Dubai is an ideal vacation destination for people from all over the world. Being the second largest emirate in the United Arab Emirates, which is located at the southern-east point of the Persian Gulf.
This shopper’s paradise has two distinct seasons -Summer and Winter. Mainly characterized by hot winds and high humidity, the Emirati summer begins around the last week of April, ending by the 1st week of October. The Winters are known to have pleasant weather. With temperatures dropping to as low as 10 °C (50 °F), having a high influx of tourists in the winter months, is not surprising.
The following is a narrative of one tourist, whose vacation was cut short. A senior woman, a citizen of Singapore with a known case of COPD. She started the experience dyspnea, cough, sputum, wheezing, along with chest discomfort over the course of the last seven days, occurring more often in the morning.
After a visit to the local doctor, she was admitted to the hospital. Her continued worsened within a couple of days; she had to be placed on a ventilator. Her family was eager to be with her, and contacted HI Flying - Air Ambulance International and we arranged for her to be brought back on a Commercial flight with stretcher arrangement – a more affordable option compared to a medevac charter flight.
More about Chronic Obstructive Pulmonary Disease
The main cause of her problem was COPD- common among patients with a long history of smoking.
The duration and amount of smoking add to the severity of the disease. In the evaluation of patients suspected with COPD, an essential step is to ascertain the number of pack-years smoked (packs of cigarettes per day multiplied by the number of years). About 80 percent of patients with COPD, living in Singapore possess a history of cigarette smoking.
The age of starting and the age of quitting should be included in the patients smoking history. Patients often underestimate the number of years they smoked. Almost all smokers will develop reduced lung function, over a period of smoking. Many studies have shown an overall “dose-response curve” for smoking and lung function. Some individuals develop severe disease with fewer pack years in comparison to others who will have minimal to no symptoms despite many pack years.
The precise threshold for the duration/intensity of cigarette smoking that results in COPD varies from one individual to another. The absence of a genetic/environmental/occupational predisposition, smoking less than 10 to 15 pack-years of cigarettes is unlikely to result in COPD although the single best variable for predicting which adults will have airflow obstruction on spirometry is a history of approximately more than 40 pack-years of smoking.
●Patients who present with episodes of increased cough, purulent sputum, wheezing, fatigue, and dyspnea that occur intermittently, with or without fever. Diagnosis can be problematic in such patients. The combination of wheezing plus dyspnea may lead to an incorrect diagnosis of asthma.
● Respiratory symptoms, in patients who generally complain of dyspnea and chronic cough. The dyspnea may initially be noticed only during exertion. It becomes noticeable with progressively less exertion or even at rest. The chronic cough is characterized by the insidious onset of sputum production, occurring the morning initially, but may progress throughout the day. With the daily volume rarely exceeding 60 ml. The sputum is usually mucoid but becomes purulent during exacerbations.
The findings on physical examination of the chest vary with the severity of the COPD.
●Early on, the physical examination is mostly normal or in some cases may show prolonged expiration on forced exhalation.
●With the severity of the airway obstruction increasing, the physical examination may reveal hyperinflation (e.g., increased resonance to percussion), decreased breath sounds, wheezes, crackles at the lung bases, and distant heart sounds. Features of severe disease include an expanded anteroposterior diameter of the chest ("barrel-shaped" chest) and a depressed diaphragm with limited movement based on chest percussion.
●Patients with end-stage COPD may use physical positions that relieve dyspnea. An example is leaning forward with arms outstretched and weight supported on the palms or elbows. Other physical examination findings include the use of the accessory respiratory muscles of the neck and shoulder girdle, expiration through pursed lips, paradoxical retraction of the lower interspaces during inspiration (i.e., Hoover's sign) cyanosis, asterixis due to severe hypercapnia, and an enlarged, tender liver due to right heart failure.
●Yellow stains on the patient’s fingers due to nicotine and tar from burning tobacco are a clue to ongoing and heavy cigarette smoking.
Evaluation for COPD is appropriate in adults, often reporting dyspnea, chronic cough, chronic sputum production or have had a gradual decline in the level of peak activity, particularly if they have a history of exposure to risk factors for the disease for examples, cigarette smoking, indoor biomass smoke. All patients are usually evaluated with spirometry. Other selected patients have laboratory testing and imaging studies.
No laboratory test is diagnostic for COPD, but specific tests are sometimes obtained, mainly to exclude other causes of dyspnea.
In the above case, the patient was already in the final stages of COPD. With her family members eagerly awaiting her arrival in Singapore. Hi flying Ambulance saved their family a considerable amount of grief and brought the patient together with her loved ones, in her moments of need.
Most importantly, they provided services which are also pocket-friendly for the patient and her family. The packages, they offer are based on the situation. Hi Flying has a 24/7 call center service available to attend to the requests for Emergency and Non-Emergency Patient Transportation.
The paperwork involved in transportation is done seamlessly by their expert team with no burden on the family members, who can then completely focus on the health and caring of the patient. Additional, Hi Flying allows any relative of the patient to fly absolutely free with no additional charges incurred.