Patient Interview Chronic Obstructive Pulmonary Disease

PatientInterview: Chronic Obstructive Pulmonary Disease

PatientInterview: Chronic Obstructive Pulmonary Disease

Identifyingdata

Age:68

Gender:Male

Maritalstatus: Married

Completepatient’s health history

Interviewer:When did you encounter the primary symptoms?

Interviewee:I noticed the first symptoms 5 years ago.

Interviewer:Which symptoms did you notice?

Interviewee:I started feeling fatigued, wheezing, feeling short of breath whendoing normal activities, and experiencing frequent chest problems.

Interviewer:In which settings did you contract the disease?

Interviewee:I was working as a coal miner when I was diagnosed with COPD.

Interviewer:Are there conditions (such as changes in weather or setting) thatworsen the symptoms?

Interviewee:My condition becomes worse during the winter and anytime a visit adusty place.

Interviewer:Did you identify anything that you could associate with theoccurrence of the primary symptoms?

Interviewee:I think my condition was caused by multiple factors, including thedust and the cold working conditions in the coal mines. I alsosuspect that my chain smoking habit made some contribution towardsthe occurrence of COPD.

Interviewer:Were you ever diagnosed with a condition similar to COPD during yourchildhood?

Interviewee:No. I only used to suffer from minor respiratory diseases, such asthe common cold.

Interviewer:Have any of your close relative been diagnosed with a similarcondition?

Interviewee:No. I discovered the existence of such a disease when I was diagnosedwith it.

Medicationhistory

Interviewer:For how long have you been under medication?

Interviewee:I have been under medication for the last 5 years, but I startedgoing to hospital after 2 years of noticing the primary symptoms.

Interviewer:Which type of prescription drugs have you taken since you started themedication process?

Interviewee:The drugs have difficult names to read, but I can at least rememberAlbuterol, tiotropium, budesonide, and theophylline.

Interviewer:Which type of over-the-counter drugs have you taken since you startedthe medication process?

Interviewee:Before I was formally diagnosed with COPD, I used to buy Sudafed overthe counter.

Interviewer:Have you used any supplement to ease your condition? If yes, whichone(s)?

Interviewee:No.

Interviewer:What is the dosage and frequency of use for each drug or supplements?

Interviewee:I was instructed to take 2 tablets of Albuterol three times a day,inhale 18 mcg of tiotropium once a day, inhale 200 mcg of budesonidetwice a day, and 3 time release capsules of theophylline three timesa day.

Medicationand compliance knowledge

Interviewer:Have you been able to comply with the doctor’s prescription?

Interviewee:At times I forget to take drugs, especially when the COPD hassubsided.

Interviewer:In your opinion, do you think there is any correlation betweencompliance and recovery?

Interviewee:I believe that taking the medication as prescribed speeds up therecovery process.

Interviewer:Do you think the drugs given to you are helpful?

Interviewee:Although my condition has developed to a chronic one, I still believethe drugs have helped me.

Pharmacodynamics,pharmacokinetics, route of administration, dose, and effects

Interviewer:Do you experience any side effects after taking any of the drugs?

Interviewee:I experience different side effects (such as blurred vision, drymouth, dizziness, tremor, and diarrhea), but it is difficult for meto determine which of the drugs cause these side effects.

Interviewer:Do you experience any adverse reactions after taking any of the drugsor supplements?

Interviewee:I experience different adverse effects, such as runny nose andscratchy throat.

Interviewer:Did your doctor inform you of any safety issues regarding any of thedrugs you have been taking?

Interviewee:No. The doctor’s instructions did not include any safety issues.

Interviewer:Do you know how the drugs affect your body?

Interviewee:No. My only interest is to get well.

Discussion

Healthhistory

Fromthe interview, the patient is an elder aged 65 years, who havesuffered from chronic obstructive pulmonary diseases (COPD) for thelast five years. COPD is one of the chronic pulmonary diseases thataffect the lungs in the long-term, making it hard to breathe(National Institute of Health, 2014). All the symptoms that thepatient stated were correct, but a set of symptoms that distinguishCOPD from other illnesses include shortness of breath, wheezing,ongoing cough, and chest tightness. The common risk factors includesmoking, exposure to dust and chemicals, and of 35 years and above.Therefore the patient is well informed about the factors (includingsmoking and exposure to dust in coal mines) that brought about COPD(Mayo Clinic, 2015).

Medicationhistory

Theclient understands the impact that the failure to seek the propermedication in time had progression of the COPD condition. From theinterview, the client visited the hospital two years after observingthe primary symptoms. During first 2 tears, he used to treat commoncold using over-the-counter drugs without the knowledge that he wassuffering from COPD. He is well informed about the type of drugs anddosage, although he does not understand how they function. The drugscan be grouped into four categories, including short-actingbronchodilators (albuterol), long-acting bronchodilators(tiotropium), corticosteroid (budesonide), and methylxanthines(theophylline).

Medicationand compliance knowledge

Thepatient understands the relationship between compliance withprescriptions and recovery, but he acknowledges that he forgets totake prescribed drugs.

Pharmacodynamics,pharmacokinetics, route of administration, dose, and effects

Thepatient had no information about the pharmacokinetics andpharmacodynamics of the drugs, but the information obtained from thecurrent literature is documented below

Pharmacokinetics

Thebody absorbs albuterol immediately after administration where theplasma concentration of about 18 ng / mL is reached within 2 hours.The drug is eliminated from the circulation in a half life ofapproximately 5 hours (Roberts, 2014).

Tiotropiumpowder is deposited in the lungs and the gastrointestinal tract.Maximum concentration of tiotropium is observed after 5 minutes ofinhalation. The level of metabolism is low where 74 % of the drug isexcreted unchanged (Roberts, 2014). The elimination half life of thedrug is about 5 days.

Budesonidehas a bioavailability of between 6 % and 13 %. The drug is 85 %protein bound. It is rapidly metabolized and eliminated within a halflife of about 2 hours (Drugs.com, 2015).

Theophyllineis absorbed rapidly and the maximum concentration is reached afterabout 1 hour of administration. About 40 % of theophylline is proteinbound. About 90 % of the drug is metabolized in the liver. About 50 %of the theophylline excreted unchanged within the first three monthsof administration.

Pharmacodynamic

Albuterolacts on receptors known as beta 2-adrenergic found in lung muscles.The muscles relax and open the airways, which in turn facilitateseasy breathing (Roberts, 2014).

Tiotropiumis considered as a long-acting drug and an anticholonergicbronchodilator. It acts as a muscarinic receptor that relaxes themuscles, leading to a bronchodilatory effect (Roberts, 2014).

Budesonidehas an affinity of 200-fold on GCS receptors, which is a reflectionof its intrinsic potency. It suppresses the concentration ofendogenous cortisol. This leads to an increase in the plasma levelsof cortisol and a high response to the stimulation of ACTH(Drugs.com, 2015).

Pharmacokyneticsof theophylline is not well known, but it is believed that itfunctions through bronchodilation and prophyletic effect ofnon-bronchidilation. The two actions enhance the breathing system ofthe patient.

Thepatient was well informed about the dosage and routine of drugadministration. Although the side effects and adverse reactions thatthe patient gave were correct, he could not tell which of the drugswere responsible for each of them. Albuterol was responsible for thedryness of the mouth and blurred vision. Tiotropium caused dizzinessand mouth dryness. Budesonide caused sores in the throat and allergicreaction. Theophylline caused troubled sleeping and tremor (Kinman,2014).

Thepatient had limited information about drug interactions and safetyissues. For example, albuterol interacts with vitamins,over-the-counter drugs, and herbal products. Tiotropium interactswith more than 706 drugs, budesonide interacts with about 772 drugs,and theophylline interacts with symbicort (Drugs.com, 2015). However,all drugs have a positive impact on a patient suffering from COPDbecause they enhance the breathing system.

Possibleinterventions

Thelack of drug efficacy can be addressed in several ways. First,adjusting the dosage as well as the frequency of usage can asappropriate can enhance the efficacy of the drug. Secondly, thehealth care provider many consider changing the drug and administermore effective types of drugs (Health Canada, 2015). The health careprovider may also adjust the combination of drugs in order to reducechances for negative interactions and enhance the efficacy of eachdrug.

Fromthe interview, the patient lack knowledge about the pharmacodynamics,pharmacokinetics, drug interactions, and safety issues. The knowledgeof the pharmacodynamics and pharmacokinetics may not be necessary forthe client. However, the health care provider should consider all thesafety issues in order to reduce chances for adverse reactions. Forexample, the doctor should assess the possibility of allergicreaction and match the dosage with the age of the patient.

Thepatient is aware of the significance of complying with theprescription, but he forgets to take drugs especially when thecondition has subsided. This issue of non-compliance can be addressedusing appropriate medication reminder alerts. For example, there aresome medical apps that can be installed in smart phone and remind thepatient whenever he is required to take a dose (Drugs.com, 2015). Thepatient can also be put under the supervision of a close relative,who should administer the drugs at the right time and in the rightquantities.

References

Drugs.com(2015). Budesonide. Drugs.com.retrieved June 21, 2015, fromhttp://www.drugs.com/ppa/budesonide.html

HealthCanada (2015). report of the post-market reporting compliance inspections conductedfrom September 1, 2005 to March 31, 2008.Ontario: Health Canada.

Kinman,T. (2014). COPDdrugs and medications.San Francisco, CA: Healthline Network Incorporation.

MayoClinic (2015). COPD: Risk factors. MayoClinic.Retrieved June 21, 2015, fromhttp://www.mayoclinic.org/diseases-conditions/copd/basics/risk-factors/con-20032017

NationalInstitute of Health (2014). What is COPD? NIH.Retrieved June 21, 2015, fromhttp://www.nhlbi.nih.gov/health/health-topics/topics/copd

Roberts,R. (2014). Clinical pharmacology: Mechanism of action. RxListIncorporation.Retrieved June 21, 2015, fromhttp://www.rxlist.com/spiriva-drug/clinical-pharmacology.htm