AJ is a 49 year old gentleman who has presented at the GP surgery this morning. He has a history of a cough for the last 2 weeks. The cough has been productive with green sputum. He is a smoker of 20 cigarettes per day. Respiratory examination revealed AE equal bilaterally. There was some occasional wheeze heard over both lower lobes. PEF was 450 (pred 550). He has no allergies.
A clinical diagnosis of acute bronchitis was made.
Should this patient be treated with antibiotics? Should he be prescribed a salbutamol inhaler?
This gentleman returned to the GP surgery one week later. He continued to have a productive cough with discoloured sputum. He had had completed a course of amoxicillin. Respiratory examination revealed good AE but again occasional wheeze now more in the R than L base. PEF was 430.
- what is indicated in the next step of management?
- can this patient be sent to the nurse for spirometry?
What clinical features might suggest an atypical pneumonia?
- what rash can occur in cases of mycoplasma pneumonia
- what are some other causes of this rash
Investigations were negative. His cough improved with the antibiotic treatment. He has still complains of a residual occasional non-productive cough. Respiratory examination again reveals a PEF around 450. It is now suspected that this gentleman might have COPD.
- what groups should you consider the diagnosis of COPD?
- what is PEF and how is it affected by restrictive and obstructive ventilatory defects?
- what is FEV1 and what affects it?
How is COPD diagnosed?
What about reversibility testing in COPD?
When would referral to a chest physician be indicated?
What about inhaled steroids in COPD? Do inhaled steroids slow decline in pulmonary function? When are combination products used?
What does of inhaled steroids might have systemic effects in an adult?
If there is a family history of emphysema, what condition should be considered?
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