Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chronic productive cough occurring on most days for at least 3 months in each of 2 consecutive years. Reports increased sputum production, often mucoid to mucopurulent, with associated exertional dyspnea and intermittent wheezing. Denies hemoptysis, night sweats, or significant weight loss. Symptoms are exacerbated by cold air, respiratory infections, and environmental irritants.
Clinical Examination Findings
General: Patient appears in no acute distress, though may demonstrate pursed-lip breathing. HEENT: No jugular venous distension. Chest: Inspection reveals increased AP diameter (barrel chest). Auscultation demonstrates prolonged expiratory phase, bilateral coarse crackles, and diffuse expiratory wheezing. Percussion is hyper-resonant. Extremities: No peripheral edema or cyanosis noted.
Treatment Protocol
Initiate long-acting bronchodilator therapy (LABA/LAMA combination). Prescribe short-acting bronchodilator (SABA) for rescue use. Consider inhaled corticosteroids (ICS) if frequent exacerbations occur. Recommend smoking cessation counseling, annual influenza vaccination, and pneumococcal vaccine. Pulmonary rehabilitation referral provided.