I would diagnose KJ with mild COPD (Chronic Obstructive Pulmonary Disease). Some of the common signs of COPD include wheezing, shortness of breath, and cough, all of which have been demonstrated by KJ. The diagnosis with COPD has also been confirmed with the FEV1 of 65% and the hyperinflated lung fields demonstrated in the chest X-Ray. Research has shown that one of the most common causes of hyperinflated lungs is COPD. It is also commonly accompanied by chronic bronchitis and emphysema. Through a test known as spirometry, one can determine the amount of air that a person expels and the actual time taken to do so. In normal adults, the ratio of FEV1/FVC should be between 70% and 80%. A measurement below 70% shows airflow limitation as in the case of KJ (65%).
As the practitioner in charge of KJ’s health, I would reassure him that COPD is a treatable infection and can be done so using lifestyle changes and adherence to medication. KJ should also be advised to cease smoking. One of the primary causes of COPD is smoking. KJ can be enrolled in special programs that will help him quit smoking. From the case study, it is also apparent that KJ is suffering from obesity. Therefore, I will advise him to begin exercises such as swimming and walking that would assist him in losing weight. As part of the losing weight program, I would also hold talks with KJ in a bid to help him change his diet. As such, this will require me to refer him to a nutritionist. It is also crucial to refer him to a pulmonary rehab program where he will improve the exercise tolerance symptoms and the general symptoms of dyspnea.
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As regards the medication, the drug of choice to give KJ would be Albuterol and Atrovent. Both drugs are inhaled. On the one hand, Atrovent is an antimuscarinic drug, while Albuterol is a beta 2 antagonist (Tindall, Sedrak, & Boltri, 2013). Research has shown that the combination of drugs works better than each one on its own. Another drug that I would prescribe is Ipratropium. It is effective in relieving the symptoms and improving the levels of FEV1. Other drugs that have also been recommended for this condition are known as the short-acting beta antagonist (SABA). However, they do not provide a long-lasting solution and as such, cannot be recommended as the regular treatment for COPD. It is therefore incumbent to prescribe long-acting beta-antagonists such as Striverdi Respimat (Tindall, Sedrak, & Boltri, 2013). As such, the patient’s symptoms will be relieved on a much longer span. The medication has additional benefits such as the improvement of lung function and reduction of the effects of severe dyspnea.
In giving the medication, it is important to remain cognizant of the fact that the patient has hypertension. Therefore, all the drugs given should not work in antagonist with the hypertensive medication. KJ will also be taught on how best to use the inhaler to ensure that he uses it in the right way. I would also book KJ after 72 hours to perform a reassessment. If the conditions have not improved, it will be incumbent upon me to sputum culture to determine whether his condition is related to a bacterial infection. Also crucial to note is the fact that COPD increases the chances for infection. It is therefore vital to ask KJ if he has ever received flu or pneumonia vaccines.
References
Tindall, W. N., Sedrak, M., & Boltri, J. (2013). Patient-Centered Pharmacology: Learning System for the Conscientious Prescribe. FA Davis.
