This case presentation describes a 51-year-old male patient admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). The patient presented with a 2-3 year history of cough with whitish, mucoid sputum that is occasionally blood-tinged, as well as right-sided chest pain. Physical examination revealed diminished breath sounds and mild pallor. The patient was started on medications including bronchodilators, corticosteroids, antibiotics, and theophylline. Over the course of his hospital stay, his vital signs and breath sounds improved. Upon discharge, he was prescribed continuing medications and counseling on smoking cessation, breathing exercises, and medication adherence for his long-term COPD

1. CASE PRESENTATION
ON
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
By: Puskar kunwor To: Mr.Kumar swamy
M.Pharm ,1st year Asst.Professor
Dept. of clinical pharmacy
SAC college of pharmacy

2. Patient details:
• Age : 51 years
• Weight: 55kg
• Sex: male
• Unit- medicine- C, M.Ward
• Date of admission: 15/6/13
• Date of discharge: 21/6/13

3. Complaints on admission:
C/O Cough with expectoration since 2-3 years,whitish in colour,mucoid,ocassionally
blood tinged.
C/O Chest pain Rt.side
Medical history: H/O Loss of appetite, breathlesness, generalized weakness, fever
(evening rise in temp.)
Medication history: None
Family history : Nothing significant
Social History : Diet mixed, Appetite: good, Sleep undisturbed ,Chronic
smoker(since 10 years), Not an alcoholic

4. PHYSICAL EXAMINATION
General : BP: 100/70 mmhg, PR: 92bpm
CVS:S1,S2+,Nomermers
RS:diminishedbreathsounds+
CNS:NFND
• Mildpallor

5. SOAP ANALYSIS FOR COPD
Subjective evidence
• C/o Cough with expectoration since 2-3 years,
• colour: whitish
• mucoid,ocassionally blood tinged.
• C/o Chest pain Rt.side,non radiating.
Objective evidence:
X-ray left basal Crepts
LAB DATA
Eosinophil: 5%
Neutrophil: 77%
Assessment:- From subjective and objective evidences it is
diagnosed that patient is suffering from COPD predominantely
Emphysema

6. Goals:
• Patient Specific:
– To reduce symptoms.
• Disease Specific:
– To reduce the frequency and severity of exacerbation and
improve health status.

7. Assessment of current therapy
Drugs Dose Route Freq Days
1 2 3 4 5 6 7
T. Cefixime 200mg PO 1-0-1 + + + + + stop
T.Ranitidine 150mg PO 1-0-0 + + + + + + +
Syp.Brozedex 2TSP PO 1-1-1 + + + + + + +
Nebn.Salbutamol
+Ipratropium Br
100/20
micro g
Inhal 1-1-1 + + + + + + +
Budesonide 0.5mg Inhal 6th hrly + + + + + + +
T.Theophyllin+Eto
phylline
35/115
mg
PO 1-0-1 + + + + + + +

8. PROGRESS REPORT
DAY 2
Pt.is alert & conscious
PR:86bpm, BP:120/80 mmHg, Pallor +,diminished breath sound +
DAY 3
PR:84 bpm, BP:118/80 mmHg, diminished breath sound +
DAY 4
PR:78bpm, BP:110/74 mmHg, diminished breath sound +
DAY 5
PR:80 bpm, BP:114/70 mmHg, diminished breath sound +
DAY 6
PR:78bpm, BP:110/70 mmHg, decreased breath sound
DAY 7
PR:78 bpm,BP:110/75 mmHg, decreased breath sound

9. Discharge medication
T. Theophyllin+Etophylline 150 mg,1-0-1
Duolin respulse,1-0-1
Syp .Brozedex 2TSP,1-1-1

10. Clinical Pharmacist Intervention
Adverse drug reaction:
• Cefixime: nephrotoxicity,neutropenia,thrombocytopenia
• Salbutamol:- tremors, tachycardia, palpitatons, dry and irritated
nose and throat, muscle cramps, hypokalemia
• Ipratropium: chest pain,bronchospasm,palpitation,headache.
• Budesonide: oral infections, throat irritation, hoarseness,
headache, adrenal insufficiency.
• Theophylline & Etofylline : hypersensitivity,circulatory
failure,ventricular arrythmias,tachycardia,respiratory arrest.
Drug -Drug interactions:
Salbutamol + Theophylline – May result in possible cardiac
adverse effects.

11. Monitoring Parameters
Salbutamol:-
I. Monitor serum potassium levels.It may cause hypokalemia.
II. Notify pt.that tremor & tachycardia may occur.
III. If GI problem occur ,administer drug with food.
Theophylline: ECG,respiratory rate

12. Patient Counseling:
– Mainly smoking cessation should be advised
– Some breathing exercise should be taught
– Psychological support should be given along with health
education
– Should be advised to avoid dust and allergens
– Medication adherence should be explained since it is an long
term therapy
– Ipratropium Bromide: Instruct patient to report signs/symptoms of
eye pain, blurred vision, excessively dry nasal passages, or nose
bleeds.
– Theophylline: Advise patient to take drug on empty stomach

13. THANK YOU