Case Study
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Slide 1
Referral
George has a diagnosis of COPD and attended his GP complaining of increased shortness of breath and expectorating green sputum. His GP noticed that George had attended him on multiple times in the last 6 months with exacerbations of COPD. He was issued with a prescription with medication to treat the exacerbation. Referral to Pulmonary Rehabilitation was discussed. George was unsure if he would manage to exercise but was agreeable to referral.
Slide 2
Assessment
Subjective assessment
Objective assessment
Diagnosis
- COPD in 2013.
Exacerbations
- Frequent exacerbations requiring antibiotics and steroids.
- Last exacerbation 1 month ago.
- Never been admitted to hospital due to lung condition.
Medications
- Salbutamol easihaler, Relvar Ellipta, Incruse Ellipta, Carbocisteine, Lisopril, Tamsulosin, Aspirin, Tolterodine, Atorvastatin, Lansoprozole, Bisoprolol.
- Inhaler technique - appropriate.
Vaccinations
- Receives flu vaccine each year. Has received pneumonia vaccine.
Smoking history
- Current smoker, has stopped in the past but restarted soon after. Has cut down on number of cigarettes smoked. Smokes around 10 cigarettes per day. Keen to stop.
Past Medical history
- Hernia, heart attack.
Social history
- Lives with his wife and family in house with internal stairs.
- Manages all his daily tasks - getting washed, dressed etc.
- Engineer.
- Hobbies are gardening and golf but hasn’t been able to do this recently.
- Doesn’t do any regular exercise.
ISWT
- 350m
- Stopped due to breathlessness.
CAT
- 22
5TSTS
- 14.5s
HADS
- Anxiety - 8
- Depression - 5
Slide 3
Joint goal setting
Goal
Treatment plan
Stop smoking.
Self management of exacerbations.
Increase exercise.
Referral to smoking cessation service.
Attend PR education sessions.
Having an action plan.
Contact GP re prescribing rescue pack.
Attend PR classes.
Referral to community exercise.
Goal improve cycling distance.
Play with kids.
Able to cycle to shop to get paper.
Slide 4
Pulmonary Rehabilitation Class
Attended hospital based class for 12 sessions. Missed 1 week due to an exacerbation of COPD.
Exercise:- Aerobic – focussed on cycling as it was his goal.
- Strengthening – Using body weight and some hand weights. Increased resistance as progressed through class.
Education:
- Attended all sessions including early identification and management of exacerbations.
Home exercise programme: checked regularly at class and advised on how to progress distance. George was keen to cycle as home exercise. He was anxious to begin with so his wife accompanied him. Gradually built up distance over time. Cycling diary was checked regularly at class and advised on how to progress distance.
Slide 5
Assessment after completion
After attending the course of PR classes Georges test results improved. Now his incremental shuttle walk improved to 370 m and his CAT score was 21.
Goals were almost met he was still working on his cycling to the shops, but felt his muscles were stronger.
George has taken aims to take his son to football practice and aims to be further involved with his children.
George was keen to continue exercising and agreed to be referred to leisure services.
He was provided with information on his local support group and plans on attending the next meeting.
George has done well at smoking cessation and has stopped.
He sets himself another goal to go to the golf range to have a coffee and hit a basket of golf balls with his friend.
