OSCE-PULMUNOLOGY

A 66-year-old man with a smoking history of one pack per day for the past
47 years presents with progressive shortness of breath and chronic cough,
productive of yellowish sputum, for the past 2 years. On examination he
appears cachectic and in moderate respiratory distress, especially after
walking to the examination room, and has pursed-lip breathing. His neck
veins are mildly distended. Lung examination reveals a barrel chest and
poor air entry bilaterally, with moderate inspiratory and expiratory
wheezing. Heart and abdominal examination are within normal limits.
Lower extremities exhibit scant pitting edema
QUESTIONS

1. What is the diagnosis

2. Define the condition
3. How will you confirm your diagnosis
4. What is the most important risk factor of this condition
5. How will you treat this patient

ANSWERS

1.COPD- Chronic Obstructive Pulmunary Disease

2. COPD is defined as a disease state characterized by airflow limitation that is not

fully  reversible. It includes: 
 ∙ Emphysema; defined as enlargement of the air spaces distal to the terminal
bronchioles  with destructive changes in the alveolar wall.  
 ∙ Chronic bronchitis; defined as daily cough with sputum production for at
least three  consecutive months a year for at least two consecutive years.  
 ∙ Small airways disease, a condition in which small bronchioles are
narrowed.  
3. Spirometry is used to confirm the diagnosis of COPD in suspected cases.
Patients whose FEV1 is <80% of predicted value and whose ratio of FEV1 to
forced vital capacity (FVC) is <70% after inhalation of a short-acting
bronchodilator are considered to have restricted airflow, indicative of COPD.
4.
Cigarette smoking is the principal risk factor for COPD.other risk factors includes
Occupational and environmental exposures to chemical fumes, dusts, and other
lung irritants, Alpha-1 antitrypsin deficiency.

5. 1. Smoking Cessation: Crucial for stopping progression of the disease.  

2. Inhaled Bronchodilator therapy: 
∙ Beta agonists. 
∙ Anticholinergics. 
3. Inhaled steroids. 
4. Mucolytics: N-acetyl cysteine.  
5. Chest physiotherapy. 
6. Theophylline. 
7. Supplemental oxygen: 
∙ For patients with resting hypoxemia (resting O2 saturation 88% or <90% with
signs of  pulmonary hypertension or right heart failure).1 
8. Hydration & nutrition. 
9. Antitussives.