After completing this case study, the reader should be able to:
Recognize modifiable risk factors for the development of chronic obstructive pulmonary disease (COPD).
Interpret spirometry readings and patient-specific factors to evaluate and appropriately provide a classification of COPD for an individual patient.
Identify the importance of nonpharmacologic therapy in patients with COPD.
Develop an appropriate medication regimen for a patient with COPD based on disease classification.
“My wife says I need to get my lungs checked. Ever since we moved, I’m having a hard time breathing.”
Dwayne Morrison is a 59-year-old man who is presenting to a new provider at the family medicine clinic today with complaints of increasing shortness of breath. He points out that he first noticed some difficulty catching his breath at his job 3 years ago. He had been able to carry heavy loads up and down a flight of stairs daily for the last 35 years without any problem. However, his shortness of breath began to make this very difficult. Coincidently at that time, he accepted a managerial position at his company that significantly reduced his activity level. After taking this position, he no longer noticed any problems, but admits that he avoids activities that cause him to physically exert himself. He noticed significant shortness of breath again after he moved to Colorado from a lower elevation 2 months ago to be closer to his grandchildren. His shortness of breath is worst when he is outside playing with his grandchildren. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He is hoping to get a good medication that will help relieve his shortness of breath because the gardening season is right around the corner, and he enjoys this hobby.
CAD (MI 7 years ago, resulting in stent placement at that time; additional stent placed 2 years ago; normal echocardiogram and stress test 3 months ago)
Chronic bronchitis × 8 years (has had one exacerbation in the last 12 months; received oral antibiotic treatment but was not hospitalized)
Father with COPD (smoked a pipe for 40 years). Mother with coronary artery disease and cerebrovascular disease.
He lives with his wife, who is a nurse. He has a 40 pack-year history of smoking. When he had an MI at age 52, he quit smoking temporarily. At present, he continues to smoke five to six cigarettes per day. He drinks two to three beers most nights of the workweek.
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