Lesson 5, Topic 2

Lung COPD – Part 2

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A 55 year old male presents with progressive shortness of breath over the past 3 months. He has a 63 pack/year history of cigarette smoking.

  • Describe the patient. How does smoking change prevalence of disease?
  • What is the chief complaint and its differential diagnosis?
  • Describe the structure of the lung and its CPC in smoking.
  • What testing is useful in smokers with SOB / cough?
  • Results from further evaluation of patient (revealed in topic)
    • Can a diagnosis be made?
  • How would our approach change if this was a 42 year old non-smoker?
  • What is the next best step?
  • Seven months later, the patient calls 911 because he has developed a fever with marked worsening of breathing over the last 2 days. When EMTs arrive, the patient is wheezing and has a dusky blue color. His SaO2 is 51%.
    • Can a diagnosis be made?
    • What is the next best step?
  • After several relatively stable years, the patient presents complaining of progressive worsening of his SOB over the past 2-3 months.
    • Is this a problem of diagnosis or natural history?


QU Lung COPD case studies 8.20.20



COPD: Natural history GOLG stages


Pathophysiology image: smoking and the bronchus

Testing for bronchiolitis obliterans: PFTs