Chronic obstructive pulmonary disease (COPD) is a progressive, non-reversible disease that makes breathing difficult. COPD is characterized by coughing, often productive; wheezing; shortness of breath; and chest tightness. The leading cause of COPD is cigarette smoking (National Institutes of Health, 2013). While 85 % of COPD patients are or were smokers, only 10-25 percent of smokers develop COPD, suggesting that a genetic predisposition may also be a factor (Warren, 2012). COPD is the third leading cause of death and major cause of disability in the United States (National Institutes of Health, 2013).
Pathophysiology of COPD
Two primary disease processes that contribute to COPD are emphysema and chronic bronchitis. The main difference between emphysema and chronic bronchitis is that in emphysema damage is to the walls of the air sacs in the lungs and in chronic bronchitis the damage is to the lining in the airways. Both conditions are generally caused by long term exposure to lung irritants, the most common of which is cigarette smoke. Other typical lung irritants contributing to COPD are air pollution, chemical fumes, and dust. The lung irritants cause inflammation; when inflammation is chronic, it causes scar tissue. Scar tissue in the airways decreases elasticity, air sacs are destroyed, walls of airways become thick and inflamed, and mucous production increases. The end result of damaged airways and excess mucous is decreased gas exchange and reduced lung capacity causing the symptoms of COPD (National Institutes of Health, 2013).
Patient History and Physical Examination
Mrs. Jones is a new patient who is a 56 year old Caucasian female. She has recently moved from Minnesota to Arizona. She has a history of COPD and seasonal allergies which she has been treating with Claritin 10mg and Albuterol MDI 2 puffs PRN. Mrs. Jones was a smoker, smoking two packs per day for 30 years and quit two years ago. Her family history is noncontributory. Mrs. Jones presents with recent fatigue, worsening runny nose and productive cough in the morning, sneezing, itchy throat, shortness of breath with minimal exertion, audible wheezing, and inability to sleep through the night. She has admitted to using her inhaler more often than prescribed in an attempt to deal with the worsening symptoms. She denies change in the color of her sputum, discolored nasal drainage, headache, facial pain, loss of appetite, and chest pain.
Physical exam showed a well-dressed, well-nourished woman who is cooperative and appropriate. Vital signs are blood pressure: 128/72, pulse: 88 and regular, and respirations: 20. Lungs have bilateral basilar wheezing. Heart is regular and without murmurs. Abdomen is soft and non-tender with bowel sounds present. It is noted that she has dark circles under both eyes. Current oxygen saturation was 92% on room air at rest. Spirometry results were FEV1=45% and FEV1/FVC=65%.
It appears that Mrs. Jones is having an exacerbation to her environmental allergies as evidenced by the sneezing, itchy throat, and runny nose. The Claritin that was working in Minnesota is not working as well with the allergens unique to Arizona. The dark circles under her eyes are often evidence of increased allergic reaction known as allergic shiners. However, the decreased oxygen saturation and spirometry values are more indicative of severe (stage III) COPD, defined by the GOLD standard as FEV1/FVC