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Abstract: The patient in this case is a 79-year-old grandfather who came to our hospital with a long-term (20 years) recurrent cough, sputum and wheezing, mostly induced after exertion and cold, which worsened in the last 10 days, and was diagnosed with chronic obstructive pulmonary disease after completing relevant tests. After hospitalization, the patient’s symptoms were controlled by medication + non-invasive ventilator assistance, and all indicators were improving.
Basic information】Male, 79 years old
Disease type】Chronic obstructive pulmonary disease
Hospital】Weihai Central Hospital
Date of consultation】May 2022
Treatment plan】Medication (piperacillin sodium tazobactam sodium for injection, methylprednisolone tablets, dihydroxypropyl theophylline tablets, budesonide suspension for inhalation, terbutaline sulfate nebulizer) + non-invasive ventilator assisted breathing
[Treatment period] 9 days of hospitalization
Treatment effect】The condition has been controlled and all indicators are improving.
I. Initial consultation
The patient was admitted to the hospital with “recurrent cough, sputum and wheezing for 20 years, aggravated for 10 days”. The patient complained that he had a cold 10 days ago, and after the cold, he started to have coughing, coughing and wheezing, and sometimes he could wake up at night, and his activity endurance decreased significantly. Oxygen partial pressure: 59.1mmHg, meeting the criteria of type II respiratory failure, and the diagnosis of chronic obstructive pulmonary disease with acute exacerbation was considered at present.
II. Treatment history
Considering the seriousness of the patient’s condition, we consulted with the family and immediately admitted the patient to hospital for further treatment, and asked the family about the patient’s usual quality of life and whether he could engage in general physical labor. The cough and sputum volume increased significantly, and the wheezing also increased significantly, and he felt wheezing with slight activity and had symptoms of drowsiness. After admission, the patient was given a chest CT, piperacillin sodium tazobactam sodium for injection, methylprednisolone tablets and dihydroxypropyl theophylline tablets for anti-inflammation and asthma, budesonide suspension and terbutaline sulfate nebulizer for inhalation, and a non-invasive ventilator for assisted breathing.
III. Treatment effect
After the treatment, the patient’s cough, sputum and wheezing symptoms were significantly better than before, and his activity endurance was significantly improved, he did not feel any significant increase in wheezing when he walked 50m by himself, and he felt that his state was similar to that before the onset of the disease, and he did not show any drowsiness. partial pressure is significantly lower than before, and oxygen partial pressure is higher than before. It can be seen that the patient’s type II respiratory failure has been significantly corrected.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but we still need to remind the patient that COPD is a relatively common disease, especially in patients who have been smoking for years, and generally, the disease can seriously affect the patient’s quality of life. In addition, infection is also an important cause of acute exacerbation of COPD, therefore, it is important to prevent infection. It is also important to avoid spicy and irritating foods in the diet. You can exercise your lung function with lip reduction breathing. You should pay attention to your cough and asthma, and once the cough and asthma symptoms are aggravated, you should apply medication in time, mainly anti-infective cough and asthma medication, and you should consult a doctor when the symptoms are not relieved.
V. Personal insight
Chronic obstructive pulmonary disease (COPD) is a common disease among elderly people, especially those with a history of smoking, and it has a significant impact on the quality of life of these patients, and repeated hospitalization also brings a great financial burden to patients. In addition, COPD is very dangerous and can lead to respiratory failure and pulmonary encephalopathy, which can threaten the life of the patient, so it is important to pay attention to prevention. If you have similar symptoms as the patient in the case, such as coughing, coughing and wheezing, you should consult a doctor in time to avoid the aggravation of the disease due to untimely treatment.