Pathophysiology
According to the case study, A.C., a 61-year old male patient was seen in a clinical setting with complaints of shortness of breath. Concerning spirometry, its results are consistent with obstructive pulmonary disease. On the basis of the patient’s past medical history, observation, and spirometry, it is possible to conclude that the most likely pulmonary diagnosis for this patient is chronic obstructive pulmonary disease (COPD). As COPD includes emphysema and chronic bronchitis, the former may be regarded as the most suitable condition. It remains one of the major causes of morbidity and mortality in the United States (Lowe et al., 2018). Its underlying processes that lead to the manifestation of signs and symptoms and further development of the disease include the peripheral airway’s inflammation and narrowing, airflow limitation due to the destruction of small airways, parenchymal destruction, and reduced FEV1 (Lowe et al., 2018). Starting with the damage of lungs’ tiny air sacs and the airways, the symptoms of COPD progress from a cough with mucus to severe shortness of breath (Duffy & Criner, 2019).
The case’s objective findings that support the presence of COPD include the patient’s long-lasting history of smoking, dyspnea with exertion, and even non-productive cough. In other words, the main symptoms of COPD that indicate the inflammation of lungs and the narrowing of airways are observed, and smoking may be regarded as the main risk factor of this disease’s development. The case’s subjective findings include bilateral hyper-inflammation of lungs, related bilateral wheezes noted with forced exhalation along with a prolonged expiratory phase, and hypertension along with coronary disease. The first two manifestations are typical in the case of COPD, however, may indicate another diseases, while the inflammation of lungs correlated with various heart diseases as well. COPD is associated with low oxygen level due to the inability of lungs to work properly caused by inflammation and narrow airways (CIS Staff, 2017). Thus, low oxygen level may put additional stress to the heart and impact blood pressure leading to additional comorbidities.
Management
According to the classification of airflow limitation severity in COPD, the patient has a moderate phase and his COPD is stable (GOLD, 2022). In this case, among “Evidence A” recommended medication classes for the treatment of this condition are Bronchodilators (Fenoterol, Levalbuterol, Salbutamol, Formoterol, and others) and Methylxanthines (Aminophylline, Theophylline) (GOLD, 2022). Bronchodilators are used to stimulate beta2-adrenergic receptors and relax airway smooth muscle. In other words, this class of medications facilitate breathing by opening airways. Methylxanthines are used for the relaxation of muscles in the airways as well and additionally serves as anti-inflammatory medications. In addition, “Evidence A” recommended non-pharmacological treatment options for this patient include the long-term administration of oxygen, smoking cessation, active and healthy lifestyle, exercise, and self-management education. In general, non-pharmacological treatment may be regarded as no less important than pharmacological one. While medications may improve the patient’s condition in emergency situations, the development of the disease will depend on his lifestyle and habits.
References
CIS Staff. (2017). COPD and heart failure: What are the symptoms and how are they related? Cardiovascular Institute of the South. Web.
Duffy, S. P., & Criner, G. J. (2019). Chronic obstructive pulmonary disease: Evaluation and management. Medical Clinics, 103(3), 453-461.
GOLD. (2022). Pocket guide to COPD diagnosis, management and prevention: 2022 report [PDF document]. Web.
Lowe, K. E., Regan, E. A., Anzueto, A., Austin, E., Austin, J. H., Beaty, T. H.,… & Crapo, J. D. (2019). COPDGene® 2019: Redefining the diagnosis of chronic obstructive pulmonary disease. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 6(5), 384. Web.
