss b. Course - Prolonged exposure to risk factors, especially smoking and occupational or environmental dust. - Occur in older age (>40 years old) - Initial presentation is cough associated sputum production - Then, patient will develop progressive shortness of breath - Frequent exacerbations if left untreated or non compliance - Patient may have chronic bronchitis or emphysema
c. Cause Risk factors - Tobacco smoking - Occupational exposure to dust - Genetics - alpha-1 antitrypsin (rare) Cause of acute exacerbation - Poor compliance to medication - Poor inhaler technique - Infection - Environmental pollutants d. Complications Of the disease - Pneumothorax - Cor pulmonale - Lung cancer Of treatment/medication Medication Side effects Bronchodilators Resting sinus tachycardia Tremors Hypokalemia, especially with combination of diuretics used.
Antimuscarinic drugs Mouth dryness Bitter, metallic taste Small increase in cardiovascular events Acute glaucoma Methylxanthines Atrial and ventricular arrythmias Grand mal convulsion Headache, insomnia, nausea and heartburn Significant drug-drug interaction Inhaled corticosteroids (ICS) Oral candidiasis Hoarseness of voice Skin bruises Pneumonia, tuberculosis Risk of decrease BMD and fracture Diabetes mellitus Cataract Mycobacterial infection Phospodiesterase-4 (PDE4) inhibitors Diarrhea Nausea Reduced appetite Weight loss Abdominal pain Sleep disturbance Headache 2. Systemic Review a. Exclude complications Pneumothorax Sudden dyspnoea Cor pulmonale Pedal edema, abdominal distension Lung cancer Haemoptysis, constitutional symptoms b. Exclude other diagnosis - refer section differential diagnosis 3. Past Medical History a. Comorbidities in COPD - Cardiovascular disease, cor pulmonale - Lung cancer - Osteoporosis
- Depression and anxiety - GERD b. Clarify the underlying diagnosis of COPD. - When was it diagnosed? - Presenting symptoms at diagnosis - Risk factors that patients has - Investigations done to confirm the diagnosis - Treatment received - Control of disease: frequency of exacerbation, effort tolerance - Severity: history of ICU admission and intubation - Complications of disease and treatment 4. Past Surgical History a. Active Complaint b. Current control or status c. Complications of disease and surgery d. Compliance to Dr recommendations 5. Social History - Patient’s exposure to risk factors - Smoking: pack years, duration, current status (active, ex-smoker) - Occupational exposure: duration, severity of exposure, use of protective equipments - Impact on patient’s life - Limitation of activity, missed work and economic impact, effects on daily routines and wellbeing - Social and family support - PHYSICAL EXAMINATION 1. Body habitus: cachexic 2. Mental status: alert/drowsy/confused 3. Sign of respiratory distress - use of accessory muscles of respiration, chest recession, purse lips 4. Skin Colour: cyanosis 5. Peripheral attachment - oxygen supplementation, venturi mask, inhaler 6. Signs of cor-pulmonale and CO2 retention - Ankle edema - Raised JVP - Bounding pulse - Flapping tremor - Papilloedema 7. Focus examination anticipated findings specific for the case a. Respiratory examination