Question

Case study

A general practitioner was visited by a 50-year-old male who was worried by a shortness of breath that had developed over the previous month. He indicated that he had had a recent “cold” with a cough, which had since improved. On questioning by the doctor, he indicated that he smoked two packs of cigarettes each day and had developed a “smoker’s cough” in the last five years. He replied to further inquiries that for the past two years he had experienced some difficulty breathing while climbing stairs and in similar demand situations. When pressed, he further revealed that his “smoker’s cough” was sometimes productive of a thick and occasionally coloured sputum, and that every winter he tended to develop what his previous doctors had called bronchitis. He was quick to point out that the prescribed antibiotics were able to deal with the problem quite effectively.

On examination, he appeared normal with no apparent cyanosis. Lung auscultation revealed slight wheezing on expiration. Spirometry revealed a depressed FEV1, while a chest X-ray and complete blood count proved normal.

The patient was prescribed antibiotic therapy to control any residual infection, and a bronchodilator to ease his breathing. He was urged to stop smoking and to return for periodic reassessment (which he never did - and this is not unusual with smokers).

1) What was the most likely diagnosis?

2) What two signs/symptoms were most indicative of this patient’s problem?

Answer 1

1. Diagnosis is chronic bronchitis

It is diagnosed as cough with sputum production for atleast 3 consecutive months in a year for atleast 2 years.

Most common causative agent is smoking for long time.

In this provided question history of past 2 years is mentioned and also patient has history of cigerate smoking.

2. Signs and symptoms suggestive of patients condition are

A.Dyspnea

B.cough with expectorant

C. Expiratory wheeze: which shows airway obstruction

(COPD- chronic obstructive pulmonary disease)