A 67 year old gentleman is referred to you from his GP. He has been attending his GP for the last 6 months with increasing shortness of breath on exertion. He has been diagnosed with COPD and started on salbutamol 200 accuhaler. It has made little difference to his symptoms. He describes chronic bronchitis. His exercise tolerance is 50 yards and he gets breathless on washing and dressing. He has had 3 courses of antibiotics and steroids in the last 3 months for ‘chest infections’. He continues to smoke 5 cigarettes per day (50 pack year history). He has no other medical history and takes no medications. He lives with his wife who does most of the activities around the house.
On examination his SpO2 is 91% on air and there are reduced breath sounds throughout his lung fields with no added sounds. There is no peripheral oedema. He is unable to stay for a CXR as his wife has her own hospital appointment to attend. He does manage spirometry.
FEV1 0.9 (34% pred) VC 2.65 (82% pred) Ratio 34%
- Describe your initial management of this patient?
More information will be posted later in the week.
Thanks again to Dr Philip Reid for this case.
