Chronic Obstructive Pulmonary Disease: Part 2: Prevention and Long-term Treatment

Gerald W. Staton, Jr., MD

Disclosures

November 05, 2009

Clinical Case

A new patient visiting the office this morning is a 58-year-old, black man whose chief complaints are chronic cough, sputum production, and dyspnea. He says that his cough and sputum production have been present for about 10 years, and the dyspnea has been slowly increasing over the last 5 years -- to the point that he has trouble walking from the parking lot into his office.

On further questioning, he mentions that each winter he has what he refers to as "month-long chest colds" that are associated with worsened dyspnea on exertion. After each of these colds, he has difficulty attaining his previous baseline exercise tolerance. On several occasions, he has taken antibiotics and a short course of oral corticosteroids for these episodes, but the severity of these episodes has not required an emergency department visit or hospitalization. He has smoked 1.5 packs of cigarettes a day since he was in the military in his 20s. He was given an inhaler containing ipratropium/albuterol by another physician, but he has not noticed much improvement in his symptoms and no longer uses the medication on a regular basis. He has tried to stop smoking on several occasions, but been able to quit for only short periods. He has hypertension that is controlled with hydrochlorothiazide.

On physical examination, he appears somewhat overweight but otherwise looks well and is in no respiratory distress. His vital signs are normal. There is no neck vein distention, and the heart sounds are normal. The chest examination reveals coarse breath sounds accompanied by scattered wheezes, but no rales or rhonchi are heard. The remainder of the examination is normal.

A chest x-ray shows increased bronchovascular markings, and an electrocardiogram reveals no abnormalities.

Office spirometry is performed, and the results are: forced vital capacity (FVC), 85% of predicted; forced expiratory volume in 1 second (FEV1), 50% of predicted; and FEV1/FVC ratio, 59%. The spirometry findings indicate that the diagnosis is moderate chronic obstructive pulmonary disease (COPD), which is likely caused predominantly by chronic bronchitis.

What treatments should be prescribed, and what are the intended benefits of those treatments?

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