A 65-year-old patient, John Brown a retired coal mine worker, with a history of COPD presents to a clinic in Warragul Hospital emergency department with complaints of worsening shortness of breath, cough with clear-white sputum production, and fatigue. The patient reports a 4 kilogram weight loss in the last month and increased dyspnoea with activity.
Vital signs are as follows: blood pressure 130/80 mmHg, heart rate 92 beats per minute, respiratory rate 24 breaths per minute, temp 37.0oC and oxygen saturation of 88% on room air. The patient appears tired and uncomfortable, using pursed-lip breathing.
Mr Brown’s usual medications are salbutamol 4 times a day (and prn) and Budesonide 2 times a day. Mr Brown doesn’t use a spacer because “I am not a child!”.
After medical review, the diagnosis is exacerbation of COPD. The recommendations are oxygen via nasal specs at 2L and sputum specimen for investigation. Mr Brown is commenced on nebulised salbutamol QID, Ipratropium bromide BD and Budesonide BD,