Pathophysiology & Clinical Findings of the Disease

Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?

According to the case study, spirometry results are consistent with obstructive, an indication that it has the most probable pulmonary being chronic obstructive pulmonary disease (COPD), specifically Emphysema, since the patient has been experiencing shortness of breath for a long without improvement despite various interventions (Roland, 2018).

Explain the pathophysiology associated with the chosen pulmonary disease.

Pathogenesis of chronic obstructive pulmonary (COPD), especially Emphysema, is based on the instinctive and adaptive inflammatory immune reaction to the inhalation of toxic gases and particles (Roland, 2018). The underlying disease process that causes COPD is based on various signs and symptoms characterized by the side effect of inhaled toxic particles and gases that narrows the peripheral airway, reduced FEV1, and parenchymal destruction from Emphysema that causes airflow limitation leading to limited airflow and loss of the small airways. Research indicates that COPD begins by damaging the lungs’ airways and the tiny air sacs. Its symptoms are progressive and worsen as time goes on because chronic obstructive pulmonary damage in the lung cannot be undone despite various interventions (Roland, 2018).

Identify at least three subjective findings from the case which support the chosen diagnosis.

Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable, and manageable health issue associated with many cigarette smokers. From the presented case of the 61-year-old man, I identified various subjective findings that support the fact that the patient is suffering from Chronic Obstructive Pulmonary Disease (COPD) since when the patient was presented showed the following signs and symptoms:

The patient was experiencing shortness of breath, a condition worsening.

A week ago, the patient had an acute onset of mid-sternal chest pain.

Complained of fatigue and increasing dyspnea for three months.

Additionally, patient history indicated that the patient was a victim of hypertension, hyperlipidemia, atherosclerotic coronary artery disease, and he was smoking. Research by PubMed scholars shows these significant signs of COPD as side effects of smoking, a risk factor of COPD.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

Classify the patient’s disease severity. Is this considered stable or unstable?

It is unstable to evaluate the patient’s disease severity as presented in the case study. This is because, as explained in the case study, the patient’s condition worsened despite various interventions being carried out before discharge. This shows that the patient had dyspnea, which research states are a significant lead to difficulty breathing due to the destruction of airways and the tiny air sacs in the lungs, leading to increased chest pains and gasping.

Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

According to the GOLD report 2022, Chronic Obstructive Pulmonary Disease, especially Emphysema, can be recommended as two medication classes based on the best evidence from the published literature. Medication classes recommended to the patient include bronchodilators, a type of medication aimed at increasing FEV1 and changing spirometric variables. An example of a drug contains formoterol and salmeterol. Another medication class that I would recommend for the patient is antimuscarinic drugs (short-acting antimuscarinics, SAMAs) that are administered to prevent bronchoconstrictor effects of acetylcholine on m3 muscarinic receptors. Such drugs include tiotropium, glycopyronium bromide, and aclidinium, among others.

Describe the mechanism of action for each of the medication classes identified above.

Mechanism action of antimuscarinic drugs, which are short-acting antimuscarinics (SAMAs), help COPD patient since muscarinic receptor antagonists help by competitively blocking any Ach binding to muscarinic receptors, which lead contribute to an anticholinergic response (Terry & Dhand, 2020).

Mechanism action for bronchodilators class of medication help makes it easier for the patient to relax the lungs muscle and widen their airways (bronchi). They are used for long-term diseases like COPD that make bronchi narrow and inflamed (Karal & Celik, 2022).

Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

Non-pharmacological treatment recommendations for this patient include smoking cessation and pulmonary rehabilitation. Smoking cessation is a non-pharmacological intervention to help COPD patients stop smoking since it helps prevent toxic particle deposition in the airways. Pulmonary rehabilitation is the most effective non-pharmacological intervention that helps in improving COPD patients’ health status and quality of life (Guilleminault et al 2018).

References

Global Initiative for Chronic Obstructive Lung Disease Global Initiative for Chronic Obstructive Lung Disease 2022 REPORT GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. (2022). https://goldcopd.org/wp-content/uploads/2021/12/GOLD-REPORT-2022-v1.1-22Nov2021_WMV.pdfGuilleminault, L., Rolland, Y., & Didier, A. (2018). Characteristics of non-pharmacological interventions in the elderly with COPD. Smoking cessation, pulmonary rehabilitation, nutritional management and patient education. Revue des Maladies Respiratoires, 35(6), 626-641. https://doi.org/10.1016/j.rmr.2017.12.004Karal, A., & Celik, H. (2022). Drugs and Natural Products Used in COPD. International Journal of Innovative Research and Reviews, 6(1), 51-58.

Roland, J. (2018, November 12). What Is the Pathophysiology of COPD? Healthline; Healthline Media. https://www.healthline.com/health/copd/pathophysiologyTerry, P. D., & Dhand, R. (2020). Inhalation therapy for stable COPD: 20 years of GOLD reports. Advances in therapy, 37(5), 1812-1828. https://doi.org/10.1007/s12325-020-01289-y