Case Study: Chronic Obstructive Pulmonary Disease (COPD) Assessment

QUESTION

M.V. is a 53-year-old accountant who smoked a pack of cigarettes a day for 30 years, equaling a 30-pack year history (i.e., 1 pack per day multiplied by number of years). He quit smoking 6 months ago. He presents with shortness of breath while hurrying on level ground or dyspnea of exertion when walking up a slight hill. However, he is not limited doing any particular activities at home. He complains of a chronic productive morning cough with ¼ cup of clear to creamy secretions. There is no change from his baseline secretion character or amount. He was treated at home for one respiratory infection last year. On physical exam, you observe wheezing throughout all lung fields, hyperresonance on percussion of the lungs, and low flat diaphragms. He has no cyanosis, clubbing, or edema. His COPD Assessment Test™ (CAT™) score is 12. Spirometry demonstrates a forced expiratory volume in 1 second (FEV₁) = 72% predicted and FEV₁/forced vital capacity (FVC) = 69%. He has no other medical conditions and is not taking any nonprescription, prescription, or complementary alternative medicine. He has no known drug allergies.

ANSWER

Case Study: Chronic Obstructive Pulmonary Disease (COPD) Assessment

Introduction

This case study focuses on the assessment of M.V., a 53-year-old former smoker with a significant smoking history and respiratory symptoms. The objective is to evaluate his condition and provide insights into the diagnosis and management of chronic obstructive pulmonary disease (COPD). The patient’s presenting symptoms, medical history, physical examination findings, and spirometry results will be discussed to determine the severity and impact of COPD on his daily life.

Patient History and Symptoms

M.V. is a 53-year-old accountant who smoked a pack of cigarettes per day for 30 years, resulting in a 30-pack year history. He successfully quit smoking 6 months ago. He reports experiencing shortness of breath during activities such as walking on level ground or uphill exertion, but he does not have limitations in his daily activities at home. M.V. also complains of a chronic productive morning cough with clear to creamy secretions, which has remained consistent in character and amount. He had one respiratory infection last year that was managed at home.

Physical Examination Findings

During the physical examination, wheezing is observed throughout all lung fields. Percussion of the lungs reveals hyperresonance, and low flat diaphragms are noted. No signs of cyanosis, clubbing, or edema are present.

Assessment

Based on the history, symptoms, and examination findings, the primary diagnosis is Chronic Obstructive Pulmonary Disease (COPD). The patient’s smoking history, persistent cough, dyspnea on exertion, and physical examination findings support this diagnosis. The COPD Assessment Test™ (CAT™) score of 12 indicates a moderate impact of COPD on M.V.’s daily life. Spirometry results demonstrate a forced expiratory volume in 1 second (FEV1) of 72% predicted and an FEV1/forced vital capacity (FVC) ratio of 69%, further confirming the presence of airflow limitation consistent with COPD.

Diagnostics and Evaluation

Spirometry plays a crucial role in evaluating COPD. The FEV1 and FEV1/FVC ratio provide objective measurements of airflow limitation. Other diagnostic tests that may be considered in COPD evaluation include chest X-ray, computed tomography (CT) scan, and arterial blood gas analysis to assess lung function, exclude other lung pathologies, and evaluate gas exchange abnormalities.

Management and Treatment

The management of COPD involves a combination of pharmacological and non-pharmacological interventions. As M.V. does not have any other medical conditions and is not taking any medications, his treatment plan can focus on the following aspects:
Smoking cessation support and counseling to maintain his smoking cessation status.
Inhaler therapy, including bronchodilators (short-acting and long-acting) to relieve symptoms and improve lung function.
Pulmonary rehabilitation programs to enhance exercise capacity and improve overall quality of life.
Education on recognizing exacerbation symptoms and the appropriate use of rescue medications.

Conclusion

M.V.’s case highlights the importance of early detection and management of COPD, especially in individuals with a significant smoking history. Through accurate diagnosis, including spirometry, healthcare providers can assess the severity of airflow limitation and implement a tailored treatment plan to alleviate symptoms, improve lung function, and enhance the patient’s quality of life.