Question

Consider Mr. L an 82-year-old Caucasian male with a 55-pack year history of smoking (current). He worked as an auto mechanic before he retired. Today he complains of moderate shortness of breath when attempting to climb 1 flight of stairs and has noticed a decline in his stamina over the past 6 months. He does have mild sputum production in the mornings (white/tan in color). His vital signs are normal with pulse oximetry of 93%. His spirometry results are as follows:
FEV1/FVC is 0.58,
TLC-87% of predicted
DLCO-72% of predicted
You note that his Expiratory limb of the flow volume loop is “scooped.”

1. As you approach Mr. L care, include the classification of COPD severity based on the GOLD guidelines.
2. Explore medication options, presenting recommendations and a minimum of one medication not selected and why.
3. Consider diagnostic testing and recommend these with an explanation.

Answer 1

Mr. L care can be classified under moderate COPD according to gold classification as the fev1/fvc ratio is 58%. . The moderate COPD ranges from 50% to 79%... hence is is classified under moderate COPD. He has also mentioned that he is having breathlessness while climbing a flight of stairs which means breathlessness during exertion..

Smoking cessation must be advised to the patient. This helps in reducing the worsening of the condition. Coming to the medications the following must be give ... bronchodialators which helps in relaxing the muscles of the area and in turn reduces the breathlessness, antibiotic in case of infection must be given... pulmonary rehabilitation is recommended.

The following are the diagnostic tests which are recommended , pulmonary function test which measure the capacity of inhalation and exhalation of the lungs.. eg.spirometry., chest x ray is recommended in order to rule out emphysema, CT scan chest may also be advised... arterial blood gas analysis is also done to find out the oxygen level in the blood and also other gas levels..

These are the classification, diagnosis and treatment of mr. L.