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Case histories discussion

Case histories discussion. Case histories discussion. Delegates will divide into groups by table Each delegate to present one case history within the group Each table will then choose one case to present to the main group, explaining the learning points. Case studies examples.

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Case histories discussion

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  1. Case histories discussion

  2. Case histories discussion • Delegates will divide into groups by table • Each delegate to present one case history within the group • Each table will then choose one case to present to the main group, explaining the learning points

  3. Case studies examples

  4. Case study 1: male aged 68 JL • Diagnosed COPD 2009 by GP • Well as a child & young adult • Does have hayfever – worse on cutting grass • Ex smoker 50pk yrs • Feels “chesty “ in the evenings

  5. Case study 1: male aged 68 JL • 3 course abx & steroids since Jan 2013 • Occasional bouts of dyspnoea associated with heart palpitations • All cardiac investigations inc BNP were normal • MRC 2 walks his dog 4-5 kms a day • Normal CXR April 2013

  6. Case study 1: male aged 68 JL

  7. Case study 1: male aged 68 JL

  8. Case study 1: male aged 68 JL • We started him on a combination inhaler & a LAMA • We arranged some allergy tests & specific IgG tests in addition to his eNO which was normal • Why? • What issues does this case illustrate?

  9. Case study 2: male aged 69 NL • 12 months recurrent chest infections • Cough & cream sputum • Symptoms resolved whilst having chemotherapy for bowel Ca • Diagnosed as “asthma” years ago by GP

  10. Case study 2: male aged 69 NL • Fit & well as a child & young adult • Ex smoker stopped 30yrs ago • 45-50 pkyrs • Occupation – buyer & worked in brake lining shops • Admission to hospital for “asthma” 2008 • Present drug Hx • Symbicort 400 1puff bd & bricanylprn ( doesn’t feel either worked)

  11. Case study 2: male aged 69 NL

  12. Case study 2: male aged 69 NL

  13. Case study 2: Discussion questions • What COPD stage is he likely to be at? • How should his treatment be adjusted?

  14. Case study 2: male aged 69 NL • His eNO was 15 so we made a diagnosis of stage B COPD • We stopped his combination inhaler • Started him on a LAMA once daily

  15. Case study 3: GB female aged 58 • Very breathless- referred by GP as so young • Exercise tolerance limited for 8 months • Has to rest after 10 minutes brisk walking • MRC 3/ CAT score 24 • No exacerbations 18 mths

  16. Case study 3: GB female aged 58 • Family history asthma • Current smoker – 50 pack years • Also has severe IHD ( already had 2 stents)

  17. Case study 3: GB female aged 58 • Drugs • Seretide 500 accuhaler 1 puff bd • Tiotropium handihaler 1 cap od • Salbutamol 4 puffs every 2 hours when breathless • Examination findings • Slim, nicotine stained fingers, • Chest – expiratory wheeze only • Pulse oximetry 95% on air at rest

  18. Case study 3: GB female aged 58

  19. Case study 3: discuss • Diagnosis • What should her therapy be? • What is her GOLD score?

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