A Case Report on Chronic Obstructive

Pulmonary Disease (Emphysema)

Presented to the
Department of Physiology and Pharmacology
University of Perpetual Help Binan
College of Medicine
By:
JelineSymbaC.Celocia
Medicine III

Salient Features
28 year old female
(+) Progressive cough and breathlessness for 23years
(+) wheeze
(+) chest tightness
(+) nocturnal cough
(+) family history of early onset COPD

Spirometric
ManeuverResults:
FEV1 of 49%
FEV1/FVC of 52%
TLC of 144%
RV of 237%
MMC score of 4
Blood tests
normal
Alpha-1
Antitrypsin
normal

Initial Results
Subjected to
SteroidTrial

NOFEV1
REVERSIBILITY

DIAGNOSIS

Extensive Centrilobular
Emphysema with an Upper
Lobe Predominance

Figure 1. Pathogenesis
of Emphysema.
Click icon to add clip smoke
art
Chronic exposure to cigarette
which
leads to inflammatory and immune cell
recruitment within the terminal spaces of
the lung

Release of elastolytic and proteinases by

the inflammatory cells which causes
damage the extracellular matrix of the lung

Structural damage thru the oxidant

induced cigarette smoke and senescence
and loss of extracellular matrix attachment

Click icon to add clip art

Figure 2. Pathophysiology of
Emphysema.
Cigarette Smoking
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Inflammatory cell
recruitment
Perforation & Obliteration of
walls

ECM destruction

Expiratory
wheeze

Click icon to add clip art

Assessment and
Management of COPD
(GOLD Classification,
2015)
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Table 1. Assessment of Severity of

Airway Limitation for COPD Based on
Postbronchodilator FEV1
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Table 2. Combined Assessment of

COPD
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Table 3. Non-pharmacologic
Management of COPD
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Figure 3. Therapeutic
Management for COPD
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Table 4. Pharmacologic Therapy for

COPD

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ESSA Drug Evaluation for

COPD

able 5. ESSA Criteria for Beta-2 Agonists

drugs.
Drug

Efficacy

Suitability

Safety

Affordability

Total

Albuterol

++

++

+++

Formoterol

+++

++

++

Salmeterol

+++

++

++

++

Table 6. ESSA Criteria for

Muscarinic Receptor Antagonists.
Drug

Efficacy

Suitability

Safety

Affordability

Total

Ipratropium

++

++

++

++

Tiotropium

+++

+++

++

THANK YOU.

References:
Conroy, K., Miller G. Shipley, M. Emphysema and COPD in a young woman.
Elsevier Ltd. Respiratory Medicine Case Reports 12. 2014; 51-52.
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Katzung, BG. and Trevor, AJ. Basic and Clinical Pharmacology, 13th edition.
McGraw Hill Companies. 2015; 352-353.
Global Initiative for Obstructive Lung Disease. Pocket Guide to COPD Diagnosis,
Management and Prevention. 2015.
The National Formulary Committee. Philippine National Drug Formulary: Essential
Medicines List, 7th edition. Volume I. 2008. Department of Health. Accessed
at www.fda.gov.ph.
The Philippine Drug Price Reference Index List. 2013. Department of Health.