Chief Complaint: Shortness of breath and increased sputum production
Background Information: James is a 60-year-old male with a known history of chronic obstructive pulmonary disease (COPD). He has a 30-pack-year history of smoking but quit 10 years ago. He has been compliant with his medications, which include an inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) combination inhaler and short-acting beta-agonist (SABA) rescue inhaler. John lives alone and manages his activities of daily living independently.
1. Shortness of Breath: James reports increasing shortness of breath over the past three days. He states that even simple tasks like getting out of bed or walking to the bathroom leave him breathless.
2. Increased Sputum Production: He notes a significant increase in the amount of yellow-green sputum he’s been coughing up, which is thicker and stickier than usual.
3. Chest Tightness: James describes a sensation of chest tightness and increased use of his SABA inhaler, but it provides only temporary relief.
4. Decreased Exercise Tolerance: He mentions that he used to take short walks daily, but now he struggles to even leave his bedroom.
Temperature: 98.6°F (37°C)
- Heart Rate: 100 bpm
- Respiratory Rate: 28 breaths/minute
- Blood Pressure: 140/90 mm Hg
- Oxygen Saturation: 88% on room air
- Physical Examination Findings:
1. General Appearance: James appears anxious, sits leaning forward with pursed lips, and uses accessory muscles for breathing.
2. Respiratory Assessment:
o Diffuse wheezing is heard upon auscultation.
o Increased anterior-posterior chest diameter is observed.
3. Cough: John has a productive cough, and his sputum is yellow-green and purulent.
1. Arterial Blood Gas (ABG):
o pH: 7.32
o PaCO2: 60 mm Hg
o PaO2: 56 mm Hg
o HCO3-: 30 mEq/L
o SaO2: 88%
2. Complete Blood Count (CBC):
o White Blood Cell (WBC) Count: 14
o Platelets 150
3. Basic Metabolic Panel (BMP):
o Sodium (Na): 139
o Potassium (K): 3.1
o Bicarbonate (HCO3): 30 mEq/L
o Creatinine: 2.1
The chest X-ray reveals hyperinflated lungs with flattened diaphragms and increased retrosternal airspace, consistent with COPD.
- 1. What are the differential diagnoses for this patient?
2. 2. What are the known diagnoses for this patient?
3. What is the plan for this patient?
4. Compare and contrast the workup, diagnosis, and treatment for a patient with asthma vs a patient with COPD.