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Abstract: The patient was a 71-year-old man who was admitted to the hospital with the chief complaint of “recurrent cough and sputum for 20 years and shortness of breath after activity for 5 years, which was aggravated by a cold 3 days ago. The patient reported that he had been a smoker for more than 40 years, with 30-40 cigarettes/day, and had not quit smoking. After admission, he was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and type II respiratory failure through medical history, imaging and other relevant examinations, and his symptoms were controlled and all indicators were improving after drug treatment.
Basic information】Male, 71 years old
Disease Type】Chronic obstructive pulmonary disease
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】January 2019
Treatment plan】Medication (piperacillin sodium tazobactam sodium for injection, ambroxol hydrochloride sodium chloride injection, methylprednisolone sodium succinate for injection, doxorubicin injection, budesonide suspension for inhalation, umebramine vilanterol inhalation powder nebulizer)
[Treatment period] Hospitalization for 10 days, regular outpatient follow up
Treatment effect】Symptoms have been controlled, and all indicators are improving
I. Initial consultation
Patient’s description: 20 years ago, cough and white sputum appeared after every cold or seasonal change, which lasted for more than 3 months every year. 5 years ago, shortness of breath appeared after activity, previous definite diagnosis: chronic bronchitis and chronic obstructive pulmonary disease. In the last 1 week, salmeterol ticapone powder inhaler was regularly applied. Three days before admission, the above symptoms were aggravated by cold with dyspnea, coughing purulent sputum, fever and other symptoms, with a maximum body temperature of 38.5°C. Outpatient examination: body temperature: 38.2℃, pulse: 102 beats/min, respiration: 27 breaths/min, blood pressure: 130/80mmHg; clear, blue lips, chest breathing, barrel-shaped chest, widened rib space; consistent decreased breath sounds in both lungs, dry rales could be heard; heart rhythm was uniform, no rales in each valve area; no edema in both lower limbs. He had a history of smoking for more than 40 years, 30-40 cigarettes/day, and had not quit smoking.
II. Treatment history
After admission, the patient had symptoms of fever and coughing purulent sputum. Routine blood manifestations: increased leukocytes and increased percentage of neutrophils. Ventilation function suggested: severe hypoventilation, mixed ventilatory dysfunction, small airway hypofunction, moderate diffusion hypofunction, negative diastolic test, maximum ventilation of 32%, and percentage of ventilatory storage of 77%. The diagnosis of acute exacerbation of chronic obstructive pulmonary disease and type II respiratory failure was made by history, imaging presentation. There was no pneumothorax, allergy or heart failure, and the triggering factor for exacerbation was infection.
Suitable antibiotic treatment was selected according to the characteristics of the infecting bacteria. Piperacillin sodium tazobactam sodium for injection was given for anti-infection treatment, while aminoglutethimide hydrochloride sodium chloride injection was given for coughing and coughing symptoms to reduce sputum, and budesonide suspension for inhalation to calm asthma. Due to the patient’s heavy wheezing, doxorubicin injection and intravenous methylprednisolone sodium succinate for injection were given to improve ventilation and reduce the patient’s carbon dioxide retention. At present, the patient’s partial pressure of carbon dioxide: 52 mmHg, partial pressure of oxygen: 60 mmHg, and pH is normal. Low-flow oxygen was given and blood gas analysis was monitored, and ventilation was changed as appropriate according to the blood gas analysis.
(Imaging manifestations)
(Ventilation function)
III. Treatment effect
The patient’s diagnosis was clear. At present, he had fever and yellow sputum, and his body temperature dropped to normal after 4 days of anti-inflammatory treatment. He continued intravenous medication for 3 days, and his dyspnea was significantly reduced compared with that before admission after giving inhalation budesonide suspension, doxorubicin injection and injectable methylprednisolone sodium succinate intravenously, and his mouth and lips were not cyanotic, and his blood gas analysis also returned to normal. The patient entered the recovery phase from the acute stage, and the patient’s grading and staging were assessed again according to the mMRC score and CAT in order to formulate a treatment plan for discharge. After the assessment, the patient was given inhalation of umebramonium vilanterol inhalation powder, and the patient was advised to use umebramonium vilanterol inhalation powder for long-term symptom control and home oxygen therapy. In conclusion, the patient was hospitalized for a total of 10 days, and the symptoms were controlled and all indicators were improving.
IV. Notes
We are glad that after active treatment, the patient’s symptoms have improved and all indexes are improving. Since COPD is a lifelong disease, if we don’t pay attention to it in normal time, it will lead to recurrent attacks, especially repeated infections will lead to disease progression and lung function decline, which will increase the number of hospital admissions and increase the economic burden, so the usual maintenance is very important.
1, increase the immunity of the body, appropriate sports, winter and spring seasons are easy to catch a cold, you can inject influenza vaccine or pneumonia vaccine.
2, smoking, air pollution, occupational dust can aggravate lung damage, leading to aggravation of the disease, so it is recommended that patients quit smoking, avoid occupational dust and other factors stimulating, if you go out it is recommended to wear a mask.
3, regular follow-up visits, including: smoking cessation, CAT score, mMRC score, whether drugs are applied on time, whether there are adverse reactions, lung function indicators, whether the inhalation method is correct, comorbidities (heart, osteoporosis, lung cancer, etc.), and anxiety, depression scores, etc.
V. Personal insight
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory system, with expiratory dyspnea as the main disease. If poorly controlled, it will lead to further decline in lung function and affect patients’ quality of life, so it is very important to educate patients about the following: the harm of COPD to the body, complications will occur if poorly controlled, common complications include. Pneumothorax, type II respiratory failure, chronic pulmonary heart disease, etc. As in this case, the acute exacerbation of the infection combined with type II respiratory failure, the main preventive measures are smoking cessation and cold prevention, long-term drug therapy and home oxygen therapy.