Essay on End Stage Copd : Asthma As A Child

Essay on End Stage Copd : Asthma As A Child

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End-stage COPD - FEV1 0.71L 2014
ex-smoker - quit 2014
Asthma as a child
Dyslipidaemia

Thank you very much for referring Richard along for further investigation and management of his three-four month history or worsening shortness of breath on exertion. As you are aware, he was diagnosed with severe COPD, with an FEV1 or 25% of predicted and at that stage, gave up smoking. Despite the very limited lung function, since that time he has coped very well. He continues to work in a clerical role with a very supportive company and lives with two housemates. He will walk his dog for 30 minutes, twice a day. On the weekends, he goes for a walk of an hour and forty-five minutes on a Saturday and an hour and a half on a Sunday. While he was walking slowly, he did notice that on the flat at his own pace he was able to achieve 4-5km distance. His breathlessness did get worse when he had any hurried exertion or steep incline, but he has been quite happy with his progress.

Three to four months ago, he noticed a dramatic and sudden decline. This was associated with worsening a mildly productive cough of whitish sputum, and he had therefore assumed that it was viral at the time. There were no other changes in exposures in his home or work environment, and he has never had any issues with dog allergies or any allergies otherwise. He had no worsening with this with the thunderstorm event recently.

Thank you to Dr Ingram for trialling antibiotics. Unfortunately, these have not helped. He had a two-week course of prednisolone, wherein the first week he had 25gm and the second week 12.5mg with no benefit whatsoever. He was off prednisolone for two weeks and has now been on prednisolone for six weeks, with the first four weeks bein...


... middle of paper ...


...owever, coronary artery calcification.

Impression/Management:
Richard 's lack of response to any prednisolone does raise the question of whether or not there is another cause for his breathlessness. It does appear that he has been on quite good treatment for his COPD and therefore I would have expected some improvement over the last three to months if all of this was done to his COPD. I therefore think it is important to rule out pulmonary emboli and also a reversible ischemia. As such, I will organise an urgent VQ scan and a myocardial perfusion scan. Given his inability to exercise, we will perform the perfusion scan as a chemically-induced scan.

I am hoping to have these organised first thing next week and I will see him with updated lung function tests to assess his progress and management moving forward. I have also organised some baseline blood tests.

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