Tailoring care for advanced COPD

Published on February 29, 2016   48 min

Other Talks in the Series: Advances in Chronic Obstructive Pulmonary Disease (COPD)

I'm presenting a COPD case study. My name is Wissam Chatila.
KM is a 58-year-old man, diagnosed with emphysema in 2010. He presents to my clinic for a second opinion for management of his COPD. He has no significant past medical history. He has no prior history of cardiovascular disease or metabolic diseases. He is a retired airport technician and former smoker. He quit one year ago, and no other history of illicit drug use and/or prior exposures. His family history is significant, with a brother who has a history of asthma.
He had three exacerbations per year over the last two or three years, some requiring hospitalizations. He had two pneumonias over the last two years, in addition to his exacerbations. He has no wheezing, by history, but has a slight cough, minimally productive, with occasional clear mucus production. His mMRC score is 3. That is, he is breathless with mild to moderate activity. He stops for breath after walking 100 yards or after a few minutes on level ground. He gets substantial relief with the use of albuterol nebulizer treatments that he takes three or four times per day.
This slide shows his pulmonary function test. The first one were done in May, 2012, by his pulmonologist. His vital capacity was 105, FEV1, 33%, and is FEB1/FVC ratio is 25%, significant for a very severe obstruction. Air trapping, his TLC is 128, and RV is 209, so he's significantly hyperinflated and air trapped. The most recent pulmonary function test shows a significant deterioration in his air flow obstruction, with an FEV1 of 17%, compared to the 33%, so it continues to be very severe and much worse compared to 2012. His hyperinflation and air trapping also have progressed, with a TLC of 138%, and RV, 295%. His DLCO is also severely reduced to 22%, and on the six-minute walk distance, he walked 165 meters, his lowest oxygen saturation was 80%, and he required 6 liters per minute to maintain an oxygen saturation about 90%. His arterial blood gas does not show significant hypercapnia, but he was hypoxemic with a PO2 of 65.