Respiratory case studies

Respiratory case studies

Patients who have been referred to the community respiratory service have benefitted from personalised support to help them manage their condition. These real examples from the service show the difference good support can make to a person living with a lung condition. 
 

Case study 1: Mrs X


Mrs X, aged 49, was referred to the Integrated Community Respiratory Service in March 2016.  She was known to the acute respiratory team but had not attended any appointments with her consultant due to agoraphobia. 

She had been on high dose steroids (30mg) and antibiotics continuously for three months.  Although she didn’t need to be admitted to hospital within this time period, she was a high user of GP call out and NHS 111.

At her first assessment with the community team, Mrs X was convinced she had pneumonia and that the only treatment she required was steroids and nebulised medications.  She had no confidence, was suffering frequent anxiety attacks related to shortness of breath and had a continuous cough and audible wheeze. 

Mrs X was under the care of the community team for 8 weeks.  During this time she:

  • slowly reduced her reliance on steroids by 5mg every week – until stopped completely. This  was supported with weekly and sometime twice weekly visits during  steroid reduction
  • was taught by the respiratory specialist physiotherapist from the pulmonary rehab team how to manage breathlessness, breath hold, prevent cough with ‘stop cough’ exercises and prevent wheeze
  • was monitored for her wheeze and reassured with chest auscultation
  • improved her inhaler technique and had compliance regularly checked. Her Accuhaler device was changed to an MDI and Spacer (Aerochamber) and was given a peak flow meter and chart and taught how to use it. Mrs X was now aware when to increase medication and when to call for help
  • improved her spirometry – from mild obstruction to normal 

The patient is now going out once a week to aqua aerobics and walks the dog with her partner.  No cough observed and wheeze has also stopped.  Patient uses the new breathing techniques frequently. 

Before seeing the community team, Mrs X said:

  • I was unable to breathe with my mouth closed
  • I thought steroids and antibiotics were the cure for my shortness of breath
  • I had no confidence and felt weak
  • I was anxious  and felt like I was having a heart attack
  • I thought I had pneumonia
  • I was contacting the GP twice or three times a week

After seeing the community team, Mrs X said:

  • I am still breathless but can manage this
  • Staff were friendly, approachable and helpful
  • I have confidence in all  the staff I have met
  • I felt safe with the care I received

Mrs X’s spirometry

 

10/03/16

25/04/16

FEV1

1.72

2.00

FEV1/FVC Ratio

67%

72%

FVC

2.55

2.76

% predicted FEV1

69%

80%

 

Case Study 2: Mr K


Mr K is a 55 year old patient with asthma and a history of frequents visits to A&E and admissions to hospital with exacerbation of asthma and COPD symptoms.

Mr K was always running out of inhalers and did not recognise the early warning signs of his breathing problems, so would often leave it too late and end up in resus. Although Mr K was not registered with a GP, he was well known to the hospital respiratory team. Between January and May 2016 he was seen on more than ten occasions and then referred to the integrated community team in May 2016.

The team worked closely with Mr K over the next two months and helped him to get registered with a GP. A self-management plan was put together including clear instructions on what to do and when, plus the issue of ‘rescue meds’.

Mr K had not fully understood the importance of regular ‘preventer’ medication to help prevent the attacks but as the weeks progressed and he could see his peak flow improving and he noticed his symptoms getting better, he understood the importance of looking after himself correctly.

Mr K and the stop smoking team set a quit date of the 1 June and by the time he was discharged from the respiratory service he had been smoke-free for 4 weeks.  SK was supported by the team until his condition was stable and both he and his nurse was happy with his self-management plan.  Mr K did not come to A&E for 11 months.

Mr K said:

“This was the first time someone had actually sat down with me and explained everything”

“I felt supported, and that everyone looking after me were ‘talking to each other’”

Last modified: 

10 May 2018