Omalizumab Therapy Case Study

CHIEF COMPLAINT: Will patient benefit from omalizumab therapy.

HISTORY OF PRESENT ILLNESS

Harry Barr is a 66-year-old white male with COPD here for followup. He was initially seen in Pulmonary Clinic 02/17/2016. At that visit most recent spirometry was from 2012 and showed Gold stage III COPD with no bronchodilator responsiveness. He was on an excellent inhaler regimen and recommendations including occluded chest CT for lung cancer screening and assessment of oxygenation for hypoxia. Since that visit, the patient has had significant worsening of his dyspnea on exertion. He also states that he has had two exacerbations over the last year requiring prednisone, but prednisone is problematic because of his diabetes. He continues on the same inhaler regimen of Symbicort, Spiriva, albuterol, and also takes theophylline. He endorses significant nasal symptoms including stuffiness and drainage for which he takes Flonase two sprays in each nostril once daily. He denies any history of childhood asthma.

PHYSICAL EXAMINATION

In general, he was a chronically ill-appearing white male in no acute distress. HEENT: The nasal mucosa on the right was erythematous and questionable polyp was present. No stridor over the neck. Chest increased AP diameter. Lungs: Diminished breath sounds through all lung fields with prolonged expiratory phase and expiratory wheezing. No crackles. No accessory muscle use. Heart: Very distant S1, S2. No murmurs, rubs, or gallops. Abdomen: Obese, nontender. No organomegaly. Extremities: 1+ pitting edema. No clubbing. No