copdcasestudy numbertwo

7/24/2019 COPDCaseStudy NumberTwo

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Case Study Number Two

SW is a 72 year old female who presents with shortness of breath on exertion and worsening fatigue for

the last few months. She does not complain of chest pain or tightness. She has noted slight bilateral footand anle swelling worse o!er past se!eral months.

"n terms of past medical history# she has smoed half a pac per day for the past $% years and is

unwilling to &uit. She has been pre!iously diagnosed with breast cancer that was treated withlumpectomy and local radiotherapy.

'uring an emergency room !isit last year for an episode of shortness of breath# she was prescribed an

albuterol inhaler She has been treated for hypertension for the past 2( years )current medications* propranolol +% mg

twice daily and hydrochlorothia,ide 2$ mg daily-

n physical examination# her !itals signs are as follows* /eart rate 0% bpm# 1espiratory rate (% bpm#

and blood pressure $23+$ mm/g. 4xamination of her lungs re!ealed an expanded chest withtympanitic# distant breath sounds and faint whee,es diffusely. /eart sounds were normal.

5or this patient# the differential diagnosis includes C6'# asthma# heart failure# pulmonary embolism#

pneumothorax and medication induced cough.

What test would most accurately determine the presence of COPD?

. Chest 891ay:. Spiral computer tomography )CT-

C. :rain natriuretic peptide ):N6-

'. Spirometry

Spirometry is performed and the following !alues are obtained*

Pre Bronchodilator Post Bronchodilator

Predicted Measured % Measured % % changeFVC 2.66 1.32 50 1.26 47 -4

FEV1 2.02 0.54 26 0.50 25 -6

FEV1/FVC 76 41 -35 3 -37 -2

PEF 315 114 36 120 3! 5

FEF 25 4.6 0.40 ! 0.30 6 -2!

FEF 50 2.!5 0.20 7 0.20 7 -

FEF 75 0.7! 0.10 13 - - 1!FEF 25-75 1.!2 0.1 10 0.1! 10 -6


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Pre Bronchodilator Post Bronchodilator

Predicted Measured % Measured % % change

FVC 2.66 1.32 50 1.26 47 -4

FEV1 2.02 0.54 26 0.50 25 -6

FEV1/FVC 76 41 -35 3 -37 -2

Based upon the results of the spirometry, you diagnose the following condition:

. ;ild C6'

:. ;oderate C6'

C. Se!ere C6'

'.


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Answers!otes

What test would most accurately determine the presence of COPD?

nswer* '

ffice spirometry is the test that would most accurately determine the presence of C6'. 1adiographic

findings noted on chest x9ray occur late in disease. Computer tomography )CT- scanning is more accurate#

but findings also occur late in disease. :rain natriuretic peptide ):N6- is used as a marer of heart failure.

Based upon the results of the spirometry, you diagnose the following condition:

nswer* '

The results of the spirometry demonstrate !ery se!ere obstruction with an 54

copdcasestudy numbertwo

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