COPD Case Study

I had just clocked in at the hospital. I took the report from the night shift therapist who looked exhausted. This wasn't unusual, but she looked a little more tired than normal. I sat down with my pen in hand to busily write down notes about the patients I would soon be caring for. She quickly gave me the high points about most of my patients. Some were just wearing oxygen while others needed a breathing treatment to get through the night. Then she asked if I was ready to hear about the patient in room 322.

I assured her I was and leaned in close to hear every word. She began to describe a patient we had seen all too often, especially in this last year. She was what we call in the medical community a 'frequent flyer'. This means she was constantly being re-admitted into the hospital after being just discharged a day, week or month earlier. The longest she had gone between admissions was three weeks. This was her ninth admission of the year and we were only into June.

She was a 72 year old woman who was admitted with cough and shortness of breath - her usual admitting diagnosis. The emergency room physician initiated a pulmonary consult the night before, but we already knew what to expect. We had given her the same respiratory therapy care during every admission - nebulizers, steroids, and oxygen.

Her history revealed an emaciated, elderly female, with chronic obstructive pulmonary disease (COPD) and recurrent pneumonia. She smoked an average of one pack of cigarettes a day for 40 years. She quit 12 years ago at age 60. She lives by herself, uses home oxygen 24/7, and takes 4 breathing treatments a day along with 2 other additional inhalers. She was prescribed blood pressure, heart, and kidney medications. To complicate this further, she had experienced two minor strokes within the last 5 years.

Prior to age 60 she had never stepped foot in a hospital or been sick a day in her life. She quit smoking because she developed what her doctor called a smoker's cough. Now here she was, a broken woman. The last ten years of her life had seen multiple admissions to the hospital and tests upon tests upon tests ordered to discover new illnesses, all related to smoking. Her body had given out and there was nothing she could do about it. She is unable to walk from her bed to the bathroom without becoming extremely short of breath. Therefore, home health placed a bedside commode in her bedroom. Home health visited her a couple times a week to make sure she was taking her medications and getting along.

Her physical presentation is that of an elderly, frail woman, weighing about 90 pounds with no muscle tone in her legs or arms. She is barrel chested, with finger clubbing and chronic cyanosis. Her blood oxygen saturation is usually around 90% on 3 liters of oxygen. With activity, her saturations drop in the mid-80's. Her entire life is geared to conserving energy and treating her breathlessness.

Now, in the hospital, she has once again developed pneumonia. More than likely, she never recovered completely from her previous lung infection. COPD makes it easier to acquire pneumonia and harder to get over it. She is financially bankrupt and unable to afford the medications needed to treat her disease. The social worker and the local county are doing what they can to help her pay for the care she receives. Sadly, it appears she won't be requiring their assistance much longer.

COPD has completely ruined her life. She was unaware of the damaging effects that smoking was having on her lungs until it was too late. Then the problems snowballed. That is how smoking does it. While you are in the prime of your life, the damage is being done, unbeknownst to you.

Regret over smoking all those years now fill her mind. I walk into her room and her eyes come to life. She is always happy when we come in to give her a breathing treatment. We talk about life and what challenges she has to face. But the talking triggers her coughing spells and she begins to cough almost continuously as the medicine nebulizes. By the end of the treatment I assess her lungs and hear that the wheezing hasn't really improved very much. I smile and walk away feeling very sad for her.

The next couple days are filled with the same routines, the same medicines and the same disappointment. On a Thursday she passes away. Much too young if you ask me. COPD robbed her of the last decade of her life. It should have been the best time for her, but it was a nightmare.