抄録
This case report highlights our experience implementing a procedure aimed at enhancing the ability of older patients with limited comprehension to engage in activities of daily living （ADLs） through respiratory rehabilitation involving optimized management of chronic obstructive pulmonary disease （COPD）. A 72-year-old man was admitted to Fujigaoka Rehabilitation Hospital for rehabilitation after sustaining with multiple fractures sustained after falling down an approximately 4-m flight of stairs. On admission, he presented with exertional dyspnea attributable to heart failure and pneumothorax. For inhalation therapy, umeclidinium bromide （UMEC, 62.5µg/day）/vilanterol trifenatate （VI, 25µg/day） was initially prescribed because of its simplicity and ease of use. However, the patient did not achieve an adequate inspiratory volume with this treatment. Consequently, the inhalation therapy was switched to tiotropium bromide hydrate （TIO, 5.0µg/day）/olodaterol hydrochloride （OLO, 5.0µg/day）, which despite being less userfriendly, required less inspiratory effort. During this period, inhalation exercises were administered under the direction of a physical therapist. On day 42 of hospitalization, the patient demonstrated sufficient respiratory capacity to transition back to UMEC/VI. In postdischarge followup, the patient reported no difficulties with inhaler use and no adverse effects such as tremors or palpitations related to the medication. This case underscores the importance of individualized inhalation device selection and respiratory training in the rehabilitation of older patients with complex comorbidities.
