EMJ-PAR-RES-008-25-1 Chronic obstructive pulmonary disease (COPD), case report, COPD, quality of life, nebuliser therapy.

Respiratory

Treating a Moderate Exacerbation in a Patient with COPDTest your knowledge

COPD Has

START

This interactive case studyhas been sponsored by PARI GmbH.

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Many Faces

Respiratory

A 59-year-old patient diagnosed with COPD presented to the pulmonology department of a hospital. (PARI, Data on file) For the last 2 years, the patient had been experiencing increasing shortness of breath that limited his physical activity. He had a 30-pack-year smoking history and was an active smoker.

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Case Presentation

He presented with a dry, unproductive cough. Auscultation of the chest showed noor very quiet breath sounds. Emphysema had already been confirmed on a chest X-ray. The blood test showed no abnormalities: no allergies or increased eosinophil values. The patient was classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3 after spirometry, and his dyspnoea as Grade 2 according to the modified Medical Research Council (mMRC) dyspnoea scale.

Symptoms and Examination

Dry unproductive cough

Emphysema

Respiratory

What would be your initial therapy regimen?

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Q1 - Test your knowledge:

Click on the options.

Long‐actingmuscarinic antagonist (LAMA) + long‐acting β‐agonist (LABA)

Short-acting bronchodilator (when required)

Smoking cessation

Regular physical activity

Short-acting bronchodilator (when required)

Smoking cessation

Regular physicalactivity

Regular physical activity

Smoking cessation

Short-acting bronchodilator (when required)

Regular physicalactivity

Smoking cessation

Short-acting bronchodilator (when required)

Long‐actingmuscarinic antagonist (LAMA) + long‐acting β‐agonist (LABA)

All answers are correct.

Respiratory

The patient presented to the hospital after a stable phase with a moderate exacerbation, without signs of infection. (PARI, Data on file) His cough had increased, with a significant amount of mucus that he struggled to cough up. After 6 months, he had a smoking relapse. Wheezing was present.

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1-year follow-up

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The X-ray images and the laboratory tests, including the blood count and blood gas analysis, were unremarkable without signs of infection. The latter showed normal oxygen saturation andnormal CO2 levels. (PARI, Data on file) His lung function test, measured based on forced expiratory volume in the first second (FEV1) and peak flow, had deteriorated from baseline. His dyspnoea had increased from Grade 2 to Grade 3 according to the mMRC dyspnoea scale.

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1-year follow-up (continued)

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How would you escalate the therapy?

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Q1 - Test your knowledge:

Click on the options.

Switch to LAMA + LABA + inhaled corticosteroid

Add a course of oral corticosteroids

Add short-acting β2-agonist (SABA) + short-acting muscarinic antagonist (SAMA) and isotonic saline via nebuliser

Add a course oforal antibiotics

Answers A, B & C are correct.

As there are no signs of bacterial infection, a course of oral antibiotics is not indicated.

Nebuliser therapy with a PARI inhalation system (PARI GmbH, Starnberg, Germany) was used twice a day to promote the mobilisation of secretions with the combination of SABA, SAMA, and isotonic saline.

A 5-day course of 20 mg daily was added due to the moderate exacerbation.

Escalate the dual therapy to triple therapy for anti-inflammatory treatment due to the moderate exacerbation.

Respiratory

The adjusted treatment led to a very rapid improvement in the patient’s symptoms and lung function. His mMRC Grade dropped from 3 to 2 (PARI, Data on file) .

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Conclusion

This clinical case shows a classic progression of COPD. After a stable phase, the patient had a smoking relapse and experienced a moderate exacerbation with increased coughing and mucus production, which required intensive anti-obstructive and anti-inflammatory treatment. With the addition of a nebuliser with SAMA, SABA, and isotonic saline solution, the patient benefited from an improvement in cough and sputum, lung function, and quality of life.

Summary

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Learn more about selecting the right device for your patient with COPD here in the interactive device selection tool.

Summary continued

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