Case Study: COPD and Comorbidities in a 66-Year-Old Female

PATIENT SUMMARY
Audrey Thomas a female, aged 66 years, who lived alone was suffering from COPD based both
laboratory diagnosis and the clinical manifestations such as difficulty in breathing, severe
dyspnoea, high respiratory rates, raised heart beat rates, hypersecretion of mucus. Moreover, the
patient suffered a myriad of conditions that could be attributed to her lifestyle or as result of
Primary conditions such include hypertension, obesity, osteoporosis, and chronic kidney disease
among others.
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that cause
inflammation leading to bronchoconstriction and airway resulting to difficulty in breathing
(Nagaratnam et al., 2018). Some of the main diseases that constitute the COPD include,
emphysema, acute severe asthmatic, and chronic bronchitis. According to Vogelmeier et al.
(2017), damage to the airways inhibits the gaseous exchange in the lungs. Smoking, infection
caused by virus and bacteria, and air pollution results to exacerbations of COPD indicative of
worsening of the underlying chronic inflammation of the airways, and the frequency of the
exacerbations is one of the important determinants of health-related quality of life a person (Divo
et al., 2015).
Case of Audrey Thomas: Day 1
Q1.
Audrey is suffering from acute severe asthmatic attack based on clinical manifestations exhibited
such as severe dyspnoea, high respiratory rate at 32 breaths/ minutes, her heart rate is 120 beats
per minute, coughs, and hypersecretion of mucus. According to Hazeldine (2013), symptoms of
acute severe asthma include Dyspnoea, Cough, respiratory rate ≥25 breaths/minute, Heart rate ≥
110 beats/minute. The acute asthmatic attack happens when person is exposed to an allergen
provoking an immune reactions leading to production of inflammatory mediators such as IgE
and mast cells among others. Immunological response results to bronchoconstriction,
bronchospasm, and hypersecretion of mucus (Whitsett and Alenghat (2015). Acute severe
asthmatic attack not only affect normal functioning of the lower respiratory tract such as trachea,
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bronchi, and the bronchioles but also the general pulmonary function is affected leading to
adverse symptoms experienced by the asthmatic patient (Hamid, Mahboub, & Ramakrishnan,
2018).
Q2.
During acute severe asthmatic attack there is reduced maximum expiratory volume per second,
reduced respiratory rates, therefore, the body compensate for this physiological changes by
cardiovascular system increasing the heart rate beat/minute to ensure availability of oxygen in
vital organs (Brinkman, & Sharma, 2018). Audrey experienced increased respiratory rate of up to
32 breaths per minutes and high heart rate ≥ 110 beats/minute. According to Kaufman (2012), in
acute severe asthma the patient’s respiratory rate of is increased to ≥25 breaths/minute and high
heart rate of ≥ 110 beats/minute to compensate for adverse clinical symptoms.
Q3
The Audrey is more likely to suffering from respiratory infections resulting to COPD. Some of
the risk factors that faced by Audrey are causal factors including smoking. According to
Kaufman (2012), environmental allergens such as cigarette smoking greatly influences
susceptibility to the development of acute severe asthmatic attack among the predisposed
persons. The long use of corticosteroid drugs by Audrey in the management of acute asthma
attack and her advanced age exposes her to more secondary infections caused by viral or
bacterial. For example, a study in China by Zhang et al. (2015), revealed that persons aged 40
years and above are 8.2 times prone to bacterial chronic bronchitis compared to the general
population. According to Hewitt et al. (2016), exacerbations of COPD can be caused by upper
respiratory viral infections such as Influenza A virus and Streptococcal pneumonia.
Q4.
Audrey is obese hence limiting his mobility, she spends most of the time sited in lounge room,
she has increased systemic inflammations, and she has been smoking for a long period.
Therefore, she has high risk of developing pulmonary embolism based on her condition and life
style. According to Kim et al. (2014), COPD patient with history of smoking, immobile, and
having systemic inflammation are at a high risk of developing pulmonary embolism. To prevent
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the development of pulmonary Audrey should be involved in physical activities and she should
be adviced to quit smoking.
Case of Audrey Thomas: Day 2
Q5.
Audrey may have developed muscle atrophy due to her sedentary life style which makes her
physically inactive and her advanced age is a risk factor leading to her falling and fracture.
Audrey would be suffering from osteoporosis which is low bone density and is common among
post-menopausal other risk factors include smoking, long term use of corticosteroids. Moreover,
bone resorption increases with menopause which is a risk factor for development of bone disease
(Sheu & Center, 2017). Audrey could later suffer chronic lower back pain and Osteoarthritis
attributed to her advance age and lack of physical activity.
Q6.
Audrey’s advanced age, gender, lifestyle, and being obese could have greatly contributed to the
fracture. These factors make person prone to osteoporosis and osteoarthritis caused by oxidative
damage, cartilage thinning, and bone resorption (Basedow et al., 2015). Moreover, studies have
established that women are at high risk of having bone fractures as compared to their male
counterparts this has been attributed to menopause where women experiences reduces oestrogen
levels (Australian Institute of Health and Welfare [AIHW], 2018 ). For example, in Australia
osteoarthritis has been cited as highly disabling and the high prevalence has been attributed to
ageing and increasing obesity of the population (Basedow et al., 2015).
Q7.
Jeon et al. (2014), established that there was a correlation between loss of bone mineral density
and the respiratory disease including bronchial asthma. Audrey condition of COPD has effect on
the normal lung function. Reduced lung function caused by airway inflammation and obstruction
increases the chances of bone disease and smoking has been cited as plausible explanation for
the occurrence of both respiratory disease and bone disease (Jeon et al., 2014).
Case of Audrey Thomas: Day 3
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