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0:00
Hi.
This is the second of
the COPD treatment cases.
I'm Janwillem Kocks.
I'm a general practitioner
and an assistant professor
at the Department
of General Practice
at the University Medical Center
in Groningen in the Netherlands.
And this case will be about
a COPD patient with asthma.
0:20
So we start with Mrs. D again.
She's a 59-year-old lady and
works in a community archive.
And she tells you that she
noticed that while carrying
boxes with books
and stuff has become
more difficult in the last months.
And you see her for the annual
review, which you do for COPD.
If you look at
the lung function,
it's quite stable in the last years,
with an FEV1 of 74% of predicted,
and a FEV1/FVC of 60%.
She tells you she had a course
of antibiotics for a lung attack
last month in the
out-of-hours GP service.
You can question if antibiotics
is the best treatment option,
but this is what she tells you.
She stopped smoking four weeks ago
after about 30 years of smoking,
and it adds up to 35 pack years.
She's got a BMI of 27.8
and a CCQ score of 1.8.
And the medication she uses
is ipratropium short-acting,
a muscarinic antagonist.
And last week she's been using
that for about three times a day
during her work and
when walking with friends.
Next is she uses
tiotropium one times a day.
And if you go back to her
and talk to her a bit longer
about her history she had
with her lung complains,
she says she was admitted to
a rehabilitation service for her CARA,
as she calls it in Dutch,
when she was seven.
The Dutch rehabilitation center
for asthma in Davos, Switzerland.
It's nice, high in
the mountains which
makes it less of a host of
mites and other things that
is bad for young asthma patients.
And it's still in use
for asthma patients.
So that's an important
new information,
and it's different
from the information
we had for the previous case.
And as she completed
the CCQ questionnaire.
