Definition COPD is a disease characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema; the air flow obstruction is generally progressive may be accompanied by airway hyper activity Signs and Symptoms Shortness of breath, especially during physical activities Wheezing Chest tightness Having to clear your throat first thing in the morning, due to excess mucus in your lungs

1. CASE PRESENTATION
ON
COPD with RV FAILURE
Presented by
MAKBUL HUSSAIN CHOWDHURY
Pharm.D 5th year
15Z11T0006

2. Definition
 COPD is a disease characterized by the presence of airflow
obstruction due to chronic bronchitis or emphysema; the air flow
obstruction is generally progressive may be accompanied by airway
hyper activity
Signs and Symptoms
 Shortness of breath, especially during physical activities
 Wheezing
 Chest tightness
 Having to clear your throat first thing in the morning, due to excess
mucus in your lungs

3.  A chronic cough that may produce mucus (sputum) that may be
clear, white, yellow or greenish
 Blueness of the lips or fingernail beds (cyanosis)
 Frequent respiratory infections
 Lack of energy
 Unintended weight loss (in later stages)
 Swelling in ankles, feet or legs

6. Risk factors
 Exposure to tobacco smoke
 People with asthma who smoke.
 Occupational exposure to dusts and chemicals.
 Exposure to fumes from burning fuel.
 Age.
 Genetics.

7. CASE STUDY
Patient name : XXX
Age: 65 years
Sex: Male
Dept: Medicine

8. Chief Complaints
 c/o cough with expectoration since 2-3 months
 Breathlessness since 2 months
 fever with chills since 5-4 days
Past medical history
 No H/O similar complaints in past
 No H/O DM/HTN/asthma

9. History of present illness:
 Patient was alright 3months back then he developed H/O cough
insidious in onset and progressive in nature .
 Cough expectoration bile stained sputum scanty in amount purulent
in consistency ,aggravated more in night , h/o breathlessness while
be walking for long distance & relived on rest .

10. Personal history:
 Appetite –normal
 Sleep- disturbed
 Habits - tobacco consumption
General physical examination
 Pallor is present
 Pulse rate :90 bpm
 BP: 120/80 mmHg

11. Systemic examination:
CVS :S1S2 + no murmurs
RS: B/L basal creps, intrascapular rhonchi, increased
right air entry
CNS : NAD
P/A: soft, epigastric tenderness+, no organomegaly

12. Laboratory data
S. No Name Observed value Normal value
1 Hemoglobin 18.3 g/dl 3.5 - 17.5 g/dl
2 WBC 9500 cells/uL 4000-11000cells/uL
3 Basophils 0 0 -3%
4 Eosinophils 3% 0.0-6.0%
5 Lymphocytes 27% 26-46%
6 Monocytes 0% 2-8%
7 RBC 6.69 mc/L 4.7 to 6.1mc/L
8 PLT 2.39Laskhs/microL 1.5-4.5Laskhs/microL
9 ESR 40 mm 0 and 20 mm/hr
10 Sr.creatinine 1.1 mg/dl 0.6-1.2mg/dl

13. Final Diagnosis
COPD with RV failure

14. Drug Chart
S.
No
Brand name Generic name Dose Route Frequency
1 Inj. Levoflox Levofloxacin 500mg iv OD
2 Inj. Pantop pantoprazole 40mg iv OD
3 Inj. Febrinil paracetamol 100ml iv BD
4 Tab. Dytor torsemide 10mg PO BD
5 Syp. Brozedex Terbutaline sulphate +
bromohexine + guaiphenesin
2tsp PO BD
6 Neb. Doulin Salbutamol+ipratropium bromide 50/20mcg QID
7 Neb. Budecort budesenoide 200mcg TID
8 Tab. Ecosprin AV Aspirin+ atorvastatin 150/20mg PO OD
9 Tab. Avas atorvastatin 40mg PO OD

15. Follow up
Day 1
 BP- 110/70mmHG
 Pulse-90bpm
 febrile
 RS: B/L basal creps , AE in right side
 CVS: S1S2+
 P/A: soft ,epigastric tenderness+
Day2
 BP:110/80 mmHG
 Pulse:82bpm
 afebrile
 RS: B/L basal creps+
 CVS: S1S2+
 P/A: NAD

16. Day3
 BP- 120/70 mmHG
 Pulse:82 bpm
 Afebrile
 CVS: S1S2+ heard with out murmur
 P/A: NAD
 Adv, AFB sputum test
Day 4
 BP-120/80mmHG
 Pulse: 90bpm
 Afebrile
 RS: left basal creps+
 CVS: s1s2 + no murmurs
 P/A: NAD

17. Pharmacist intervention
Significant interactions found in prescribeddrugs:
 atorvastatin + budesonide: Atorvastatin will increase the level or
effect of budesonide by P-glycoprotein (MDR1) efflux transporter.
Pharmacist suggestion:
Discontinue the budesonide and start with fluticasone 200 mcg
inhalation and continue the therapy.

18. Patient counselling
About disease:
 COPD with RV failure is the comorbid condition that affects the lungs and
heart respectively, so you may have the symptoms like breathlessness,
chest pain etc.
About drugs:
 Consumption of drugs in right time Tab.pantop(pantoprazole): take the
drug once a day half an hour before meals in the morning, this helps to
relieve your gastric acidity.
 Cap. abphylline: this is drug for used to avoid breathlessness.

19. Patient counselling
About life style modification:
 Avoid high salt contained food
 Limit fluid intake to 6-8 cups/day
 Reduce the daily intake of saturated fat and
 cholesterol.

20. Patient counselling
About life style modification:
 Avoid high salt contained food
 Limit fluid intake to 6-8 cups/day
 Reduce the daily intake of saturated fat and
 cholesterol.