copd

1. FAMILY CASE:
COPD
ARIT, CODEN, DELGADO, SILVA

2. FAMILY
BACKGROUND

3. FAMILY BACKGROUND
Name: S.S.
Sex: Male
Marital Status: Married
Age: 78 years old
Educational Attainment: Elementary
Address: Cabuyao, Laguna
Status: Deceased

4. FAMILY
CLASSIFICATION

5. FAMILY CLASSIFICATION
Family Structure: Nuclear
Family Location: Matrilocal
Family Stage: Family launching young adults
Decision-Making: Patriarchal
Set-up: Paternalistic
Class: Upper class

6. FAMILY
LIFELINE

7. FAMILY LIFELINE
YEAR PSYCHOSOCIAL EVENT IMPACT
1937 Started smoking Patient was 14 years old. Often lights up a cigarette, use
it for a while, then lets it sit in the ashtray beside him as
he works.
1957 Wedding Patient and his wife stayed at Cabuyao, Laguna and
started a garment business.
1974 Moved residence They moved just in front of their old residence, which
eventually became the wedding gift for their eldest child.
1983
Diagnosed with Emphysema and
Asthma
Patient experienced one week of intermittent cough,
fever, and shortness of breath.
Patient stopped smoking and decided to implement a
lifestyle more suited for his health as he is the head of
the family. Started supplemental oxygen for his asthma

8. YEAR PSYCHOSOCIAL EVENT IMPACT
1988 Diagnosed with Diabetes His Attending Physician requested him to become a
member of the group of diabetic patients in the Lung
center. He felt that he didn't have much time left but his
family kept his hopes up by stating that ‘hindi yan kaya
mo yan tatagal pa.
1988-1995 Children moved out Patient’s children eventually married and moved out of
their household
1990 Symptoms persist Patient was confined in Calamba Medical center, as per
his annual hospital confinement, but didn’t see any
improvement. The family then decided to transfer the
patient to Lung Center in Quezon City yet again.
FAMILY LIFELINE

9. YEAR PSYCHOSOCIAL EVENT IMPACT
1998 Symptoms prevailed This is the time the patient kept going back and forth to
the hospital. His condition got worse.
1999 Died of COPD. Confined at Pamana Hospital in Cabuyao and eventually
became bedridden. The patient was advised by his health
care practitioners to be sent home to spend his remaining
time with family and loved ones.
FAMILY LIFELINE

10. FAMILY
GENOGRAM

11. CS F.
S
L.S R.S A.S
M.S M.S
M.S
L.S L.L
C.S
C.S
C.S
V.S E.S E.S
P.C I.C E.C
J.C J.N
A.E
L.V
B.E
C.M L.S
S.S
Emphysema
Diabetes
Asthma
68 yo 66 yo
36yo 27 yo
35 yo 34 yo
34yo
33yo
32 yo 32 yo 31 yo 31 yo 28 yo 25 yo
N.G
S. Family
Cabuyao Laguna
1995
Separated
Living together
Deceased
Same household
m.1988
m.1989
m.1990
M.1986
S. 1991
LT.1994
M.1992
S. 1992
m.1957

12. FAMILY
PROFILE

13. Sociodemographic Profile of household members
Name Age Civil
Status
Education Occupation Religion Relation to
Index patient
S.S 68 yo Married Elementary Entrepreneur
Roman
Catholic
Index
patient
P.C. 66 yo Married Elementary Housewife
Roman
Catholic
Wife
L.S (twins) 31 yo Single
Post
Graduate
degree
Dentist
Roman
Catholic
Son
M.S 28 yo Single High School Unemployed
Roman
Catholic
Son
E.S 25 yo Single
College
Level
Unemployed
Roman
Catholic
Daughter

14. Economic Profile of Earning Individuals in the
Household
Name
Relationship to
index
Occupation Wages/ Income
S.S Index Patient Entrepreneur 400,000/ month
L.S (twins) Son Dentist No fixed income

15. Environmental Provfile
Number of Members
in the Family
14
Currently Lives with
Wife, 2 sons and
youngest daughter
House
7BR 2-storey
concrete house
Drainage Closed
Pets 1 dog
Toilet Flush Type
Water Source Deep Well
Drinking Water
Distilled/ Mineral
Water
Electricity Meralco
LPG cooking Uses LPG
Garbage collection Weekly

16. Psychodynamics of Household Members
to index patient
Name Relationship
Type of
relationship
(Good/Bad)
Reason
P.C wife Good
Loves him dearly and saw how he sustains the
family
L.S
(TWINS)
Son Good Patient has no conflict with his children
M.S Son Good Patient has no conflict with his children
E.S Daughter Good Patient has no conflict with his children

17. FAMILY
FUNCTION

18. FAMILY MAP

19. FAMILY MAP
Time reference 1995
SS
74
LS
31
MS
28
PS
66
ES
25
Family of map among household members. The patient has a strong and equal bond to each of the members of the
family. Each member of the family has a strong bond with one another.

20. APGAR 1

21. APGAR 1
APGAR QUESTIONNAIRE PALAGI (2) PAMINSAN-
MINSAN (1)
HALOS HINDI (0)
Adaptation Ako’y nasisiyahan dahil nakakaasa
ako ng tulong mula sa aking
pamilya sa oras ng
pangangailangan.
✔
Partnership Ako’y nasisiyahan sa paraang
nakikipagtalakayan sa akin ang
aking pamilya tungkol sa aking
mga problema.
✔
Growth Ako’y nasisiyahan at ang aking
pamilya ay tinatanggap at
sinusuportahan ang aking mga
nais na gawin patungo sa mga
bagong landas para sa aking
ikauunlad.
✔
Time reference 1987-1995

22. APGAR 1
APGAR QUESTIONNAIRE PALAGI (2) PAMINSAN-
MINSAN (1)
HALOS HINDI (0)
Affection Ako’y nasisiyahan sa paraang
ipinadadama ng aking pamilya
ang kanilang pagmamahal at pag
unawa sa aking damdamin
katulad ng galit, lungkot, at pag-
ibig.
✔
Resolve Ako’y nasisiyahan na ang aking
pamilya at ako ay nagkakaroon ng
panahon sa isa’t-isa.
✔
TOTAL
8 = Highly Functional
Highly functional = 8-10, Moderately functional = 4-7, Severely functional = 0-3

23. APGAR 1: Explained by the wife of the index patient
The APGAR 1 Table shows the level of satisfaction within the family functioning. As per a family member
close to the patient, the questionnaire summed a total score of 8/10 which shows that their family is
Highly functional.
Adaptation - The patient is confident that he could expect help from his family especially those who are
in close proximity as they are readily extending any kind of help.
Partnership - Most of the time family members discuss issues with the patient especially when it is about
his health.
Growth - Family members support the decisions of the patient. One example is when the patient became
less stingy after being diagnosed and children follows what the patient requests such as routinely buying
food at a popular restaurant in Calamba.
Affection - Family members openly express their concerns with regards to their father’s situation. One
example is when the 2nd child told the patient how furious she was with the lack of action of the hospital
and wishes to find another doctor and institution.
Resolve - Reunions and gatherings are not usual in the family as patient was known to be stingy.

24. APGAR 2

25. APGAR 2
NAME AGE SEX RELATIONSHIP HOW DO YOU GET ALONG?
WELL FAIRLY POOR
PS 66 F Wife ✔
LS 31 M Son ✔
MS 28 M Son ✔
ES 25 F Daughter ✔
The patient lives with his wife, 6th, 8th, and 9th children and they get along well. He made most of the decisions. The family
supports what the patient needs, especially, emotional and social aspect.
Time reference 1995

26. SCREEM

27. SCREEM-RES
Resources Kapag may nagkakasakit sa aming pamilya…
Strongly
Agree
3
Agree
2
Disagree
1
Strongly
Disagree
0
SOCIAL Kami ay nagtutulungan sa isa’t isa sa aming pamilya. ✔
Natutulungan kami ng aming mga kaibigan at kasamahan
sa komunidad.
✔
CULTURAL Ang aming kultura at nagpapatatag ng loob ng aming
pamilya.
✔
Ang kultura ng pagtutulungan at pagmamalasakit sa
aming komunidad ay nakatutulong sa aming pamilya.
✔
RELIGIOUS Ang aming pananampalataya at rehiyon ay nakatutulong
sa aming pamilya.
✔
Natutulungan kami ng aming mga kasamahan sa simbahan
o mga grupong relihiyoso.
✔
Time reference 1987-1995

28. SCREEM-RES
Resources Kapag may nagkakasakit sa aming pamilya…
Strongly
Agree
3
Agree
2
Disagree
1
Strongly
Disagree
0
ECONOMIC Sapat ang naipong pera ng aming pamilya para sa aming
mga pangangailangan.
✔
Sapat ang kinikita ng aming pamilya para sa aming mga
pangangailangan.
✔
EDUCATION Sapat ang aming edukasyon/kaalaman upang
maintindihan ang mga impormasyon tungkol sa sakit.
✔
Sapat ang aming edukasyon/kaalaman upang maalagaan
ang may sakit.
✔
MEDICAL Madaling makakuha ng tulong medical sa aming
komunidad.
✔
Natutulungan kami ng mga doctor, nars, at “health
workers”.
✔

29. 27 = Adequate Family
Resources
25-36 = Adequate Family
Resources
13-24 = Moderately Inadequate
Family Resources
0-12 = Severely Inadequate
Family Resources
SCREEM-RES

30. SCREEM-RES Analysis:
Adequate Family Resources
● SOCIAL interaction is evident among family members. There is sufficient help
provided by each of the family member.
● CULTURAL satisfaction is evident in times of crisis, it gives courage and
strengthens the bond of the family.
● RELIGION offers satisfying spiritual experiences.
● ECONOMIC stability is more than enough to provide an ability to meet
economic demands of normal life events and crises.
● EDUCATION of family members such as having a doctor helps the family to
comprehend health information especially the patient’s condition.
● MEDICAL accessibility is not a problem. Family members are able to seek
medical care easily.

31. Parameter Resource Pathology
Social The family works together especially in taking care of the patient.
Friends are also around most of the time.
No pathology/weakness seen.
Cultural Their culture of being family oriented and staying together gives them
the strength to strive. The family was self-sufficient with regards to
their financial capabilities and community efforts were not identified.
There were no initiative extension of help
with regards to community efforts.
Religion The family is Roman Catholic in which the wife was strictly religious
and obligates the family to pray the rosary everyday at 6pm. Religious
group efforts were not also identified as the family is self-sufficient.
There were no initiative extension of help
with regards to religious group efforts.
Economic The family has good investments, they were able to accumulate and
save to be self-sufficient. The patient himself was known to be stringy.
No Pathology/Weakness seen.
Education Most family members were engineers and business professionals few
were health professionals and some including the patient didn’t finish
a degree thus there are times when they hardly understand the
doctor’s recommendations and prescriptions.
Not all family members including the patient
are adept in understanding health
information.
Medical Medical is accessible as one family member is a medical doctor and
they have the financial capability to seek consult from a doctor who is
just a call away.
No Pathology/Weakness seen.

32. INDIVIDUAL
REACTION TO
ILLNESS

33. INDIVIDUAL REACTION TO ILLNESS
1. How does the patient feel about his/her illness (Hopeful/Angry/depressed/worried, etc)? Why?
The patient feels hopeful about his condition. He has a son and daughter-in-law who are doctors. Everyone in his
family does their best effort to provide for and help each other during these trying times.
1. How do the family members feel about the illness (worried/hopeful/depressed/angry)? What
do you think is/are the reason/s of that feeling? Especially the partner? Is she/he
supportive/Fearful? How can you say?
Patient’s wife was very supportive. She was there with him in all his doctor appointments and until his final moments
of life – she never left his side. They never separated rooms and had a very meaningful relationship amidst nurturing
and looking after nine children. All of them showed respect, love, and support to their father in the best way possible.
1. Insights about her/his illness?
Though it took him long enough to quit smoking for good, the patient was well aware of the gravity of his condition.
That’s why he opted to agree with his primary care physician for a lifestyle change upon receiving his diagnosis.

34. ASSESSMENT
OF IMPACT OF
ILLNESS

35. ASSESSMENT OF IMPACT OF ILLNESS
The status of the family during the patient’s course of illness was quite good,
as there was no mention of social or financial burden. They showed their love
and support throughout. But the burden of the passing of the head of the
family swiftly followed. Various conflicts started to arise within. Disagreements
on the division of property, inheritance, and favoritism displayed by the wife.
As both of them focused on the garment business while rearing their children,
some of them grew up with either grandparents or helpers. Personalities from
different upbringing started clashing now that the head that holds the family
together is no longer present.

36. IDENTIFIED
PROBLEMS AND
RECOMMENDATION

37. Identified Problems and Recommendations
The patient had a good bond and strong relationship with his family members. He was
the breadwinner and decision maker in their household. After the patient has passed,
poor communication skill was noted as the main source of conflicts within the family.
This led to the creation of misunderstandings, missed opportunities, and mistrust.
We recommend for the family to:
● Have an open communication.
● Develop more social relationship amongst themselves and community members.
● Attend church services to assist their spiritual needs
● Advice for lifestyle changes such as avoidance of smoking and alcohol, level of
physical activity, stress management practice, and nutrition/dietary.

38. Chronic Obstructive
Pulmonary Disease
(COPD)

39. INTRODUCTION
Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause
of death in the world but is projected to be the 3rd leading cause of death by 2020.
More than 3 million people died of COPD in 2021 accounting for 6% of all deaths
globally. COPD represents an important public health challenge that is both
preventable and treatable. COPD is a major cause of chronic morbidity and mortality
throughout the world; many people suffer from this disease for years and die
prematurely from it or its complications. Globally, the COPD burden is projected to
increase incoming decades because of continued exposure to COPD risk factors and
aging of the population.

42. ?

43. OVER ALL KEY POINTS
● Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that
is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or
alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
● The most common respiratory symptoms include dyspnea, cough and/or sputum production. These
symptoms may be under-reported by patients.
● The main risk factor for COPD is tobacco smoking but other environmental exposures such as
biomass fuel exposure and air pollution may contribute. Besides exposures, host factors predispose
individuals to develop COPD. These include genetic abnormalities, abnormal lung development and
accelerated aging.
● COPD may be punctuated by periods of acute worsening of respiratory symptoms called
exacerbations.
● In most patients, COPD is associated with significant concomitant chronic diseases, which increase its
morbidity and mortality.

44. RISK FACTORS:
● Tobacco smoke
● Indoor air pollution
● Occupational exposures
● Outdoor air pollution
● Genetic factors
● Age and sex
● Lung growth and development
● Socioeconomic status
● Asthma and airway hyper-reactivity
● Chronic bronchitis
● Infections

49. ASSESSING DISEASE PATTERN AND SEVERITY
Symptoms and risk of exacerbations - Each patient is classified as being in one of four groups (A,B,C,D).
Symptoms are assessed using a validated instrument, the modified Medical Research Council (mMRC)
dyspnea scale or the COPD Assessment Test (CAT). Exacerbation risk is based on the patient’s history of
exacerbations in the past year; two or more exacerbations requiring antibiotics and/or systemic
glucocorticoids or one or more COPD hospitalizations indicate a greater risk of future exacerbations
The symptom and risk components are combined into four groups as follows:
Group A: Minimally symptomatic, low risk of future exacerbations: mMRC grade 0 to 1 or CAT score
<10; 0 to 1 exacerbation per year and no prior hospitalization for exacerbation
Group B: More symptomatic, low risk of future exacerbations: mMRC grade ≥2 or CAT score ≥10; 0 to
1 exacerbation per year and no prior hospitalization for exacerbation
Group C: Minimally symptomatic, high risk of future exacerbations: mMRC grade 0 to 1 or CAT score
<10; ≥2 exacerbations per year or ≥1 hospitalization for exacerbation
Group D: More symptomatic, high risk of future exacerbations: mMRC grade ≥2 or CAT score ≥10; ≥2
exacerbations per year or ≥1 hospitalization for exacerbation

59. PHARMACOLOGIC TREATMENT
MINIMALLY SYMPTOMATIC, LOW RISK OF EXACERBATION (GROUP A)
Short-acting bronchodilators — Short-acting beta agonists and short-acting muscarinic antagonists
(anticholinergic) can be used alone or in combination for relief of intermittent symptoms of COPD. All of
the short-acting bronchodilators improve symptoms and lung function.
● Beta agonists:
○ albuterol & levalbuterol
○ generally prescribed on an as-needed basis
● Muscarinic antagonists:
○ ipatropium
○ as-needed and regularly scheduled dosing not compared
● Combination therapy:
○ ipratropium-albuterol
○ Combination therapy is often preferred because the combination of a short-acting beta
agonist plus a short-acting muscarinic antagonist achieves a greater bronchodilator response
than either one alone.

60. PHARMACOLOGIC TREATMENT
MORE SYMPTOMATIC, LOW RISK OF EXACERBATION (GROUP B)
Long-acting beta agonist (LABA) or long-acting muscarinic antagonist (LAMA)
Overall efficacy and safety appear comparable in terms of symptom control. Both LAMAs and LABAs
reduce exacerbations, but LAMAs have a greater effect.
● Long-acting beta agonists:
○ salmeterol, formoterol, arformoterol, indacaterol, vilanterol, & olodaterol
○ arformoterol - only available as solution for nebulization
● Long-acting muscarinic antagonists:
○ tiotropium, aclidinium, umeclidinium, & glycopyrrolate
○ as-needed and regularly scheduled dosing not compared

61. PHARMACOLOGIC TREATMENT
MINIMALLY SYMPTOMATIC, HIGH RISK OF EXACERBATION (GROUP C)
● Initial therapy with a LAMA
○ Reduced exacerbation rate associated with LAMAs
MORE SYMPTOMATIC, HIGH RISK OF EXACERBATION (GROUP D)
● Initial therapy with a LAMA
○ LAMA alone will reduce dyspnea and exacerbations in most such patients
● LAMA-LABA for severe breathlessness
○ tiotropium-olodaterol, umeclidinium-vilanterol, glycopyrronium-indacaterol, glycopyrrolate-
formoterol, aclidinium-formoterol,
● Alternative choice LABA-ICS
○ fluticasone-salmeterol,
○ budesonide-formoterol and mometasone-formoterol (off-label)

73. References:
● The 2019 Philippine Health Statistics: Epidemiology Bureau DOH
● GOLD 2020 edition
● UpToDate

74. THANK YOU!