Chronic Obstructive Pulmonary Disease ( Copd )

3059 Words May 1st, 2015 13 Pages
Mr Johns, a 60-year-old male with a history of heavy smoking and a productive cough, presents with increasing shortness of breath on exertion and now at rest. His vital signs convey a normal temperature, low blood pressure, and an elevated pulse and respiration rate. There are abnormities in his routine blood results. Physical examination highlights bilateral neck vein distension and pitting oedema at his extremities, as well as peripheral cyanosis and a swollen abdomen. On auscultation there is a loud second heart sound, and an additional heart can be heard. Examination of the chest reveals coarse crackles and wheezes. Mild hepatomegaly is also noted. Such findings are consistent with a differential diagnosis of right heart failure (Cor pulmonale) resulting from chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma or congestive cardiac failure. However, pathophysiological exploration will confirm or deny this diagnosis, and reveal other conditions that may be responsible for the Mr John’s presenting symptoms.

Mr Johns has demonstrated through his increase in sputum production (more than twice a year) and changes in mucus quality (from grey to yellowish-green, that is, purulent) during those periods. It became blood-tinged (haemoptysis) in the last 3 months. This could be explained by COPD, where there is an exacerbation in mucociliary dysfunction (Rodríguez-Roisin, 2005). A differential diagnosis to explain Mr John’s sputum production is Bronchiectasis.…
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