Pulmonary Function Testing
Instructions:
Patients with respiratory disorders often require short-term and long-term treatment. While short-term treatments may successfully relieve a patient’s current symptoms, long-term treatment and management is a necessary component of the care plan. Prior to establishing a care plan, it is essential to complete a thorough patient evaluation. Patients presenting with symptoms of respiratory disorders such as chronic obstructive pulmonary disease (COPD) frequently require pulmonary function testing. These pulmonary function tests are designed to assess patient lung function. Results of these tests can be used in conjunction with the COPD guidelines to develop effective treatment and management plans for patients.
To prepare:
Review the COPD guidelines in the Global Initiative for Chronic Obstructive Lung Disease article in this week’s Learning Resources.
Reflect on COPD diagnosis, management, and prevention strategies suggested in the guidelines. Consider how to implement these strategies in a clinical setting.
Locate and select a case study from a reputable source on a patient whose condition required pulmonary function testing.
Consider the COPD guidelines for diagnosis and think about a potential diagnosis for the patient in the case study that you selected.
Reflect on treatment and management options based on the patient’s diagnosis.
To complete:
Write a 2- to 3-page paper that addresses the following:
Describe COPD diagnosis, management, and prevention strategies suggested in the COPD guidelines. Explain how to implement these strategies in a clinical setting.
Explain your diagnosis for the patient in the case study that you selected. Compare the patient’s pulmonary function test results to the COPD guidelines when making your diagnosis.
Describe treatment and management options based on the patient’s diagnosis.
Solution.
Pulmonary Function Testing
Introduction
COPD (Chronic Obstructive Pulmonary Disease) is a respiratory infection that occurs in the lung leading to shortness of breath, inflammation of the airways and increased the difficulty in physical activity (Hanania & Sharafkhaneh, 2011). The prevalence of certain symptoms can help in coming up with a diagnosis. Spirometry is conducted to find out these symptoms. This paper aims to look at COPD diagnosis and management.
Diagnosis
Individual indicators are used in the case of diagnosing COPD:
- Dyspnea that is
persistent and gets worse with exercise
- A chronic cough
- Production of chronic sputum
- History of exposure- if the patient has been exposed to high-risk factors like tobacco smoke, dust, and industrial chemicals.
- A family history of COPD.
Management
It is important to know the severity of COPD on the patient’s health and also to assess the risk of future exacerbations so as to offer the right patient therapy. Several aspects of COPD should be considered:
- Symptoms- validated questionnaires are used to assess the symptoms
- The risk of exacerbations- acute worsening of COPD can occur. Medical experts asses the history (or lack) of exacerbations.
- Airflow limitation (spirometry)- it shows the different levels of severity in airflow limitation
- Comorbidities- other conditions may exist in a patient who suffers from COPD. They include; anxiety, depression, cardiovascular diseases metabolic syndrome and lung cancer among others. These other conditions may increase mortality of COPD patients.
Once COPD is diagnosed, management of illness should be based on future risks and current symptoms. Management of COPD involves reducing the symptoms and future risks. The side effects of managing COPD should be completely minimized since most patients tend to have comorbidities that require extreme caution. Treatment can either be pharmacological or non-pharmacological depending on the severity of the COPD. These two methods are available at the clinical level.
Medical practitioners should be on the lookout for exacerbation symptoms. Sharp changes should be noted quickly and their severity measured accordingly. Arterial gas measurements and chest radiographs are some of the means to test the severity of exacerbations (2016). Treatment can be offered in the form of supplemental oxygen or bronchodilators.
Prevention
One of the leading causes of COPD is nicotine which comes from cigarettes. Therefore, it goes without saying that a cessation of smoking is a positive move in preventing the disease. People should be counseled on the effects of tobacco use and encouraged accordingly. A replacement therapy such as nicotine gum could be offered in cases where it is required. A reduction in widespread pollution by dust and other chemicals also helps to prevent incidences of the disease. Patients are advised to stay in clean surroundings and perform physical exercises often enough.
Case study
A 54-year-old man with a cough and dyspnea. He doesn’t smoke and is not exposed to outside pollution. (“UW Homepage”, 2016)
Pre- Bronchodilator Post-Bronchodilator
Test actual predicted %predicted actual %change
FVC (L) 3.19 4.22 76 4.00 25
FEV1 (L) 2.18 3.39 64 2.83 30
FEV1/FVC (%) 68 80 71 4
The readings of FVC and FEV1 are below the normal limit (80% of the predicted figure for the patient). The ratio of FEV1/FVC is 0.68 meaning it is less than the lower normal limit minus 8. When the FEV1 and FVC are small as well as the combined FEV1/FVC, it gives grounds for a diagnosis of airflow obstruction.
Treatment: the patient has a
combined FEV1/FVC below 72% and his FEV1 is 64. It means
his airflow obstruction is defined as moderate. According to the case study,
FVC improves by 25% and FEV1 by 30% after a bronchodilator was used.
This response shows that a bronchodilator will suit this patient nicely. The
patient should also engage in physical activity and get a Pneumococcal
vaccination.
References
UW Homepage. (2016). Washington.edu. Retrieved 29 September 2016, from http://www.washington.edu/
2016). Retrieved 29 September 2016, from http://www.goldcopd.it/materiale/2015/GOLD_Pocket_2015.pdf
Hanania, N. & Sharafkhaneh, A. (2011). COPD. New York: Humana Press.