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COPD treatment case I: COPD with “bronchitis attacks”
Published on February 29, 2016 11 min
A selection of talks on Clinical Practice
Behavioral medicine: what it is and what it does
- Dr. Gina Touch Mercer
- University of Arizona College of Medicine - Phoenix, USA
The history and foundations of medical research ethics
- Prof. Dr. Christian Lenk
- Ulm University, Germany
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.
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.