Steve

Case study example 17

 

This patient is an ex-smoker and has ‘probable’ asthma. He remembers having problems with chest infections and recurrent colds as a child. His father had pulmonary TB and died when he was 7 years old and although he was followed up in TB Clinic for many years he does not remember being diagnosed with TB.

He then worked underground for 35 years and smoked 20 cigarettes per day for 20 years.

Over the last 30 years he has had a productive cough, productive of small amounts of white sputum on a daily basis. Inhaled corticosteroids seem to have relieved these symptoms somewhat. He has a past medical history of eczema, hypothyroidism, hypertension and a TIA associated with loss of vision in his left eye.

What does the spirometry result indicate?

3 Comments
  1. Profile photo of Janet Thomas
    Janet Thomas 2 years ago

    My first time in commenting on a Spirometry on here, so here goes.
    He had eczema and a past history of chest problems as a child. His symptoms improved after inhaled corticosteroids and his post brochodilater PEF improved by 21.9% which is quite significant. However he has a 20 pack year smoking history and is an ex miner and his FEV1 only improved by 100ml. This indicates very little reversibility. This puts him in the range of a severe COPD. I would order a chest X-ray, and sputum sample, continue with the ICS and add in a LABA. I would probably add a LAMA possibly on day of diagnosis or after review in 1m.. He may have some benefit from a SABA so would also suggest he use it on a PRN basis.

  2. Profile photo of Leanne Moore
    Leanne Moore 2 years ago

    Based on his numbers I agree, severe COPD. Graph also points to this, scalloped shape and on the time volume graph the line does not appear to have plateaued after 14 secs.

    However with his childhood Hx of chest probs and eczema could he also be an asthma? He’s had an 11% increase in FEV1 post bronchodilator? Possibly mixed picture?

  3. Profile photo of Rhys
    Rhys 2 years ago

    Yes very good observation. Tough one here as it depends on what asthma guideline is used. It’s true there is a 11% improvement in FEV1 but as Janet says it is only 100ml (consider the accepted variability between baseline spirometry measurements!).
    Whilst there is some reversibility this is certainly not conclusive of asthma – a candidate for overlap syndrome perhaps – see this paper which explains a little more on this:

    http://thorax.bmj.com/content/64/8/728.short

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