Identify at least three subjective findings from the case that support the chosen diagnosis.
Evaluation of the patient revealed a nonproductive cough in the morning, shortness of breath on exertion, and fatigue. According to the patient, his fatigue and shortness of breath have worsened over the past three months. These findings are suggestive of chronic obstructive pulmonary disease.
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Identify at least three objective findings from the case that support the chosen diagnosis.
Firstly, a chest x-ray revealed hyper-inflated lungs and a bilaterally flattened diaphragm. Hyperinflation occurs due to limited airflow, which leads to the retention of inhaled air and increases the risk of hypercapnia (Celli & Wedzicha, 2019). A bilaterally flattened diaphragm suggests emphysema associated with COPD (Celli & Wedzicha, 2019). Secondly, an examination of the lungs revealed bilateral wheezes, forced expiration, and prolonged exhalation phase. These features suggest the presence of obstructive pulmonary disease (Celli & Wedzicha, 2019). Thirdly, spirometry findings reveal a forced expiratory volume in the first second (FEV1) of less than 80 percent of the predicted value (64 percent), a lower forced vital capacity (FVC), and an FEV1: FVC ratio of less than 0.7 (0.56). Additionally, there are insignificant changes in the spirometry readings of the FEV1/FVC ratio after administering a bronchodilator. These findings are suggestive of chronic pulmonary disease.
Management of the Disease
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Classify the patient’s disease severity. Is this considered stable or unstable?
According to GOLD’s criteria, the patient has moderate COPD. Based on these criteria, moderate COPD presents with an FEV1 reading ranging from less than or equal to 50 percent to less than 80 percent of the predicted value (GOLD, 2022). In this context, the patient’s post-bronchodilator FEV1 reading is 66 percent of the predicted value. The patient’s COPD is considered stable. This is because the patient’s symptoms are not severe, and a rapid pulmonary decline is absent. However, the patient should be managed adequately to avert his condition worsening.