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Friday, December 11, 2015

A 74 Year Old Chronic Smoker Presents With Fatigue And Shortness Of Breath

A 74-year-old man who is a chronic smoker presents with fatigue and shortness of breath. He has not seen a physician for many years and says he has been basically healthy.
On physical examination, he is found to be pale, mildly cachectic, and his lips are cyanotic.
His breath sounds are distant, although crackles can be heard in both lung bases. His heart sounds are best heard in the epigastrium; and a third heart sound is present. He has mild peripheral edema.
His resting pulse oximetry is 74%.
The chest X-ray (CXR) shows emphysema and his echocardiogram confirms heart failure.
The X Ray is shown below:



Case Discussion:

Emphysema:
is a chronic obstructive pulmonary disease characterized by airflow limitation that is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases
Emphysema is pathologically defined as an abnormal permanent enlargement of air spaces distal to the terminal bronchioles, accompanied by the destruction of alveolar walls and without obvious fibrosis.

Pathology: Mediated by chronic inflammatory responses to environmental factors,especially cigarette smoke, that results in recruitment of inflammatory cells in terminal air spaces and release of elastolytic proteinases that damage the extracellular lung matrix and cause ineffective repair of elastin and other matrix components.
Gas exchange abnormalities result in hypoxemia and hypercapnia. Pulmonary hypertension may occur as a result of hypoxic vasoconstriction of small pulmonary arteries.

Clinical Features: Most patients seek medical attention late in the course of disease since the disease starts slowly and progresses gradually.
Most patients present in fifth decade of life with a productive cough or acute chest illness. This cough is often called as 'smokers cough'.
On physical examination the hallmark is the limitation of expiratory flow with relative preservation of inspiratory flow.

Differential Diagnosis: include:

  • Congestive heart failure
  • Chronic asthma
  • Bronchiectasis 
  • Bronchitis.
  • Bronchiolitis obliterans.
Diagnosis:
1. Postbronchodilator spirometry secures the diagnosis and provides the severity classification.
2. A serum level of α1-antitrypsin should be measured if you suspect a genetic mutation.
3. A CXR is not useful for diagnosis but is helpful for excluding other diseases or identifying comorbidity.

Management: Management of COPD is based on symptoms, risk or history of exacerbations,
1. Patient education about the disease and avoiding the risk factors. 
2. Influenza and pneumococcal vaccination, are most effective in the elderly.
3.For patients with stable COPD, only smoking cessation and oxygen therapy has shown significant improvement. 
4. For symptomatic relief following are recommended:
  • Short-acting inhaled bronchodilators.
  • Inhaled long-acting β-agonists.
  • Combination long-acting β-agonists with inhaled anticholinergic agents. 
  • Inhaled long-acting anticholinergic.I
  • Inhaled glucocorticoids. 
  • Theophylline
  • Mucolytic agents (e.g., guaifenesin, carbocysteine, potassium iodide)




3 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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    Replies
    1. “I was walking and my husband was telling me to slow down because he couldn’t keep up with me.”
      Denise F. lived with COPD and chronic asthma for many years. When her quality of life continued to decline, Denise decided to try something different.While being with her horses brought her peace and joy, not being able to breathe made spending time with them challenging. When her grandchildren would visit, she couldn’t even participate in their activities.
      After the herbal recommendation at the multivitamincare .org, Denise my best friend no longer needs oxygen or a walker and has seen many improvements. She can walk, clean her house, go shopping, enjoy a vacation, ride her horses, lift hay bales and do anything she wants to do.
      Now, when her grandchildren visit, they can ride horses together and make wonderful memories. And, Denise wants to lead the way, “I was walking and my husband was telling me to slow down because he couldn’t keep up with me.”
      If you or someone you love has COPD, emphysema, pulmonary fibrosis or another chronic lung disease and would like to see results like Denise’s, contact them at +1 (956) 758-7882 or their website to learn more about your lung disease treatment options.








































      Delete
  2. “I was walking and my husband was telling me to slow down because he couldn’t keep up with me.”
    Denise F. lived with COPD and chronic asthma for many years. When her quality of life continued to decline, Denise decided to try something different.While being with her horses brought her peace and joy, not being able to breathe made spending time with them challenging. When her grandchildren would visit, she couldn’t even participate in their activities.
    After the herbal recommendation at the multivitamincare .org, Denise my best friend no longer needs oxygen or a walker and has seen many improvements. She can walk, clean her house, go shopping, enjoy a vacation, ride her horses, lift hay bales and do anything she wants to do.
    Now, when her grandchildren visit, they can ride horses together and make wonderful memories. And, Denise wants to lead the way, “I was walking and my husband was telling me to slow down because he couldn’t keep up with me.”
    If you or someone you love has COPD, emphysema, pulmonary fibrosis or another chronic lung disease and would like to see results like Denise’s, contact them at +1 (956) 758-7882 or their website to learn more about your lung disease treatment options.

    ReplyDelete