Clinical Case Database / Category: Patient Management
Chronic obstructive pulmonary disease: aiming for a good outcome.
Publication details
Dr Gulammehdi Haji, Dr Graeme Wilson
Foundation Years Journal, volume 5, issue 9, p.12 (123Doc Education, London, October 2011)
Abstract
The aim of this case history is to highlight some of the current issues around assessing and treating a patient with an acute exacerbation of COPD. It details the presentation to hospital of a 78 year-old woman with severe COPD during her final acute exacerbation. She had once again presented to the accident and emergency department significantly short of breath despite the use of her home oxygen. In spite of thorough assessment, investigation and appropriate management, she did not survive. Treatment was rapidly administered and NIV was used in an attempt to correct an acute respiratory acidosis which had developed on a background of chronic respiratory failure secondary to COPD, with ensuing cor pulmonale. Appropriate decisions were made early about the ceiling of care and despite maximal therapy the patient deteriorated. Once a diagnosis of dying was made the patient was managed accordingly to ensure that her death was not distressing. As a foundation year doctor when faced with complex cases such as this, with clinically very unwell patients who may not survive it is very important to seek help early.
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Authors
Dr Gulammehdi Haji
Speciality Trainee 3, Respiratory Medicine,
Charing Cross Hospital, Imperial College Healthcare NHS Trust
Dr Graeme Wilson
Consultant Respiratory Physician, Charing Cross Hospital,
Imperial College Healthcare NHS Trust
References
1. Hurd S. The impact of COPD on lung health worldwide: Epidemiology and incidence. Chest 2000;117:1S-4S
2. Tashkin D P, Celli B, Senn S, et al. A 4-year trial of Tiotropium in Chronic Obstructive Pulmonary Disease. N Engl J Med 2008;359:1543-54
3. Caverley P M A, Anderson J A, Celli B, et al. Salmeterol and Fluticasone Propionate and Survival in Chronic obstructive Pulmonary Disease. N Engl J Med 2007;356:775-89
4. BTS guidelines, British Thoracic Society Standards of Care Committee. Thorax 2002;57;192-211
5. Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ 2003;326:30-34
Disclaimers
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
Financial Statement
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
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When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.