COPD Case Study

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, irreversible lung disorder characterized by airflow limitation due to chronic bronchitis, emphysema, or both. It is most commonly caused by long-term exposure to smoking or environmental pollutants. COPD significantly impacts the quality of life and may lead to frequent hospitalizations.

Case Presentation

Patient Profile

• Name: Mr. R (pseudonym)

• Age: 62 years

• Gender: Male

• Occupation: Retired factory worker (cement industry)

• History: Chronic smoker (30 years, 1.5 packs/day)

• Comorbidities: Hypertension, Type-2 Diabetes

Chief Complaints

• Shortness of breath for 6 months, worsening gradually

• Chronic cough with thick sputum, especially in the morning

• Wheezing and fatigue

• More episodes of breathlessness for the last 3 weeks

History of Present Illness

The patient reported progressive dyspnea, initially on exertion but now even at rest. He had recurrent episodes of respiratory infection in the past year. Weight loss of 4 kg in 3 months was noted. No history of TB.

Physical Examination

Parameter	Findings
Respiratory Rate	28 breaths/min
Pulse	96 bpm
Blood Pressure	138/86 mmHg
SpO₂	88% on room air
Chest Auscultation	Bilateral wheezing, decreased breath sounds
Shape of Chest	Barrel-shaped chest
Use of accessory muscles	Present

Investigations

Test	Result	Interpretation
Chest X-Ray	Hyperinflated lungs, flattened diaphragm	Features suggestive of emphysema
CBC	Mild leukocytosis	Respiratory infection
ABG	pH 7.33, ↑PCO₂, ↓PO₂	Respiratory acidosis
Spirometry (FEV₁/FVC)	55%	Severe COPD
Sputum Culture	No growth of TB

Diagnosis

Stage III – Severe COPD (Based on GOLD Classification)

• FEV₁ 30–50% predicted

• Chronic respiratory symptoms

• Frequent acute exacerbations

Management Plan

Medical Treatment

• Bronchodilators: Salbutamol + Ipratropium inhaler

• Long-acting bronchodilator: Tiotropium

• Inhaled corticosteroid: Budesonide

• Antibiotic: Azithromycin for secondary infection

• Oxygen therapy: 2 L/min via nasal cannula

• Mucolytic agent: Ambroxol

• Vaccination: Influenza and pneumococcal vaccines advised

Non-pharmacological Management

• Pulmonary rehabilitation (breathing exercises, chest physiotherapy)

• Nutrition counseling – high-protein, high

• high-calorie diet

• Smoking cessation counseling

• Avoid exposure to dust and pollutants

Nursing Management

Goals

• Improve ventilation and oxygenation

• Reduce anxiety and respiratory distress

• Promote effective airway clearance

Interventions

• Monitor respiratory rate, oxygen saturation, ABG levels

• Fowler’s position to ease breathing

• Encourage pursed-lip and diaphragmatic breathing

• Maintain adequate hydration to loosen secretions

• Provide emotional support and education about inhaler use

Outcome

After 10 days of treatment and rehabilitation support:

• Improved oxygen saturation to 94%

• Reduced coughing and breathlessness

• Better tolerance to mild physical activity

Discussion

This case highlights the importance of early detection, smoking cessation, and long-term management in COPD patients. Regular follow-up and adherence to inhaled therapy significantly reduce hospital readmissions.

Conclusion

COPD is a chronic, progressive disease that needs comprehensive care and lifestyle modification. With timely intervention and pulmonary rehabilitation, patients can achieve better quality of life and reduced exacerbations.

Key Points

• Smoking and occupational pollution are major risk factors.

• Spirometry is essential for diagnosis and staging.

• Inhaled bronchodilators and corticosteroids are cornerstone therapy.

• Pulmonary rehabilitation is crucial for long-term success.