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Tailoring care for advanced COPD

Published on February 29, 2016 Updated on September 30, 2021   48 min

A selection of talks on Clinical Practice

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0:00
I'm presenting a COPD case study, my name is Wissam Chatila. KM is a 58 year-old man diagnosed with emphysema in 2010,
0:06
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 a former smoker, he had quit one year previously. There was no other history of illicit drug use and/or prior exposures. Family history is significant for a brother who has history of asthma.
0:45
He had three exacerbations per year over the last two or three years, some requiring hospitalization. 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 a hundred 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.
1:34
This slide shows his pulmonary function tests. The first ones were done in May 2012 by his pulmonologist. His vital capacity was 105, FEV1 33 percent, and his FEV1/FVC ratio is 25 percent, significant for 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 percent compared to the previous 33 percent, so he continues to be very severe and much worse compared to 2012. His hyperinflation and air-trapping have also progressed, with a TLC of 138 percent and RV of 295 percent. His DLCO is also severely reduced to 22 percent. On the six-minute walk distance he walked 165 meters, his lowest oxygen saturation was 80 percent, and he required six liters per minute to maintain an oxygen saturation above 90 percent. His arterial blood gas does not show significant hypercapnia, but he was hypoxemic with a PO2 of 65.

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