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I'm presenting a COPD case study.
My name is Wissam Chatila.
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KM is a 58-year-old man,
diagnosed with emphysema in 2010.
He presents to my clinic
for a second opinion
for management of his COPD.
He has no significant
past medical history.
He has no prior history of
cardiovascular disease or metabolic
diseases.
He is a retired airport
technician and former smoker.
He quit one year ago, and no
other history of illicit drug
use and/or prior exposures.
His family history is
significant, with a brother
who has a history of asthma.
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He had three exacerbations per year
over the last two or three years,
some requiring hospitalizations.
He had two pneumonias
over the last two years,
in addition to his exacerbations.
He has no wheezing,
by history, but has
a slight cough, minimally
productive, with
occasional clear mucus production.
His mMRC score is 3.
That is, he is breathless with
mild to moderate activity.
He stops for breath
after walking 100 yards
or after a few minutes
on level ground.
He gets substantial
relief with the use
of albuterol nebulizer
treatments that he
takes three or four times per day.
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This slide shows his
pulmonary function test.
The first one were done in May,
2012, by his pulmonologist.
His vital capacity was 105,
FEV1, 33%, and is FEB1/FVC ratio
is 25%, significant for a
very severe obstruction.
Air trapping, his TLC is 128, and
RV is 209, so he's significantly
hyperinflated and air trapped.
The most recent
pulmonary function test
shows a significant deterioration
in his air flow obstruction,
with an FEV1 of 17%,
compared to the 33%,
so it continues to be very severe
and much worse compared to 2012.
His hyperinflation and air
trapping also have progressed,
with a TLC of 138%, and RV, 295%.
His DLCO is also
severely reduced to 22%,
and on the six-minute walk
distance, he walked 165 meters,
his lowest oxygen
saturation was 80%,
and he required 6 liters
per minute to maintain
an oxygen saturation about 90%.
His arterial blood gas does not
show significant hypercapnia,
but he was hypoxemic
with a PO2 of 65.
