You have a 42-year-old female that presents to your office with respiratory and

Question

You have a 42-year-old female that presents to your office with respiratory and visual symptoms. She enjoys astronomy, but recently a visual change has made this difficult. She has noticed some difficulty seeing distant galaxies through her telescope. Also, she has noticed a mild, and sometimes productive cough, for 3-4 months. She has noticed worsening of the cough when she has been exposed to smoke from bonfires. You ask her additional questions and discover that she has smoked cigarettes, 1 ppd for 22 years. In further questioning, she admits the cough has really been present closer to 1 year. She has had some shortness of breath with exercise over the last 6 months. PMH: Hypertension. She is on lisinopril, metoprolol, and hydrochlorothiazide. Your physical examination is normal. You ordered a chest x-ray that is also normal. Her spirometry results are: - FEV1: 85% of predicted - FEV1/FVC is 65% Anything else you would ask her? What is her diagnosis? What would be your treatment plan (please be specific)?

Explanation / Answer

Anything else that should be asked is her; genetic predisposition; i.e. family history pertaining to the disease as for example the deficiency of the Alpha-1 Antitrypsin protein in the bloodstream is associated with this disease.

This female appears to be suffering from Stage II: Moderate COPD based on her spirometry results

Non-pharmacological treatment must include smoking cessation

cardio-selective b-blockers e.g. (e.g. celiprolol) for hypertension

Stage II: Moderate COPD drugs like Albuterol on an as-needed basis

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