Pulmonary Function Testing

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The Diagnosis

The diagnosis of the COPD is dependent on the thinking of it as being a cause of breathlessness as well as a cough. The suspicion of the diagnosis is by the symptoms as well as the signs and the supported spirometry. According to Gershon, Warner, Cascagnette, et al. (2011), the diagnosis of the COPD needs to be considered in the patients that are above the age of 35 who are at the risk factor and who indicate any of more of the following signs:

  • Exertional breathlessness
  • Frequent winter ‘bronchitis.’
  • Chronic cough
  • Wheeze
  • Regular sputum production

The Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (2016), asserts that the patients who are considered for COPD need to be asked about the presence of factors such as;

  • Weight loss
  • Waking at night
  • Effort Intolerance
  • Ankle swelling
  • Occupational hazards
  • Fatigue
  • Haemoptysis
  • Chest pain

The chief symptoms that are associated with COPD are breathlessness. There should be the use of the medical research council dyspnea scale in the grading of the breathlessness according to the level of exertion that is needed in eliciting it (Buttaro, Trybulski, Polgar& Sandberg-Cook, 2013).

According to McDonough, Yuan, Suzuki, et al. (2011), the grades of the degree of breathlessness that is related to the diverse activities encompass:

  1. The individuals who are not troubled by the breathlessness other than on the cases of strenuous exercise
  2. The individuals who are short of breath when they are hurrying or walking up a straight hill
  3. The parties that walk slower that the contemporaries on a level ground as a result of the breathlessness or have to stop for breath when they are walking at their pace
  4. Those who stop to take a breath after walking for approximately 100 meters or after just a few minutes on a level ground
  5. Those that are too breathless to leave their houses and in other cases too breathless when either dressing or undressing

Spirometry needs to be undertaken at the diagnosis as well as when trying to reconsider the diagnosis if the patients indicate an exceptionally good response to the treatment. At the time of the preliminary diagnosis, it is imperative that in addition to the spirometry, all the patients should have a chest radiograph to assist in the exclusion of the other pathologies (Global Initiative for Chronic Obstructive Lung Disease, 2011). It is additionally imperative that the patient has a full blood count assessment to identify anemia or polycythemia along with the calculation of the body mass index.

Management

Following the diagnosis of the COPD, it is imperative that there is the implementation of effective management of the conditions via the reliance on the individualized assessment of the current symptoms along with the future risks (Global Initiative for Chronic Obstructive Lung Disease, 2011). The objectives of the management should be:

To relieve the symptoms through the improvement of the exercise tolerance, improving the health status along with the prevention of the progression of the disease. Management should additionally be tasked with the prevention along with the treatment of the exacerbation and consequently, reduce mortality. The nonpharmacological management of COPD needs to be by the individualized assessment of the symptoms and exacerbation risks and employs strategies as cessation of smoking, physical activity, pneumococcal vaccination, flu vaccination and pulmonary rehabilitation (Global Initiative for Chronic Obstructive Lung Disease, 2011).

The pharmacological treatment encompasses issues to do with bronchodilators for both the B2-agonists and anticholinergics, with the long-acting formulations being preferred over the short-acting formulations. There additionally is the use of the corticosteroids along with the phosphodiestarae-4 inhibitors when there is no evidence in the recommendation of the short therapeutic trial using the oral corticosteroids for the patients with COPD to establish the ones to respond to the inhaled ICS and other medications (Gershon, Warner, Cascagnette, et al., 2011),

The selected case study is that of an asthma patient. The asthma diagnosis encompasses the assessment of the personal and medical history to try and understand the symptoms and their causes. It will additionally encompass the physical exam by looking at the patient’s ears, nose, eyes, skin, throat, chests as well as lungs (Buttaro, Trybulski,Polgar& Sandberg-Cook, 2013). The exam could include an X-ray of the lungs and sinuses.

The lung function test is administered to confirm that the patient has asthma via the taking of breathing tests that are done before as well as after inhaling the bronchodilator. The spirometry will be employed as the test to confirm asthma, where the patient breathes into a spirometer to assess the amount of air he can breathe in and out (Mahmoudi, 2016). There additionally will be the peak airflow test to assess the rate at which one can force air in as well as out of the lungs and the trigger test to try and provoke a mild reaction where if the patient will not react, then he does not have asthma but he does, then he has asthma.

Since the patient was diagnosed with asthma, the best treatment option is the reliance on the long-term asthma management medications that will serve as the cornerstone of his treatment. These will encompass the inhaled corticosteroids, the leukotriene modifiers, the long-acting beta agonists as well as a combination of inhalers as the fluticasone-salmeterol (Mahmoudi, 2016).

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013).Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby.

Gershon AS, Warner L, Cascagnette P, et al. (2011). Lifetime risk of developing chronic obstructive pulmonary disease: a longitudinal population study. Lancet 2011; 378:991.

Global Initiative for Chronic Obstructive Lung Disease. (2011). At-a-glance outpatient management reference for chronic obstructive pulmonary disease (COPD). Retrieved from
http://www.goldcopd.org/uploads/users/files/GOLD_AtAGlance_2011_Jan18.pdf

Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016. www.goldcopd.org (Accessed on March 17, 2016).

Mahmoudi, M. (2016). Allergy and Asthma: Practical Diagnosis and Management. Springer.

McDonough JE, Yuan R, Suzuki M, et al.( 2011). Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med 2011; 365:1567.

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