Case Study 1
- Matron
- Dec 1, 2024
- 2 min read
A 63 year old male with increasing breathlessness...
CLINICAL HISTORY
Alan is a 63 year old Caucasian male presenting for post bronchodilator spirometry testing
He tells you he has noticed himself becoming increasingly breathless over the last 6 months
His breathlessness is worse on exercise
He denies any chest tightness or chest pain
He denies any haemoptysis
A review of his notes reveals that he has had 2 courses of antibiotics during the last 2 years for 2 separate chest infections
He has no known allergies
He is an ex-smoker (stopped 10 years ago) and has a cumulative 28 pack year history of smoking
He is a joiner/builder and has done this since leaving school at the age of 16
He tells you that, as far as he is aware, there is no family history of respiratory problems but adds that he doesn't know anything about his fathers side of the family
PROBABILITY ASSESSMENT
Based on the clinical history provided, what do you think is the most likely cause of Alan's symptoms?
POST BRONCHODILATOR SPIROMETRY DATA
Alan was given 400 mcg of salbutamol via a spacer device, and 20 minutes later, his lung function was assessed using spirometry. His results are as follows:
Clinical Report of Alan's Lung Function Data:
Alan's LLN for his FEV/FVC ratio is 0.647
His ACTUAL FEV/FVC ratio is 0.558 > because this is less than his LLN this supports the presence of airflow obstruction
Alan's FVC of 4.07 is greater than his LLN of 3.34 which excludes the presence of a co-existing restrictive defect
His FEV1 is 2.27 which is 66.8% of his predicted FEV1 of 3.398
As this sits between 50-80% this would suggest that Alan has a moderate degree of airway obstruction
FINAL INTERPRETATION
Alan's clinical presentation and history is suggestive of COPD
He has a significant pack year history of cigarette smoking
His post bronchodilator spirometry test results indicate the presence of moderate airway obstruction
Combining the clinical history/presentation and the results of his lung function testing it is possible to confirm a diagnosis of moderate COPD
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