Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production, Swelling in ankles, feet or legs and wheezing. It's caused by long-term exposure to irritating gases or smoking. Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. 

1. CASE PRESENTATION ON COPD
WITH RIGHT SIDE PLEURAL
EFFUSION
By:-
B. Sunil Kumar Nayak
1

2. Introduction
• Chronic obstructive pulmonary disease (COPD) is a chronic
inflammatory lung disease that causes obstructed airflow from the
lungs. Symptoms include breathing difficulty, cough, mucus
(sputum) production, Swelling in ankles, feet or legs and wheezing.
It's caused by long-term exposure to irritating gases or smoking.
• Emphysema and chronic bronchitis are the two most common
conditions that contribute to COPD.
2

3. Emphysema causes destruction
of the fragile walls and elastic
fibers of the alveoli. Small
airways collapse when we
exhale, impairing airflow out of
the lungs.
Bronchitis in which bronchial tubes
become inflamed and narrowed and
lungs produce more mucus, which
can further block the narrowed
tubes. Which develops a chronic
cough trying to clear the airways.
3

4. Demographic details
Age : 71 years
Sex : Male
Ward : MMW
No. of days Hospitalized : 5 days
Complaints:
Shortness of breath- grade II since 15 days, cough with sputum,
fever since 10 days, pedal edema since 4 days
Histories :
Family history, medical and medication history was nothing significant.
4

5. • Personal history
Smoking since 20 years
Provisional diagnosis
• Chronic obstructive pulmonary disorder……?
5

6. Pharmaceutical care plan
Subjective evidence:
Shortness of breath- grade II, cough with sputum, fever, pedal edema
Objective evidence:
Chest X-Ray : Moderate right side pleural effusion
WBC : 13300 (6000-11000c/cumm)
ESR : 20 (10mm for 1st hour)
6

7. Other investigations
HBsAG : Non-Reactive HCV : Non-Reactive
HIV 1&2 : Negative CUE : Normal
Chest X-Ray : Moderate right side pleural effusion
N :69
L: 23
E: 08
M: 01
B: 00
Factor Day1 Day2 Day3
HB (12-14g/dl) 10.7 10.5 10.5
RBC (4.4-5.4 M/cumm) 3.7 3.7 3.7
WBC (6000-11000c/cumm) 13300 9600 7600
Platelets (1.5-4.5 L/cumm) 1.51 1.51 1.52
ESR (10mm for 1st hour) 20 - 10
Na+ (135-145 mmol/l) 135 140 -
K+ (3.5-5.5 mmol/l) 3.1 3.1 -
Cl- (95-110 mmol/l) 96 98 -
7

8. Assessment :
Based on subjective and objective evidence the patient was diagnosed
as COPD with right side pleural effusion.
Final diagnosis:
COPD with right side pleural effusion
8

9. Plan
Goals of the treatment
• Reduce the symptoms such as Shortness of breath, fever, cough,
pedal edema.
• To prevent from the complications like lung cancer, pulmonary
hypertension.
9

10. Generalized treatment
• COPD is preventable, it cannot be cured. Once lung damage occurs,
treatment focuses on preventing additional damage, reducing
symptoms of the disease, and enhancing the quality of daily
activities.
• Bronchodilators
Short acting- Terbutaline-1mg,Ipatropium- 20mcg,Salbutamol-2.5-5mg
Long acting- Salmeterol- 25-50mcg Formoterol- 80mcg
• Corticosteroids
Budesonide-100mcg Prednisolone-10mg
• Phosphodiesterase 4 (PDE4) Inhibitors
Roflumilast- 500µg
• Oxygen Therapy
• Antibiotics
Amoxicillin- 1g Azithromycin- 500mg
Erythromycin-500mg Doxycycline- 500mg 10

11. current therapy
S.NO DRUGS DOSE ROA FREQ DA DS
1 Inj.Amoxicillin 1.2g IV BD 1 5
2 Inj.Furosemide 20mg IV BD 1 5
3 Inj.Pantoprazole 40mg IV OD 1 5
4 Neb. Ipratropium+Salbutamol - NEB 4th hrly 1 5
5 Tab.Paracetamol 650mg PO SOS 1 5
6 Tab.Cilnidipine 5mg PO BD 1 5
7 Syp.Pot.chloride 20ml PO TD 1 5
8 Syp.Al.hydroxide, Mg.hydroxide,
oxctacaine
0.29+98
+10 mg
PO TD 2 5
9 Inj.Azithromycin 500mg IV OD 3 5
10 Tab.Sildanafil 10mg PO BD 2 5
11

12. Day wise assessment and notes
DAY PR (BPM) BP (mm Hg) OTHERS
1 92 120/60 -
2 92 140/80 Decreased breath sounds
3 96 140/90 c/o chest pain, burning is stomach
4 80 140/80 -
5 92 120/70 DISCHARGE
12

13. Discharge medication
• Tab.Azithromycin
500mg-po-od
• Tab.Sildenafil
10mg-po-od
• Tab.Spironolactone+Furosemide
50+20mg- po-od
• Tab.cyanocobalamin
5mcg-po-od
13

14. Patient counselling
About disease
Patient’s representative is counselled that COPD is a chronic
inflammatory lung disease that causes obstructed airflow from the
lungs. Symptoms include breathing difficulty, cough, mucus
(sputum) production, Swelling in ankles, feet or legs and wheezing.
It's caused by long-term exposure to irritating gases or smoking.
14

15. About medication
Patient’s representative was counselled regarding the
medications that should take in time and don’t skip the medication.
• Tab.cyanacobalamin should be taken in the afternoon after lunch.
• Tab.sildanafil should be taken once daily in the morning.
• Tab.spirnolactone+furosemide should be taken once daily in the
afternoon.
• Tab.Azithromycin should be taken once daily.
15

16. About life style modifications
• Avoid close contact with people who have respiratory infections
• Quit smoking
• Participate in a pulmonary rehabilitation program
• Avoid exposure to environmental irritants like pollen, dust etc.
• Breathing exercises can strengthen chest muscles and make
breathing easier.
16

17. Thank you
17