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JANWILLEM KOCKS: Hi.
I'm Janwillem Kocks.
I'm a general practitioner and
researcher at the Department
of General Practice at
the University Medical Center
in Groningen.
This talk will be
about a COPD patient
with bronchitis attacks.
And this is the first of
a series of three cases
in which I will run through
the decision-making
on COPD patients
and management.
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I would like to introduce
Mrs. D. and she's a 59-year-old lady.
And she works in
a community archive.
And during the annual
review for her COPD,
she tells you that it's
becoming more and more
difficult to carry the boxes
she has to carry for work
doing the last months.
And if you do
the lung function test,
you'll find a lung function
FEV1 of 74% of predicted,
and an FEV1/FVC ratio of 68%.
And actually, this has been
quite stable over the last years.
And she tells you she had
a course of antibiotics for one
of her bronchitis
attacks or lung attacks
during the last months when
in the weekend she had trouble,
and she went to
the out-of-hours GP service.
She's been smoking quite
a lot, of 35 pack years.
But she tells you very happily that
she stopped smoking four weeks ago.
And it was actually
the moment when she
was in trouble with her
coughing and breathlessness.
She's a bit overweight
with a BMI of 27.8.
And she has a CCQ score,
so a score on the questionnaire of 1.8.
I'll come back to that later on.
For the last years, she's been
using ipratropium bromide
as a dosis aerosol as needed.
And she tells you she's been
using that more and more lately.
At the moment, she's been using
it for about three times a day,
both at work and when she goes
out walking with her friends.
After the bronchitis attack,
for which she attended
the out-of-office service,
she received a prescription
of fluticason/salmeterol,
and she uses
that twice a day,
which is quite proactive
from the out-of-office GP.
