case presentation for copd

COPD Patient Case Study- Clinical Simulation Exam Scenario

COPD Case Study: Patient Diagnosis and Treatment (2024)

by John Landry, BS, RRT | Updated: Apr 4, 2024

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that affects millions of people around the world. It is primarily caused by smoking and is characterized by a persistent obstruction of airflow that worsens over time.

COPD can lead to a range of symptoms, including coughing, wheezing, shortness of breath, and chest tightness, which can significantly impact a person’s quality of life.

This case study will review the diagnosis and treatment of an adult patient who presented with signs and symptoms of this condition.

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COPD Clinical Scenario

A 56-year-old male patient is in the ER with increased work of breathing. He felt mildly short of breath after waking this morning but became extremely dyspneic after climbing a few flights of stairs. He is even too short of breath to finish full sentences. His wife is present in the room and revealed that the patient has a history of liver failure, is allergic to penicillin, and has a 15-pack-year smoking history. She also stated that he builds cabinets for a living and is constantly required to work around a lot of fine dust and debris.

COPD patient in hospital vector illustration

Physical Findings

On physical examination, the patient showed the following signs and symptoms:

His pupils are equal and reactive to light.
He is alert and oriented.
He is breathing through pursed lips.
His trachea is positioned in the midline, and no jugular venous distention is present.

Vital Signs

Heart rate: 92 beats/min
Respiratory rate: 22 breaths/min

Chest Assessment

He has a larger-than-normal anterior-posterior chest diameter.
He demonstrates bilateral chest expansion.
He demonstrates a prolonged expiratory phase and diminished breath sounds during auscultation.
He is showing signs of subcostal retractions.
Chest palpation reveals no tactile fremitus.
Chest percussion reveals increased resonance.
His abdomen is soft and tender.
No distention is present.

Extremities

His capillary refill time is two seconds.
Digital clubbing is present in his fingertips.
There are no signs of pedal edema.
His skin appears to have a yellow tint.

Lab and Radiology Results

ABG results: pH 7.35 mmHg, PaCO2 59 mmHg, HCO3 30 mEq/L, and PaO2 64 mmHg.
Chest x-ray: Flat diaphragm, increased retrosternal space, dark lung fields, slight hypertrophy of the right ventricle, and a narrow heart.
Blood work: RBC 6.5 mill/m3, Hb 19 g/100 mL, and Hct 57%.

Based on the information given, the patient likely has chronic obstructive pulmonary disease (COPD) .

The key findings that point to this diagnosis include:

Barrel chest
A long expiratory time
Diminished breath sounds
Use of accessory muscles while breathing
Digital clubbing
Pursed lip breathing
History of smoking
Exposure to dust from work

What Findings are Relevant to the Patient’s COPD Diagnosis?

The patient’s chest x-ray showed classic signs of chronic COPD, which include hyperexpansion, dark lung fields, and a narrow heart.

This patient does not have a history of cor pulmonale ; however, the findings revealed hypertrophy of the right ventricle. This is something that should be further investigated as right-sided heart failure is common in patients with COPD.

The lab values that suggest the patient has COPD include increased RBC, Hct, and Hb levels, which are signs of chronic hypoxemia.

Furthermore, the patient’s ABG results indicate COPD is present because the interpretation reveals compensated respiratory acidosis with mild hypoxemia. Compensated blood gases indicate an issue that has been present for an extended period of time.

What Tests Could Further Support This Diagnosis?

A series of pulmonary function tests (PFT) would be useful for assessing the patient’s lung volumes and capacities. This would help confirm the diagnosis of COPD and inform you of the severity.

Note: COPD patients typically have an FEV1/FVC ratio of < 70%, with an FEV1 that is < 80%.

The initial treatment for this patient should involve the administration of low-flow oxygen to treat or prevent hypoxemia .

It’s acceptable to start with a nasal cannula at 1-2 L/min. However, it’s often recommended to use an air-entrainment mask on COPD patients in order to provide an exact FiO2.

Either way, you should start with the lowest possible FiO2 that can maintain adequate oxygenation and titrate based on the patient’s response.

Example: Let’s say you start the patient with an FiO2 of 28% via air-entrainment mask but increase it to 32% due to no improvement. The SpO2 originally was 84% but now has decreased to 80%, and his retractions are worsening. This patient is sitting in the tripod position and continues to demonstrate pursed-lip breathing. Another blood gas was collected, and the results show a PaCO2 of 65 mmHg and a PaO2 of 59 mmHg.

What Do You Recommend?

The patient has an increased work of breathing, and their condition is clearly getting worse. The latest ABG results confirmed this with an increased PaCO2 and a PaO2 that is decreasing.

This indicates that the patient needs further assistance with both ventilation and oxygenation .

Note: In general, mechanical ventilation should be avoided in patients with COPD (if possible) because they are often difficult to wean from the machine.

Therefore, at this time, the most appropriate treatment method is noninvasive ventilation (e.g., BiPAP).

Initial BiPAP Settings

In general, the most commonly recommended initial BiPAP settings for an adult patient include this following:

IPAP: 8–12 cmH2O
EPAP: 5–8 cmH2O
Rate: 10–12 breaths/min
FiO2: Whatever they were previously on

For example, let’s say you initiate BiPAP with an IPAP of 10 cmH20, an EPAP of 5 cmH2O, a rate of 12, and an FiO2 of 32% (since that is what he was previously getting).

After 30 minutes on the machine, the physician requested another ABG to be drawn, which revealed acute respiratory acidosis with mild hypoxemia.

What Adjustments to BiPAP Settings Would You Recommend?

The latest ABG results indicate that two parameters must be corrected:

Increased PaCO2
Decreased PaO2

You can address the PaO2 by increasing either the FiO2 or EPAP setting. EPAP functions as PEEP, which is effective in increasing oxygenation.

The PaCO2 can be lowered by increasing the IPAP setting. By doing so, it helps to increase the patient’s tidal volume, which increased their expired CO2.

Note: In general, when making adjustments to a patient’s BiPAP settings, it’s acceptable to increase the pressure in increments of 2 cmH2O and the FiO2 setting in 5% increments.

Oxygenation

To improve the patient’s oxygenation , you can increase the EPAP setting to 7 cmH2O. This would decrease the pressure support by 2 cmH2O because it’s essentially the difference between the IPAP and EPAP.

Therefore, if you increase the EPAP, you must also increase the IPAP by the same amount to maintain the same pressure support level.

Ventilation

However, this patient also has an increased PaCO2 , which means that you must increase the IPAP setting to blow off more CO2. Therefore, you can adjust the pressure settings on the machine as follows:

IPAP: 14 cmH2O
EPAP: 7 cmH2O

After making these changes and performing an assessment , you can see that the patient’s condition is improving.

Two days later, the patient has been successfully weaned off the BiPAP machine and no longer needs oxygen support. He is now ready to be discharged.

The doctor wants you to recommend home therapy and treatment modalities that could benefit this patient.

What Home Therapy Would You Recommend?

You can recommend home oxygen therapy if the patient’s PaO2 drops below 55 mmHg or their SpO2 drops below 88% more than twice in a three-week period.

Remember: You must use a conservative approach when administering oxygen to a patient with COPD.

Pharmacology

You may also consider the following pharmacological agents:

Short-acting bronchodilators (e.g., Albuterol)
Long-acting bronchodilators (e.g., Formoterol)
Anticholinergic agents (e.g., Ipratropium bromide)
Inhaled corticosteroids (e.g., Budesonide)
Methylxanthine agents (e.g., Theophylline)

In addition, education on smoking cessation is also important for patients who smoke. Nicotine replacement therapy may also be indicated.

In some cases, bronchial hygiene therapy should be recommended to help with secretion clearance (e.g., positive expiratory pressure (PEP) therapy).

It’s also important to instruct the patient to stay active, maintain a healthy diet, avoid infections, and get an annual flu vaccine. Lastly, some COPD patients may benefit from cardiopulmonary rehabilitation .

By taking all of these factors into consideration, you can better manage this patient’s COPD and improve their quality of life.

Final Thoughts

There are two key points to remember when treating a patient with COPD. First, you must always be mindful of the amount of oxygen being delivered to keep the FiO2 as low as possible.

Second, you should use noninvasive ventilation, if possible, before performing intubation and conventional mechanical ventilation . Too much oxygen can knock out the patient’s drive to breathe, and once intubated, these patients can be difficult to wean from the ventilator .

Furthermore, once the patient is ready to be discharged, you must ensure that you are sending them home with the proper medications and home treatments to avoid readmission.

Written by:

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
Chang, David. Clinical Application of Mechanical Ventilation . 4th ed., Cengage Learning, 2013.
Rrt, Cairo J. PhD. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 7th ed., Mosby, 2019.
Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
Faarc, Heuer Al PhD Mba Rrt Rpft. Wilkins’ Clinical Assessment in Respiratory Care. 8th ed., Mosby, 2017.
Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.

COPD Digital Resource Toolkit for Health Professionals

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Healthcare providers play an important role in the diagnosis and management of COPD. Often a visit to a physician's office is not triggered by breathing issues and patients do not always fully report their symptoms.

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Diagnosis and Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

*new* quick search this issue.

As more and more patients present to the ED with symptoms that suggest an acute exacerbation of COPD –worsening dyspnea, cough and sputum production – emergency clinicians can improve patient comfort and possibly mitigate morbidity and mortality with the right testing and treatment interventions:

Copd is a clinical diagnosis, but some tests can exclude comorbid conditions, when to give antibiotics and when to culture, the spo 2 range to aim for, ecg findings typical of copd, the role of ultrasound, oxygen, bronchodilators, corticosteroids, and antibiotics: which ones, and how much, reviewing noninvasive ventilation and intubation options.

Case Presentations

Introduction

Selected abbreviations, critical appraisal of the literature.

Epidemiology of COPD
Etiology of Acute Exacerbation of COPD
Pathophysiology of COPD
Differential Diagnosis
Prehospital Care
Physical Examination
Laboratory Testing and Arterial Blood Gas Sampling
Chest Imaging
Electrocardiogram
Serum Cardiac Biomarkers
Microbiologic Evaluation
Point-of-Care Ultrasound
Other Tests
Supplemental Oxygen
Bronchodilators
Corticosteroids
Antibiotics
Magnesium Sulfate
Methylxanthines
Noninvasive Positive-Pressure Ventilation
Mechanical Ventilation
High-Flow Nasal Cannula
Capnography
Outpatient Versus Inpatient Care
Management for Patients Going Home

Risk Management Pitfalls in Managing Acute Exacerbation of COPD

Time- and Cost-Effective Strategies
Case Conclusions
Clinical Pathway For Diagnostic Evaluation of Acute Exacerbation of COPD
Clinical Pathway For Management of Acute Exacerbation of COPD
Table 1. Model of Symptom Risk Evaluation of COPD
Table 2. Differential Diagnosis of Acute Exacerbation of COPD
Table 3. Summary of Diagnostic Testing in Patients With Acute Exacerbation of COPD
Table 4. Arrhythmias Related to COPD
Table 5. Electrocardiogram Abnormalities Related to COPD
Table 6. Antibiotics to Consider for the Treatment of Acute Exacerbation of COPD
Table 7. Exclusion Criteria for Noninvasive Positive-Pressure Ventilation and Indications for Intubation
Table 8. Ventilator Setting Recommendations Post Intubation
Table 9. Factors Associated With Risk of Death From COPD Exacerbation
Table 10. Indications for Hospital Admission
Figure 1. Saber-Sheath Trachea on Computed Tomography
Figure 2. Electrocardiogram of Multifocal Atrial Tachycardia
Figure 3. Electrocardiogram of Right Ventricular Hypertrophy
Figure 4. End-Tidal Capnography Tracings

Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a clinical diagnosis that is based on changes in dyspnea, cough, and/or sputum production in a COPD patient; however, patients presenting with an acute exacerbation may be undiagnosed or have a variety of comorbid conditions that can complicate diagnosis. This issue presents strategies and algorithms for the early use of evidence-based interventions, including appropriate use of antibiotics, bronchodilators, and corticosteroids, along with noninvasive ventilation with capnography, to minimize morbidity and mortality associated with this disease.

Case Presentation

It is change of shift, and you receive sign-out on a 67-year-old gentleman with a history of COPD presenting with 5 days of worsening productive cough, wheezing, and increased albuterol use despite outpatient treatment with prednisone and doxycycline. His oxygen saturation was 86% on arrival, and the nurse placed him on oxygen therapy at 6 L/min via nasal cannula shortly before you arrived. You find the patient sitting on the edge of his bed, tachypneic, with increased work of breathing and audible wheezing on auscultation. He is alert and acknowledges your presence but does not speak. You wonder why he continues to be hypoxic and if there is any other intervention that is indicated . . .

Your next patient is a 57-year-old woman with a history of smoking 2 packs of cigarettes per day. Her husband called 911 because she was having increased difficulty with breathing and productive cough for the previous week. She has no documented pulmonary history. Upon arrival, EMS noted that she could not speak in full sentences, her oxygen saturation was 81% on room air, and she had diffuse end-expiratory wheezing on auscultation. IV access was obtained. She was given continuous albuterol nebulization without relief and started on supplemental oxygen. The chest x-ray does not demonstrate a focal infiltrate; however, her lungs appear hyperinflated, with flattened diaphragms and a small cardiac silhouette. You wonder if she has COPD with an acute exacerbation and whether prednisone and antibiotics are indicated . . .

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. From a financial perspective, COPD exacted a net $36 billion toll in 2010 in the United States, and its costs are expected to continue to rise. 1 Despite decreasing tobacco use nationally, emergency department (ED) visits for COPD-related problems continue to climb, with over 1.7 million in 2011 alone. Moreover, about one-fifth of COPD patients presenting to the ED required hospitalization. 2

COPD is characterized by a persistent airflow limitation, after administration of bronchodilators, that can be identified on spirometry as a ratio of forced expired volume in 1 second (FEV 1 ) to forced vital capacity (FVC) that is < 70%. Although COPD is a treatable disease, the airflow limitation is not fully reversible. Previous definitions of COPD have included the terms emphysema and chronic bronchitis ; however, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines do not, and they clarify the distinction: Emphysema is a pathological term that refers to the destruction of alveoli, which can be present but is not inherent in patients with COPD. Chronic bronchitis is an independent clinical entity characterized by cough and sputum production for at least 3 months in each of 2 consecutive years and can occur without the development of airflow limitation. Guidelines define acute exacerbation of COPD (AECOPD) as an event characterized by a worsening of the patient’s respiratory symptoms (dyspnea, cough, and/or sputum production) that is beyond normal day-to-day variations, and that leads to a change in medication. 3,4

Patients with COPD often have comorbid conditions that may have either resulted from COPD, (eg, pulmonary hypertension or malnutrition) or are simply associated with it (eg, anxiety, cardiovascular disease, sleep apnea, and venous thromboembolism). 5 Because of the myriad presenting features of COPD and/or these comorbidities, diagnostic challenges exist when these patients present to the ED in extremis. This issue of Emergency Medicine Practice reviews the most recent evidence-based recommendations for the diagnosis and management of AECOPD, with a focus on tailoring management to the underlying pathophysiology of the disease state.

A literature search was performed in PubMed, with the search terms COPD , chronic obstructive pulmonary disease, and acute COPD exacerbation. The search was limited to articles published within the last 10 years, and studies relating specifically to acute COPD exacerbation (as opposed to stable COPD) were reviewed. In addition, references were appraised for additional relevant articles. A total of 127 articles have been included in this review.

The Cochrane Library was searched for systematic reviews using the key term acute COPD exacerbation , which identified 25 articles. In addition, guidelines from the GOLD, American Thoracic Society (ATS), European Respiratory Society (ERS), American College of Chest Physicians (ACCP), and National Institute for Health and Care Excellence (NICE) were reviewed.

COPD is a composite of heterogenous etiologies that contribute to variations in the presentation in patient populations. For example, it has been increasingly recognized that exposures to substances other than cigarette smoke contribute to the pathophysiology of disease. The asthma-COPD overlap syndrome is a newly identified condition, with varied acceptance in the community, but it illustrates that a history of asthma does not exclude coexisting COPD. Cohorts included in studies are similarly diverse, making the generalizability of results challenging. Clinically, the varied presentation of COPD makes detecting previously undiagnosed patients more difficult; however, these patients may well be the ones seeking care in the ED.

The current state of the literature remains limited mainly by the retrospective observational nature of most studies. There are few randomized controlled trials to direct management of acute COPD exacerbations. Furthermore, existing studies have wide-ranging outcome measures, such as pulmonary function, symptom scores, rate of exacerbation, and short-term mortality. In the absence of high-quality data, some interventions should be directed by prior individual patient response.

1. “But the patient said he has asthma.”

Not all wheezing is asthma, and not all patient-reported histories of asthma are actually asthma. Ensure that the patient’s risk factors and history align with the diagnosis.

2. “I know she has COPD, but I doubt that’s what’s causing her respiratory distress.”

Inadequately assessing triggers for AECOPD may lead you down an expensive and ultimately fruitless diagnostic path. A good history can increase efficiency, decrease costs, and most importantly, improve clinical outcomes.

3. “This COPD patient’s respiratory and hemodynamic statuses are simply not improving, despite doing everything by the book. What’s going on?”

Largely due to the high systemic inflammatory state in individuals with COPD, patients presenting with an AECOPD have a surprisingly high incidence of pulmonary embolism. Be vigilant to ensure that the patient does not have a pulmonary embolism when he fails to respond as expected to the standard interventions for an AECOPD.

4. “COPD is not possible - I don’t hear any wheezing.”

Although wheezing is often considered a hallmark of COPD, a lack of wheezing can actually signify a loss of effective airflow and can indicate imminent clinical deterioration.

5. “His COPD exacerbation wasn’t that bad - I didn’t need to actually measure anything.”

Much of the physical examination is inherently subjective, which may cause an underappreciation of the severity of a patient’s AECOPD. A focused diagnostic assessment can identity poor prognostic markers.

6. “We need to keep the oxygen saturation as high as possible to make sure that oxygenation remains stable.”

Not only is there no benefit to maintaining an oxygen saturation in the high 90s in a patient with COPD, it may actually be harmful. Recent guidelines agree on an arterial saturation target of 88% to 92%.

7. “She looks really sick; let’s intubate to assist her breathing now.”

Many patients can avoid endotracheal intubation with early implementation of NIPPV with bilevel positive airway pressure. Taking into account the absolute contraindications for NIPPV, consider a trial to assist breathing.

8. “We need to provide high tidal volumes on the ventilator to blow down the CO 2 !”

Despite a desire to increase minute ventilation to remove CO 2 in a COPD patient, excessive tidal volumes on the ventilator may actually injure the lungs.

9. “I don’t need to give any oral or IV corticosteroids because the patient is already on inhaled ones.”

Although some systemic absorption of inhaled steroids can occur, it is insufficient to suppress the inflammatory process in the airways during an AECOPD. Therefore, oral or IV steroids are necessary for these circumstances.

10. “There’s no need to tell the patient to stop smoking because it’s so obvious and, plus, there’s nothing I can do to change that.”

Smoking cessation can normalize the natural rate of decline in a person’s lung function, even in a long-term smoker, and brief clinician advice about the need to stop smoking

Tables and Figures

Table 1. Model of Symptom Risk Evaluation of COPD

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study is included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

Ford ES, Murphy LB, Khavjou O, et al. Total and state-specific medical and absenteeism costs of COPD among adults aged = 18 years in the United States for 2010 and projections through 2020. Chest . 2015;147(1):31-45. (Retrospective observational study)
Ford ES. Hospital discharges, readmissions, and ED visits for COPD or bronchiectasis among US adults: findings from the nationwide inpatient sample 2001-2012 and Nationwide Emergency Department Sample 2006-2011. Chest . 2015;147(4):989-998. (Retrospective observational study)
* Celli BR, MacNee W, Agusti A, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J . 2004;23(6):932-946. (Systematic review; consensus guidelines)
* Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016. http://goldcopd.org/. Accessed September 10, 2017. (Systematic review; consensus guidelines)
Cavailles A, Brinchault-Rabin G, Dixmier A, et al. Comorbidities of COPD. Eur Respir Rev . 2013;22(130):454-475. (Review article)
Mannino D, Watt G, Hole D, et al. The natural history of chronic obstructive pulmonary disease. Eur Respir J . 2006;27(3):627-643. (Review article)
Heron M. Deaths: leading causes for 2014. Natl Vital Stat Rep . 2016;65(5):1-96. (Retrospective observational study)
Mathers C, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLOS Medicine . 2006;3(11):e442. (Retrospective epidemiologic study)
Yeatts KB, Lippmann SJ, Waller AE, et al. Population-based burden of COPD-related visits in the ED. Chest. 2013;144(3):784-793. (Retrospective observational study; 97,511 patients)
Mannino DM, Higuchi K, Tzy-Chyi Y, et al. Economic burden of COPD in the presence of comorbidities. Chest. 2015;148(1):138-150. (Retrospective observational study; 183,681 patients)
Suissa S, Dell’Anioello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67(11):957-963. (Prospective observational study; 73,106 patients)
Seemungal T, Harper-Owen R, Bhowmik A, et al. Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med . 2001;164(9):1618-1623. (Prospective observational study; 83 patients)
Querol-Ribelles J, Molina J, Naberan K, et al. Discrepency between antibiotics administered in acute exacerbations of chronic bronchitis and susceptibility of isolated pathogens in respiratory samples: multicentre study in primary care setting. Int J Antimicrob Ag . 2006;28(5):472-476. (Prospective observational study; 1537 patients)
Monso E, Ruiz J, Manterola J, et al. Bacterial infection in chronic obstructive pulmonary disease. A study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med . 1995;152(4):1316-1320. (Prospective observational study; 69 patients)
Ko F, Ip M, Chan PK, et al. A 1-year prospective study of the infectious etiology in patients hospitalized with acute exacerbations of COPD. Chest . 2007;131(1):44-52. (Prospective, observational study; 373 patients)
Atkinson RW, Anderson HR, Sunyer J, et al. Acute effects of particulate air pollution on respiratory admissions. Am J Respir Crit Care Med . 2001;164(10):1860-1866. (Retrospective observational study; 79,008 patients)
Peacock JL, Anderson HR, Bremner SA, et al. Outdoor air pollution and respiratory health in patients with COPD. Thorax . 2011;66(7):591-596. (Prospective observational study; 94 patients)
Schikowski T, Mills IC, Anderson HR, et al. Ambient air pollution: a cause of COPD? Eur Respir J . 2014(43):250-263. (Systematic review; 14 studies)
Macklem PT. Therapeutic implications of the pathophysiology of COPD. Eur Respir J . 2010;35:676-680. (Review article)
Cameron L, Pilcher J, Weatherall M, et al. The risk of serious adverse outcomes associated with hypoxaemia and hyperoxaemia in acute exacerbations of COPD. Postgrad Med J. 2012;88(1046):684-689. (Retrospective observational study; 680 patients)
Ringbaek TJ, Terkelsen J, Lange P. Outcomes of acute exacerbations in COPD in relation to pre-hospital oxygen therapy. Eur Clin Respir J . 2015;2:10.3402/ecrj.v2.27283. eCollection 2015. (Retrospective observational study; 405 patients)
Denniston AK, O’Brien C, Stableforth D. The use of oxygen in acute exacerbations of chronic obstructive pulmonary disease: a prospective audit of pre-hospital and hospital emergency management. Clin Med (Lond) . 2002;2(5):449-451. (Prospective observational study; 97 patients)
Mal S, McLeod S, Iansavichene A, et al. Effect of out-of-hospital noninvasive positive-pressure support ventilation in adult patients with severe respiratory distress: a systematic review and meta-analysis. Ann Emerg Med . 2014;63(5):600-607. (Systematic review; 7 studies, 632 patients)
US Preventive Services Task Force (USPSTF), Siu AL, Bibbins-Domingo K, et al. Screening for chronic obstructive pulmonary disease: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(13):1372-1377. (Systematic review; consensus guidelines)
Straus SE, McAlister FA, Sackett DL, et al. The accuracy of patient history, wheezing, and laryngeal measurements in diagnosing obstructive airway disease. CARE-COAD1 Group. Clinical assessment of the reliability of the examination-chronic obstructive airways disease. JAMA . 2000;283(14):1853-1857. (Prospective observational study; 309 patients)
Soler N, Agusti C, Angrill J, et al. Bronchoscopic validation of the significance of sputum purulence in severe exacerbations of chronic obstructive pulmonary disease. Thorax . 2007;62(1):29-35. (Prospective observational study; 40 patients)
Seemungal TA, Donaldson GC, Bhowmik A, et al. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med . 2000;161(5):1608-1613. (Prospective observational study; 101 patients)
Austin MA, Wills KE, Blizzard L, et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. BMJ . 2010;341:c5462. (Randomized controlled trial; 405 patients)
Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J . 2005;26(2):234-241. (Prospective observational study; 205 patients)
Mattos WL, Signori LG, Borges FK, et al. Accuracy of clinical examination findings in the diagnosis of COPD. J Bras Pneumol. 2009;35(5):404-408. (Prospective case-control study; 98 patients)
Bohadana AB, Mohankumar T. Symptoms and signs in the assessment of chronic airflow obstruction. Indian J Chest Dis Allied Sci . 1982;24(2-3):133-142. (Review)
Fletcher CM. The clinical diagnosis of pulmonary emphysema; an experimental study. Proc R Soc Med . 1952;45(9):577-584. (Retrospective observational study)
Holleman DR Jr, Simel DL, Goldberg JS. Diagnosis of obstructive airways disease from the clinical examination. J Gen Intern Med . 1993;8(2):63-68. (Prospective observational study)
Schapira RM, Schapira MM, Funahashi A, et al. The value of the forced expiratory time in the physical diagnosis of obstructive airways disease. JAMA. 1993;270(6):731-736. (Cross-sectional study; 500 patients)
Marini JJ, Pierson DJ, Hudson LD, et al. The significance of wheezing in chronic airflow obstruction. Am Rev Respir Dis . 1979;120(5):1069-1072. (Prospective observational study; 83 patients)
Straus SE, McAlister FA, Sackett DL, et al. Clinical assessment of the reliability of the examination-chronic obstructive airways disease. Accuracy of history, wheezing, and forced expiratory time in the diagnosis of chronic obstructive pulmonary disease. J Gen Intern Med . 2002;17(9):684-688. (Prospective observational study; 161 patients)
Tokuda Y, Miyagi S. Physical diagnosis of chronic obstructive pulmonary disease. Intern Med . 2007;46(23):1885-1891. (Review article)
McKeever TM, Hearson G, Housley G, et al. Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study. Thorax . 2016;71(3):210-215. (Prospective observational study; 234 patients)
Kelly AM, Kerr D, Middleton P. Validation of venous pCO2 to screen for arterial hypercarbia in patients with chronic obstructive airways disease. J Emerg Med. 2005;28(4):377-379. (Prospective observational study; 112 patients)
Asiimwe AC, Brims FJ, Andrews NP, et al. Routine laboratory tests can predict in-hospital mortality in acute exacerbations of COPD. Lung . 2011;189(3):225-232. (Retrospective, observational study; 5985 patients)
Webb WR. Radiology of obstructive pulmonary disease. AJR Am J Roentgenol. 1997;169(3):637-647. (Review article)
Emerman CL, Cydulka RK. Evaluation of high-yield criteria for chest radiography in acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med. 1993;22(4):680-684. (Retrospective observational study; 742 patients)
Sherman S, Skoney JA, Ravikrishnan KP. Routine chest radiographs in exacerbations of chronic obstructive pulmonary disease. Diagnostic value. Arch Intern Med. 1989;149(11):2493-2496. (Retrospective observational study; 242 patients)
Tsai TW, Gallagher EJ, Lombardi G, et al. Guidelines for the selective ordering of admission chest radiography in adult obstructive airway disease. Ann Emerg Med . 1993;22(12):1854-1858. (Prospective observational study; 128 patients)
MacDonald MI, Shafuddin E, King PT, et al. Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. Lancet Respir Med . 2016;4(2):138-148. (Review article)
McCord J, Barzak S. Multifocal atrial tachycardia. Chest . 1998;113(1):202-209. (Review article)
Goudis CA, Konstantinidis AK, Ntalas IV, et al. Electrocardiographic abnormalities and cardiac arrhythmias in chronic obstructive pulmonary disease. Int J Cardiol. 2015;199:264-273. (Review article)
Vanfleteren LE, Franssen FM, Uszko-Lencer NH, et al. Frequency and relevance of ischemic electrocardiographic findings in patients with chronic obstructive pulmonary disease. Am J Cardiol. 2011;108(11):1669-1674. (Retrospective observational study; 543 patients)
Lazovic B, Svenda MZ, Mazic S, et al. Analysis of electrocardiogram in chronic obstructive pulmonary disease patients. Med Pregl . 2013;66(3-4):126-129. (Retrospective observational study; 110 patients)
Pavasini R, d’Ascenzo F, Campo G, et al. Cardiac troponin elevation predicts all-cause mortality in patients with acute exacerbation of chronic obstructive pulmonary disease: systematic review and meta-analysis. Int J Cardiol . 2015;191:187-193. (Systematic review, 10 studies; meta-analysis, 8 studies)
Buchan A, Bennett R, Coad A, et al. The role of cardiac biomarkers for predicting left ventricular dysfunction and cardiovascular mortality in acute exacerbations of COPD. Open Heart . 2015;2(1):e000052. (Systematic review; 14 studies)
Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med . 2008;359(22):2355-2365. (Review article)
Sykes A, Mallia P, Johnston SL. Diagnosis of pathogens in exacerbations of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2007;4(8):642-646. (Review article)
Boixeda R, Almagro P, Diez-Manglano J, et al. Bacterial flora in the sputum and comorbidity in patients with acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis . 2015;10:2581-2591. (Retrospective observational study; 536 patients)
Larsen MV, Janner JH, Nielsen SD, et al. Bacteriology in acute exacerbation of chronic obstructive pulmonary disease in patients admitted to hospital. Scand J Infect Dis. 2009;41(1):26-32. (Retrospective observational study; 118 patients)
Wu X, Chen D, Gu X, et al. Prevalence and risk of viral infection in patients with acute exacerbation of chronic obstructive pulmonary disease: a meta-analysis. Mol Biol Rep . 2014;41(7):4743-4751. (Systematic review and meta-analysis; 17 studies)
Zwaans WA, Mallia P, van Winden ME, et al. The relevance of respiratory viral infections in the exacerbations of chronic obstructive pulmonary disease-a systematic review. J Clin Virol. 2014;61(2):181-188. (Systematic review; 19 studies, 1728 patients)
Akhtar S, Theodoro D, Gaspari R, et al. Resident training in emergency ultrasound: consensus recommendations from the 2008 Council of Emergency Medicine Residency Directors Conference. Acad Emerg Med . 2009;16 Suppl 2:S32-S36. (Consensus statement)
Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest . 2008;134(1):117-125. (Prospective observational study; 260 patients)
Gallard E, Redonnet JP, Bourcier JE, et al. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea. Am J Emerg Med . 2015;33(3):352-358. (Prospective observational study; 147 patients)
Laursen CB, Sloth E, Lambrechtsen J, et al. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms. Chest . 2013;144(6):1868-1875. (Prospective observational study; 139 patients)
Laursen CB, Sloth E, Lassen AT, et al. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med . 2014;2(8):638-646. (Prospective randomized trial; 320 patients)
Stolz LA, Stolz U, Fields JM, et al. Emergency medicine resident assessment of the emergency ultrasound milestones and current training recommendations. Acad Emerg Med . 2017;24(3):353-361. (Prospective observational study; 539 patients)
Pothirat C, Chaiwong W, Phetsuk N, et al. Peak expiratory flow rate as a surrogate for forced expiratory volume in 1 second in COPD severity classification in Thailand. Int J Chron Obstruct Pulmon Dis . 2015;10:1213-1218. (Prospective observational study; 300 patients)
Emerman CL, Cydulka RK. Use of peak expiratory flow rate in emergency department evaluation of acute exacerbation of chronic obstructive pulmonary disease. Ann Emerg Med . 1996;27(2):159-163. (Prospective observational study; 199 patients)
Rizkallah J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest . 2009;135(3):786-793. (Systematic review and meta-analysis; 5 studies, 550 patients)
Aleva FE, Voets LW, Simons SO, et al. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis. Chest . 2017;151(3):544-554. (Systematic review; 7 studies)
* Vestbo J, Hurd SS, Agusti AG, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med . 2013;187(4):347-365. (Consensus statement; guidelines)
Robinson TD, Freiberg DB, Regnis JA, et al. The role of hypoventilation and ventilation-perfusion redistribution in oxygen-induced hypercapnia during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med . 2000;161(5):1524-1529. (Prospective observational study; 22 patients)
Schreck D. Asthma pathophysiology and evidence-based treatment of severe exacerbations. Am J Health Syst Pharm . 2006;63(3). (Review article)
Karpel JP, Pesin J, Greenberg D, et al. A comparison of the effects of ipratropium bromide and metaproterenol sulfate in acute exacerbations of COPD. Chest . 1990;98(4):835-839. (Prospective randomized trial; 32 patients)
Gruber P, Swadron S. The acute presentation of chronic obstructive pulmonary disease in the emergency department: a challenging oxymoron. Emerg Med Pract . 2008;10(11):1-28. (Review article)
McCrory DC, Brown CD. Anticholinergic bronchodilators versus beta2-symathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev . 2002(4):CD003900. (Systematic review; 4 trials)
Turner MO, Patel A, Ginsburg S, et al. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Intern Med. 1997;157(15):1736-1744. (Systematic review and meta-analysis; 12 studies, 507 patients)
Turner JR, Corkery KJ, Eckman D, et al. Equivalence of continuous flow nebulizer and metered-dose inhaler with reservoir bag for treatment of acute airflow obstruction. Chest 1988;93(3):476-481. (Randomized controlled trial; 75 patients)
Summer W, Elston R, Tharpe L, et al. Aerosol bronchodilator delivery methods. Arch Intern Med . 1989;149(3):618-623. (Randomized controlled trial; 36 patients)
Keatings VM, Jatakanon A, Worsdell YM, et al. Effects of inhaled and oral glucocorticoids on inflammatory indices in asthma and COPD. Am J Respir Crit Care Med. 1997;155(2):542-548. (Prospective crossover study; 15 patients)
Culpitt SV, Maziak W, Loukidis S, et al. Effect of high dose inhaled steroid on cells, cytokines, and proteases in induced sputum in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999;160(5 Pt 1):1635-1639. (Randomized controlled trial; 25 patients)
Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet. 1999;354(9177):456-460. (Randomized controlled trial; 56 patients)
Thompson WH, Nielson CP, Carvalho P, et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med . 1996;154(2 Pt 1):407-412. (Randomized controlled trial; 27 patients )
Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med . 2003;348(26):2618-2625. (Randomized controlled trial; 147 patients)
Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med. 1999;340(25):1941-1947. (Randomized controlled trial; 271 patients)
Schacke H, Docke W, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther. 2002;96(2):23-43. (Review article)
de Jong YP, Uil SM, Grotjohan HP, et al. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest. 2007;132(6):1741-1747. (Randomized controlled trial; 435 patients)
* Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA . 2013;309(21):2223-2231. (Randomized controlled trial; 314 patients)
National Institute for Health and Care Excellence (NICE). Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Clinical guideline [CG101]. June 2010. Available at: https://www.nice.org.uk/guidance/cg101. Accessed September 10, 2017. (Consensus statement; guidelines)
Nseir S, Di Pompeo C, Cavestri B, et al. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: prevalence, risk factors, and outcome. Crit Care Med. 2006;34(12):2959-2966. (Prospective observational study; 857 patients)
Quon BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and meta-analysis. Chest. 2008;133(3):756-766. (Systematic review, meta-analysis; 35 trials, 2958 patients)
* Vollenweider DJ, Jarrett H, Steurer-Stey CA, et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev . 2012;12:CD010257. (Systematic review and meta-analysis; 16 trials, 2068 patients)
Stefan MS, Rothberg MB, Shieh MS, et al. Association between antibiotic treatment and outcomes in patients hospitalized with acute exacerbation of COPD treated with systemic steroids. Chest. 2013;143(1):82-90. (Retrospective observational study; 53,900 patients)
Gonzalez JA, Garcia CH, Gonzalez PA, et al. Effect of intravenous magnesium sulfate on chronic obstructive pulmonary disease exacerbations requiring hospitalization: a randomized placebo-controlled trial. Archivos de Bronconeumologia . 2006;42(8):384-387. (Randomized controlled trial; 24 patients)
Edwards L, Shirtcliffe P, Wadsworth K, et al. Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial. Thorax . 2013;68(4):338-343. (Randomized controlled trial; 161 patients)
* Ram FS, Picot J, Lightowler J, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2004;(3)(3):CD004104. (Systematic review and meta-analysis; 14 studies)
Merlani PG, Pasquina P, Granier JM, et al. Factors associated with failure of noninvasive positive pressure ventilation in the emergency department. Acad Emerg Med . 2005;12(12):1206-1215. (Retrospective observational study; 104 patients)
Allen JY, Macias CG. The efficacy of ketamine in pediatric emergency department patients who present with acute severe asthma. Ann Emerg Med . 2005;46(1):43-50. (Randomized controlled trial; 68 patients)
Hirota K, Lambert D. Ketamine: its mechanism(s) of action and unusual clinical use. Br J Anaesth. 1996;77(4):441-444. (Review article)
Sato T, Hirota K, Matsuki A, et al. The relaxant effect of ketamine on guinea pig airway smooth muscle is epithelium-independent. Anesthesiol Analges . 1997;84:641-647. (Animal study)
Howton JC, Rose J, Duffy S, et al. Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Ann Emerg Med. 1996;27(2):170-175. (Randomized controlled trial; 53 patients)
Parrilla FJ, Moran I, Roche-Campo F, et al. Ventilatory strategies in obstructive lung disease. Semin Respir Crit Care Med . 2014;35(4):431-440. (Review article)
Bonin F, Sommerwerck U, Lund LW, et al. Avoidance of intubation during acute exacerbation of chronic obstructive pulmonary disease for a lung transplant candidate using extracorporeal carbon dioxide removal with the Hemolung. J Thorac Cardiovasc Surg . 2013;145(5):e43-e44. (Case report)
Pazarli AC, Koseoglu HI, Doruk S, et al. Procalcitonin: is it a predictor of noninvasive positive pressure ventilation necessity in acute chronic obstructive pulmonary disease exacerbation? J Res Med Sci. 2012;17(11):1047-1051. (Cross-sectional study; 118 patients)
Hashemian SM, Fallahian F. The use of heliox in critical care. Int J Crit Illn Inj Sci. 2014;4(2):138-142. (Review article)
Hunt T, Williams MT, Frith P, et al. Heliox, dyspnoea and exercise in COPD. Eur Respir Rev . 2010;19(115):30-38. (Systematic review; 8 studies)
Jolliet P, Ouanes-Besbes L, Abroug F, et al. A multicenter randomized trial assessing the efficacy of helium/oxygen in severe exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med . 2016. (Randomized controlled trial; 445 patients)
Maggiore SM, Richard JC, Abroug F, et al. A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease. Crit Care Med. 2010;38(1):145-151. (Randomized controlled trial; 204 patients)
Mieloszyk RJ, Verghese GC, Deitch K, et al. Automated quantitative analysis of capnogram shape for COPD-normal and COPD-CHF classification. IEEE Trans Biomed Eng . 2014;61(12):2882-2890. (Prospective observational trial; 139 patients)
Roche N, Rabbat A, Zureik M, et al. Chronic obstructive pulmonary disease exacerbations in emergency departments: predictors of outcome. Curr Opin Pulm Med . 2010;16(2):112-117. (Review article)
Bustamante-Fermosel A, De Miguel-Yanes JM, Duffort-Falco M, et al. Mortality-related factors after hospitalization for acute exacerbation of chronic obstructive pulmonary disease: the burden of clinical features. Am J Emerg Med . 2007;25(5):515-522. (Retrospective observational study; 763 patients)
Quintana JM, Esteban C, Unzurrunzaga A, et al. Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments. BMC Medicine. 2014;12(1):66. (Prospective observational study; 2487 patients)
Roche N, Zureik M, Soussan D, et al. Predictors of outcomes in COPD exacerbation cases presenting to the emergency department. Eur Respir J . 2008;32(4):953-961. (Prospective, observational study; 794 patients)
Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc . 2013;10(2):81-89. (Systematic review; 37 studies, 189,772 subjects)
Hu G, Zhou Y, Wu Y, et al. The pneumonia severity index as a predictor of in-hospital mortality in acute exacerbation of chronic obstructive pulmonary disease. PLoS One . 2015;10(7):e0133160. (Prospective observational study; 752 patients)
Chang CL, Sullivan GD, Karalus NC, et al. Predicting early mortality in acute exacerbation of chronic obstructive pulmonary disease using the CURB65 score. Respirology . 2011;16(1):146-151. (Prospective observational study; 252 patients)
Xiao K, Guo C, Su L, et al. Prognostic value of different scoring models in patients with multiple organ dysfunction syndrome associated with acute COPD exacerbation. J Thorac Dis . 2015;7(3):329-336. (Retrospective observational study; 153 patients)
Steer J, Gibson J, Bourke SC. The DECAF Score: predicting hospital mortality in exacerbations of chronic obstructive pulmonary disease. Thorax . 2012;67(11):970-976. (Prospective observational study; 920 patients)
Echevarria C, Steer J, Heslop-Marshall K, et al. Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD. Thorax . 2016;71(2):133-140. (Prospective observational study; 1725 patients)
Steer J, Norman EM, Afolabi OA, et al. Dyspnoea severity and pneumonia as predictors of in-hospital mortality and early readmission in acute exacerbations of COPD. Thorax. 2012;67(2):117-121. (Prospective observational study; 920 patients)
Shorr AF, Sun X, Johannes RS, et al. Validation of a novel risk score for severity of illness in acute exacerbations of COPD. Chest . 2011;140(5):1177-1183. (Retrospective observational study; 34,669 patients)
Esteban C, Arostegui I, Garcia-Gutierrez S, et al. A decision tree to assess short-term mortality after an emergency department visit for an exacerbation of COPD: a cohort study. Respir Res. 2015;16:151. (Prospective observational study; 2487 patients)
Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of acute exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest . 2015;147(4):894-942. (Consensus statement; guidelines)
Schembri S, Morant S, Winter JH, et al. Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax. 2009;64(7):567-572. (Retrospective observational study; 177,120 patients)
Tomczyk S, Bennett NM, Stoecker C, et al. Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged = 65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep . 2014;63(37):822-825. (Consensus statement)
Kraicer-Melamed H, O’Donnell S, Quach C. The effectiveness of pneumococcal polysaccharide vaccine 23 (PPV23) in the general population of 50 years of age and older: a systematic review and meta-analysis. Vaccine . 2016;34(13):1540-1550. (Systematic review, meta-analysis)
Lee TA, Weaver FM, Weiss KB. Impact of pneumococcal vaccination on pneumonia rates in patients with COPD and asthma. J Gen Intern Med. 2007;22(1):62-67. (Retrospective observational study; 34,193 patients)
Lodewijckx C, Sermeus W, Vanhaecht K, et al. Inhospital management of COPD exacerbations: a systematic review of the literature with regard to adherence to international guidelines. J Eval Clin Pract . 2009;15(6):1101-1110. (Systematic review; 7 studies)
Sandhu SK, Chu J, Yurkovich M, et al. Variations in the management of acute exacerbations of chronic obstructive pulmonary disease. Can Respir J . 2013;20(3):175-179. (Retrospective observational study; 293 patients)
Tsai CL, Ginde AA, Blanc PG, et al. Improved care of acute exacerbation of chronic obstructive pulmonary disease in two academic emergency departments. Int J Emerg Med . 2009;2(2):111-116. (Retrospective observational study; 272 patients)

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Van Holden, MD; Donald Slack, III, MD; Michael T. McCurdy, MD, FCCM, FCCP, FAAEM; Nirav G. Shah, MD, FCCP

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October 1, 2017

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COPD 101 is an overview of key clinical concepts for COPD, including risk factors, epidemiology, screening and diagnostics, and treatment strategies. This presentation is the starting point for anyone new to COPD or seeking to improve overall care for their COPD population. Patient education materials, created specifically to assist clear communication of disease management concepts, are also included to help optimize therapy plans.

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Patient Case Presentation

Patient info:.

Mr. D.J. is a 64 year old white male who was referred to the pulmonary clinic by his primary care provider for difficulty breathing. Mr. D.J. noticed that he was having quite a bit of difficulty breathing, especially with activity. He coughs often and he notes a productive thick mucus. He states that this has been happening to him “for years”, and seems to be worse in the winter months.

Mr. D.J. notes that he is a 2 pack a day smoker and has been since he was 16 years old. He is not interested in quitting as he says “I don’t know what I would do without [my cigarettes], it’s all I’ve got.”

Past Medical History:

Shortness of breath for approximately 3 years
Productive cough for months at a time throughout those 3 years

Pertinent Family History:

Father died from lung cancer at age 60 years
Mother has emphysema
Brother has asthma
Sister alive and well at age 61

Pertinent Social History:

Has worked full time in agriculture since he was 14 years old
All family members are smokers. Family smokes in the house as well

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2: Case Study #1- Chronic Obstructive Pulmonary Disease (COPD)

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2.1: Learning Objectives
2.2: Patient- Erin Johns
2.3: At Home
2.4: Emergency Room

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How to present patient...

How to present patient cases

Related content
Peer review
Mary Ni Lochlainn , foundation year 2 doctor 1 ,
Ibrahim Balogun , healthcare of older people/stroke medicine consultant 1
1 East Kent Foundation Trust, UK

A guide on how to structure a case presentation

This article contains...

-History of presenting problem

-Medical and surgical history

-Drugs, including allergies to drugs

-Family history

-Social history

-Review of systems

-Findings on examination, including vital signs and observations

-Differential diagnosis/impression

-Investigations

-Management

Presenting patient cases is a key part of everyday clinical practice. A well delivered presentation has the potential to facilitate patient care and improve efficiency on ward rounds, as well as a means of teaching and assessing clinical competence. 1

The purpose of a case presentation is to communicate your diagnostic reasoning to the listener, so that he or she has a clear picture of the patient’s condition and further management can be planned accordingly. 2 To give a high quality presentation you need to take a thorough history. Consultants make decisions about patient care based on information presented to them by junior members of the team, so the importance of accurately presenting your patient cannot be overemphasised.

As a medical student, you are likely to be asked to present in numerous settings. A formal case presentation may take place at a teaching session or even at a conference or scientific meeting. These presentations are usually thorough and have an accompanying PowerPoint presentation or poster. More often, case presentations take place on the wards or over the phone and tend to be brief, using only memory or short, handwritten notes as an aid.

Everyone has their own presenting style, and the context of the presentation will determine how much detail you need to put in. You should anticipate what information your senior colleagues will need to know about the patient’s history and the care he or she has received since admission, to enable them to make further management decisions. In this article, I use a fictitious case to show how you can structure case presentations, which can be adapted to different clinical and teaching settings (box 1).

Box 1: Structure for presenting patient cases

Presenting problem, history of presenting problem, medical and surgical history.

Drugs, including allergies to drugs

Family history

Social history, review of systems.

Findings on examination, including vital signs and observations

Differential diagnosis/impression

Investigations

Case: tom murphy.

You should start with a sentence that includes the patient’s name, sex (Mr/Ms), age, and presenting symptoms. In your presentation, you may want to include the patient’s main diagnosis if known—for example, “admitted with shortness of breath on a background of COPD [chronic obstructive pulmonary disease].” You should include any additional information that might give the presentation of symptoms further context, such as the patient’s profession, ethnic origin, recent travel, or chronic conditions.

“ Mr Tom Murphy is a 56 year old ex-smoker admitted with sudden onset central crushing chest pain that radiated down his left arm.”

In this section you should expand on the presenting problem. Use the SOCRATES mnemonic to help describe the pain (see box 2). If the patient has multiple problems, describe each in turn, covering one system at a time.

Box 2: SOCRATES—mnemonic for pain

Associations

Time course

Exacerbating/relieving factors

“ The pain started suddenly at 1 pm, when Mr Murphy was at his desk. The pain was dull in nature, and radiated down his left arm. He experienced shortness of breath and felt sweaty and clammy. His colleague phoned an ambulance. He rated the pain 9/10 in severity. In the ambulance he was given GTN [glyceryl trinitrate] spray under the tongue, which relieved the pain to 5/10. The pain lasted 30 minutes in total. No exacerbating factors were noted. Of note: Mr Murphy is an ex-smoker with a 20 pack year history”

Some patients have multiple comorbidities, and the most life threatening conditions should be mentioned first. They can also be categorised by organ system—for example, “has a long history of cardiovascular disease, having had a stroke, two TIAs [transient ischaemic attacks], and previous ACS [acute coronary syndrome].” For some conditions it can be worth stating whether a general practitioner or a specialist manages it, as this gives an indication of its severity.

In a surgical case, colleagues will be interested in exercise tolerance and any comorbidity that could affect the patient’s fitness for surgery and anaesthesia. If the patient has had any previous surgical procedures, mention whether there were any complications or reactions to anaesthesia.

“Mr Murphy has a history of type 2 diabetes, well controlled on metformin. He also has hypertension, managed with ramipril, and gout. Of note: he has no history of ischaemic heart disease (relevant negative) (see box 3).”

Box 3: Relevant negatives

Mention any relevant negatives that will help narrow down the differential diagnosis or could be important in the management of the patient, 3 such as any risk factors you know for the condition and any associations that you are aware of. For example, if the differential diagnosis includes a condition that you know can be hereditary, a relevant negative could be the lack of a family history. If the differential diagnosis includes cardiovascular disease, mention the cardiovascular risk factors such as body mass index, smoking, and high cholesterol.

Highlight any recent changes to the patient’s drugs because these could be a factor in the presenting problem. Mention any allergies to drugs or the patient’s non-compliance to a previously prescribed drug regimen.

To link the medical history and the drugs you might comment on them together, either here or in the medical history. “Mrs Walsh’s drugs include regular azathioprine for her rheumatoid arthritis.”Or, “His regular drugs are ramipril 5 mg once a day, metformin 1g three times a day, and allopurinol 200 mg once a day. He has no known drug allergies.”

If the family history is unrelated to the presenting problem, it is sufficient to say “no relevant family history noted.” For hereditary conditions more detail is needed.

“ Mr Murphy’s father experienced a fatal myocardial infarction aged 50.”

Social history should include the patient’s occupation; their smoking, alcohol, and illicit drug status; who they live with; their relationship status; and their sexual history, baseline mobility, and travel history. In an older patient, more detail is usually required, including whether or not they have carers, how often the carers help, and if they need to use walking aids.

“He works as an accountant and is an ex-smoker since five years ago with a 20 pack year history. He drinks about 14 units of alcohol a week. He denies any illicit drug use. He lives with his wife in a two storey house and is independent in all activities of daily living.”

Do not dwell on this section. If something comes up that is relevant to the presenting problem, it should be mentioned in the history of the presenting problem rather than here.

“Systems review showed long standing occasional lower back pain, responsive to paracetamol.”

Findings on examination

Initially, it can be useful to practise presenting the full examination to make sure you don’t leave anything out, but it is rare that you would need to present all the normal findings. Instead, focus on the most important main findings and any abnormalities.

“On examination the patient was comfortable at rest, heart sounds one and two were heard with no additional murmurs, heaves, or thrills. Jugular venous pressure was not raised. No peripheral oedema was noted and calves were soft and non-tender. Chest was clear on auscultation. Abdomen was soft and non-tender and normal bowel sounds were heard. GCS [Glasgow coma scale] was 15, pupils were equal and reactive to light [PEARL], cranial nerves 1-12 were intact, and he was moving all four limbs. Observations showed an early warning score of 1 for a tachycardia of 105 beats/ min. Blood pressure was 150/90 mm Hg, respiratory rate 18 breaths/min, saturations were 98% on room air, and he was apyrexial with a temperature of 36.8 ºC.”

Differential diagnoses

Mentioning one or two of the most likely diagnoses is sufficient. A useful phrase you can use is, “I would like to rule out,” especially when you suspect a more serious cause is in the differential diagnosis. “History and examination were in keeping with diverticular disease; however, I would like to rule out colorectal cancer in this patient.”

Remember common things are common, so try not to mention rare conditions first. Sometimes it is acceptable to report investigations you would do first, and then base your differential diagnosis on what the history and investigation findings tell you.

“My impression is acute coronary syndrome. The differential diagnosis includes other cardiovascular causes such as acute pericarditis, myocarditis, aortic stenosis, aortic dissection, and pulmonary embolism. Possible respiratory causes include pneumonia or pneumothorax. Gastrointestinal causes include oesophageal spasm, oesophagitis, gastro-oesophageal reflux disease, gastritis, cholecystitis, and acute pancreatitis. I would also consider a musculoskeletal cause for the pain.”

This section can include a summary of the investigations already performed and further investigations that you would like to request. “On the basis of these differentials, I would like to carry out the following investigations: 12 lead electrocardiography and blood tests, including full blood count, urea and electrolytes, clotting screen, troponin levels, lipid profile, and glycated haemoglobin levels. I would also book a chest radiograph and check the patient’s point of care blood glucose level.”

You should consider recommending investigations in a structured way, prioritising them by how long they take to perform and how easy it is to get them done and how long it takes for the results to come back. Put the quickest and easiest first: so bedside tests, electrocardiography, followed by blood tests, plain radiology, then special tests. You should always be able to explain why you would like to request a test. Mention the patient’s baseline test values if they are available, especially if the patient has a chronic condition—for example, give the patient’s creatinine levels if he or she has chronic kidney disease This shows the change over time and indicates the severity of the patient’s current condition.

“To further investigate these differentials, 12 lead electrocardiography was carried out, which showed ST segment depression in the anterior leads. Results of laboratory tests showed an initial troponin level of 85 µg/L, which increased to 1250 µg/L when repeated at six hours. Blood test results showed raised total cholesterol at 7.6 mmol /L and nil else. A chest radiograph showed clear lung fields. Blood glucose level was 6.3 mmol/L; a glycated haemoglobin test result is pending.”

Dependent on the case, you may need to describe the management plan so far or what further management you would recommend.“My management plan for this patient includes ACS [acute coronary syndrome] protocol, echocardiography, cardiology review, and treatment with high dose statins. If you are unsure what the management should be, you should say that you would discuss further with senior colleagues and the patient. At this point, check to see if there is a treatment escalation plan or a “do not attempt to resuscitate” order in place.

“Mr Murphy was given ACS protocol in the emergency department. An echocardiogram has been requested and he has been discussed with cardiology, who are going to come and see him. He has also been started on atorvastatin 80 mg nightly. Mr Murphy and his family are happy with this plan.”

The summary can be a concise recap of what you have presented beforehand or it can sometimes form a standalone presentation. Pick out salient points, such as positive findings—but also draw conclusions from what you highlight. Finish with a brief synopsis of the current situation (“currently pain free”) and next step (“awaiting cardiology review”). Do not trail off at the end, and state the diagnosis if you are confident you know what it is. If you are not sure what the diagnosis is then communicate this uncertainty and do not pretend to be more confident than you are. When possible, you should include the patient’s thoughts about the diagnosis, how they are feeling generally, and if they are happy with the management plan.

“In summary, Mr Murphy is a 56 year old man admitted with central crushing chest pain, radiating down his left arm, of 30 minutes’ duration. His cardiac risk factors include 20 pack year smoking history, positive family history, type 2 diabetes, and hypertension. Examination was normal other than tachycardia. However, 12 lead electrocardiography showed ST segment depression in the anterior leads and troponin rise from 85 to 250 µg/L. Acute coronary syndrome protocol was initiated and a diagnosis of NSTEMI [non-ST elevation myocardial infarction] was made. Mr Murphy is currently pain free and awaiting cardiology review.”

Originally published as: Student BMJ 2017;25:i4406

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed

↵ Green EH, Durning SJ, DeCherrie L, Fagan MJ, Sharpe B, Hershman W. Expectations for oral case presentations for clinical clerks: opinions of internal medicine clerkship directors. J Gen Intern Med 2009 ; 24 : 370 - 3 . doi:10.1007/s11606-008-0900-x pmid:19139965 . OpenUrl CrossRef PubMed Web of Science
↵ Olaitan A, Okunade O, Corne J. How to present clinical cases. Student BMJ 2010;18:c1539.
↵ Gaillard F. The secret art of relevant negatives, Radiopedia 2016; http://radiopaedia.org/blog/the-secret-art-of-relevant-negatives .

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Respir Med Case Rep

Early COPD diagnosis and treatment: A case report

Associated data.

Not applicable.

Chronic obstructive pulmonary disease (COPD) refers to a group of widely diffuse diseases that cause airflow blockage characterized by persistent respiratory symptoms such as dyspnea, chronic cough, recurrent wheezing, chronic sputum production, and progressive restricted airflow associated with exacerbations. COPD is the third leading cause of death worldwide and can only be treated not cured.

Pulmonary function tests do not permit the identification of initial obstructive airways disease. Forced expiratory flow (FEF 25-75 ), which calculates obstruction severity at small and medium bronchial airways levels, allows an early COPD diagnosis.

We report a 72-year-old ex-smoker male not exposed to occupational risk with symptoms suggesting early COPD. Baseline pulmonary function tests were normal, except FEF 25-75 . The patient did not respond to the first 6 months of treatment with long-acting muscarinic antagonist (LAMA), whereas he showed a clear clinical and FEF 25-75 response to 1-year treatment with LAMA associated with long-acting β2 agonist (LABA).

This clinical case report highlights the usefulness of FEF 25-75 evaluation in early COPD diagnosis and monitoring and confirms the efficacy of LAMA–LABA association for small airways obstruction treatment.

1. Introduction

Chronic obstructive pulmonary disease (COPD) refers to a group of widely diffuse diseases, including emphysema and chronic bronchitis, that cause airflow blockage. It is characterized by persistent respiratory symptoms such as dyspnea, chronic cough, chronic production of sputum, recurrent wheezing, and restricted airflow [ 1 ]. COPD is characterized by airflow limitation that is not fully reversible. Airflow limitation is progressive and associated with abnormal inflammatory response of the lungs, particularly caused by cigarette smoking [ 2 ].

COPD is the third leading cause of death worldwide because of associated comorbidities such as smoking, environmental pollution, and occupational risk [ 3 ]. Despite accurate studies and clinical trials analyzing COPD etiology and phenotypes, currently it can only be treated not cured.

Although COPD affects the lungs, it causes systemic damages with heart involvement developing pulmonary hypertension and cor pulmonale [ 4 ].

The importance of exacerbations is closely related to COPD clinical course, and their reduction increases the outcome and improves the quality of life (QOL). Exacerbations are events requiring therapy with antibiotics, systemic steroids, or both. The severity of exacerbations is defined by the location of care such as home and emergency room or hospital. Mild exacerbations involve upper airways and are treated with adjustments in bronchodilator or inhaled corticosteroid therapy, and moderate exacerbations involve lower respiratory tracts and are treated with antibiotics and systemic corticosteroids. Based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines [ 1 ], the COPD classification of airflow limitation severity is defined as follows: (i) mild forced expiratory volume in 1 second (FEV 1 ) ≥ 80% predicted; (ii) moderate 50% ≤ FEV 1 < 80% predicted; (iii) severe 30% ≤ FEV 1 <50% predicted; and (iv) very severe FEV 1 <30% predicted. An additional sensitive parameter to evaluate early airflow obstruction in peripheral airways is forced expiratory flow (FEF) rate between 25% and 75% of forced vital capacity (FVC). The normal value of FEF 25–75% depends on age and height, and the results of FEF 25–75% are little effort-dependent and representative of air movement through small airways [ 5 , 6 ].

The aim of this clinical case is to highlight the usefulness of pulmonary function tests and particularly FEF 25–75% in early COPD diagnosis to improve therapeutic approach, reduce acute exacerbations, QOL, and disease outcome.

2. Case report

A 72-year-old ex-smoker male, 5 pack-years, was admitted with exertional dyspnea lasting 6 months and productive cough lasting 3 months suggesting early COPD. The patient was not exposed to occupational risk and was neither affected by allergy nor other relevant comorbidities. Physical chest examination showed fine rhonchi without wheezing and crackling sounds. Cyanosis was absent, and pulse oximetry was 96% in room air. No signs of cardiovascular failure were detected.

Pulmonary function tests at baseline, including FEV 1 and FEV 1 /FVC ratio, were in the normal range and did not suggest an initial obstructive airways disease. Note that the FEF 25-75 values were suggestive of moderate small airways obstruction ( Table 1 ). The patient was first treated with long-acting muscarinic antagonist (LAMA – umeclidinium bromide 65 mcg/daily). However, dyspnea and cough did not ameliorate, and the patient suffered from exacerbation responsive to antibiotics. Spirometry after 6 months of LAMA therapy showed a decrease of FEF 25-75 , especially of FEF 25 from 59% to 50%. Then, the treatment was modified using the association of LAMA with long-acting β2 agonist (LABA – vilanterol 22 mcg/daily) according to GOLD guidelines. Patient evaluation after 12 months of LAMA–LABA therapy revealed excellent response with decreased dyspnea and cough and absence of exacerbations. Spirometry showed clear regression of small airways obstructive parameters. Notably FEF 25 increased from 50% to 62% ( Table 1 and Fig. 1 ).

FEF 25-75 values before and after treatment.

FEF: forced expiratory flow; LAMA: long-acting muscarinic antagonist; LABA: long-acting β2 agonist.

FEF 25-75 behavior during LAMA and LAMA–LABA treatment.

3. Discussion

In the reported case, the patient's symptoms such as productive cough associated with dyspnea under exertion worsened and were poorly controlled, particularly in the course of an exacerbation occurring during 6-month LAMA therapy. The persistent symptoms required more effective treatment and led, according to GOLD guidelines, to a therapeutic change replacing LAMA alone with LAMA–LABA association [ 7 ] ( Fig. 2 ).

Efficacy of LAMA–LABA therapy in COPD.

The efficacy of umeclidinium plus vilanterol led to an evident reduction in symptoms avoiding COPD exacerbations at 6, 12, and 18 months of follow-up. The therapeutic benefit was confirmed by spirometry, particularly by FEF 25-75 increase. These findings confirm the usefulness of the association of antimuscarinic agent with LABA in COPD treatment [ 1 ].

Finding normal parameters in pulmonary function tests does not permit, as in this case, to identify an initial obstructive airways disease. Only FEF 25-75, which calculates obstruction severity at several small and medium bronchial airways levels, allows an early COPD diagnosis.

Recently, Kwon Sun et al. [ 5 ] confirmed that FEF 25-75 is reduced in early COPD and associated with small airway disease . Interestingly, the previously performed Boston early-onset COPD study identified FEF 25-75 as a potential indicator of genetic susceptibility to develop COPD. However, the same authors suggested that this measure does not provide information beyond FEV 1 /FVC for demonstrating small airways disease [ 8 ] .

Note that many clinical trials assessing COPD diagnosis and treatment used only FVC and FEV 1 to evaluate the severity of airways obstruction and therapeutic response [ 3 , [9] , [10] , [11] , [12] , [13] , [14] ].

The hallmarks of the present case are that it (i) underlines that FEF 25-75 decrease is the earliest and sensitive pulmonary function test parameter suggesting COPD diagnosis; (ii) FEF 25-75 decrease reflects the loss of elastic recoil and air trapping from emphysema and COPD small airways; and (iii) highlights that lower FEF 25-75 is closely associated with an increase in COPD severity, providing new knowledge of pathophysiological and anatomical mechanisms that lead to clinical outcomes in COPD [ 6 ].

Authors’ contributions

RGC and GB: conceptualization and investigation. FP: reviewing and editing.

Ethics approval

Consent to publication, availability of data and material.

University of Genoa Grant n.:100007-2020-SD-FRA_001.

Declaration of competing interest

The Authors do not have any conflict of interest.

Handling Editor: DR AC Amit Chopra

Abbreviations

Chronic obstructive pulmonary disease (COPD)

Overview  
Theory  
Diagnosis  
Management  
Follow up  
Resources  

Case history

Case history #1.

A 66-year-old man with a smoking history of one pack per day for the past 47 years presents with progressive shortness of breath and chronic cough, productive of yellowish sputum, for the past 2 years. On examination he appears cachectic and in moderate respiratory distress, especially after walking to the examination room, and has pursed-lip breathing. His neck veins are mildly distended. Lung examination reveals a barrel chest and poor air entry bilaterally, with moderate inspiratory and expiratory wheezing. Heart and abdominal examination are within normal limits. Lower extremities exhibit scant pitting edema.

Case history #2

A 56-year-old woman with a history of smoking presents to her primary care physician with shortness of breath and cough for several days. Her symptoms began 3 days ago with rhinorrhea. She reports a chronic morning cough productive of white sputum, which has increased over the past 2 days. She has had similar episodes each winter for the past 4 years. She has smoked 1 to 2 packs of cigarettes per day for 40 years and continues to smoke. She denies hemoptysis, chills, or weight loss and has not received any relief from over-the-counter cough preparations.

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Chronic Obstructive Pulmonary Disease (COPD) Case Study

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