Understanding Parkinsonism Complicated by COPD Exacerbation in an Elderly Patient
A 76-year-old male with a history of COPD and Parkinsonism presents with breathlessness, cough, and thick white sputum. Laboratory findings show increased TLC, ESR, and Neutrophils. The chest X-ray reveals mild pleural effusion. Smoking is highlighted as a possible cause of COPD exacerbation. The patient's Parkinsonism is attributed to a lack of dopaminergic neurons in the substantia nigra, leading to muscle control issues.
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SCENARIO: Here is a 76 yrs old elderly male patient hospitalized for 9 days with complaints of breathlessness and cough with expectoration since 3 days. CHIEF COMPLAINTS- c/o, breathlessness and cough with expectoration since 3 days. Breathlessness insidious in onset and progressive. Sputum was thick and white in colour. PAST MEDICAL HISTORY- k/c/o , COPD since 2 yrs and parkinsonism since 1 yr. PAST MEDICATION HISTORY- Tab. Deriphylline 1-0-1 Tab. Syndopa 100mg 1-1-1 Tab. Amantadine 100mg 1-1-1
SOCIAL /PERSONAL HISTORY- Patient is a smoker since 25yrs Alcoholic since 25yrs. Systemic examination- rhonchi heard. LABORATORY VALUES- TEST VALUES TLC cumm 12800 (increased) ESR mm/hr 30 (increased) NEUTROPHILS 82 (increased)
CHEST X RAY- Right mild pleural effusion is present. SOAP ANALYSIS SUBJECTIVE DATA- Here is a 76 yrs old male patient hospitalized for 9 days with complaints of breathlessness and cough with expectoration since 3 days. OBJECTIVE DATA- The Total Leukocyte Count (12,800) is increased- which indicates infection/ inflammation. The ESR (30) values are increased - which indicates infection. The Neutrophil (82) values are increased- Neutrophil values are increased in COPD conditions. Chest X- Ray indicates presence of mild pleural effusion in the right lung
ASSESSMENT- 1. Breathlessness- it occurs due to excessive mucous production and mucous plugging in the airways. (in COPD there will be hypertrophy of the mucous glands and goblet cells causing excessive production of mucous, there would also be impairment in the mucociliary function hence the mucous is not expelled out causing airway obstruction of airways). 2. Cough with Expectoration- cough is the protective reflux of the body to expel out sputum, through the activation of mechano and chemoreceptor present in the airways. 3. COPD- it is a progressive, irreversible chronic obstructive airway disorder characterized by airway obstruction.
Here the patient is a chronic smoker since 25 yrs. So smoking could be the possible etiology involved in the causation of COPD. Smoking generates release of oxidants. These oxidants react with various proteins and lipids in the cell leading to the cell and tissue damage. Oxidants also promote inflammation by release of various chemical mediators like TNF- and IL-8, through the activation of neutrophils. Oxidants due to smoking also causes the imbalance of protease and antiprotease. 4. PARKINSONISM- It occurs due to lack of dopaminergic neurons in the substantia nigra. Thereby deficiency of dopamine occurs due to which there will be a loss of control of muscle tone and coordination of movements. Imbalance between neurotransmitters like dopamine and acetyl choline .
S. No 1. BRAND NAME GENERIC DOSAGE 1 2 3 4 5 6 7 8 9 NAME levofloxacin I. LEVOFLOX 100ml 1-0-0 1gm 1-0-1 150mg 1-0-1 1amp 1-0-1 100mg 1-1-1 100mg 1-1-1 1-1-1-1 y y y y y y 2. I.GRAMOCEF Ceftriaxone y y y y y y 3. I. RANTAC ranitidine y y y y y y y y y 4. I.DERIPHYLLIN E TAB. SYNDOPA levodopa + Theophylline y y y y y y y y y 5. y y y y y y y y y carbidopa amantadine 6. T. AMANTADINE DUOLIN.NEB y y y y y y y y y 7. Salbutamol+ ipratropium Acetyl cystein y y y y y y y y y 8. MUCOMIX. NEB TAB.D3 1-1-1-1 Y y y y y 9. Calcium + vitamin D 1-0-0 y y y
DISCHARGE DRUGS- 1. tab. Rantac 150mg 1-0-0 2. tab. Syndopa 100mg 1-1-1 3. tab. Deriphylline 1-1-1 4. tab. Amantadine 100mg 1-1-1 5. duolin nebulizer 1-1-1-1 6. tab. D3 1-0-0 INTERVENTION- Note- corticosteroid is usually given in the treatment of COPD, but the drug was not given during the patient hospitalization. PATIENT COUNSELLING- Medication- Take rantac daily after breakfast. Take syndopa thrice daily after food. This drug can cause drowsiness in the daytime hence driving vehicle or running any machinery should be avoided.
Take theophylline on empty stomach. Take 2 to 3 puffs of duolin nebulizer for every 6 hours. Take tablet D3 daily morning after breakfast. Use caution while rising from sitting position. Disease- Avoid stress Avoid smoking/ abstain from smoking Avoid exposure to allergens/ smoke Strict adherence to medications is encouraged. Help the patient improve perception of the disease through education. Adherence to medications is encouraged. Avoid tea/ diary products. Avoid alcohol.
Exercise can prevent complications of Parkinson's disease like bent posture. If the speech is slurred, then consult a speech therapist.
