Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea and chronic productive cough. History significant for heavy tobacco use (pack-years: [X]). Symptoms characterized by airflow obstruction, worsening with physical activity. No history of alpha-1 antitrypsin deficiency or occupational dust exposure.
Clinical Examination Findings
General: Patient appears in mild respiratory distress with pursed-lip breathing. Chest: Hyper-inflated, barrel-shaped chest with increased AP diameter. Auscultation: Diminished breath sounds bilaterally, prolonged expiratory phase, and occasional end-expiratory wheezing. Percussion: Hyper-resonance throughout lung fields. Heart: Distant heart sounds, no murmurs. Extremities: No peripheral edema or cyanosis.
Treatment Protocol
1. Smoking cessation counseling and nicotine replacement therapy. 2. Long-acting bronchodilators (LABA/LAMA) for symptom management. 3. Pulmonary rehabilitation referral. 4. Annual influenza and pneumococcal vaccination. 5. Supplemental oxygen therapy if resting SpO2 < 88%. 6. Follow-up PFTs in [X] months.