-Year-Old Male, 180 Pounds, No Known Drug Allergies ✓ Solved

70 Year Old Male 60 180 Poundsno Known Drug Allergies Nkdamedicati

70-year old male 6’0” 180 pounds No Known Drug Allergies (NKDA) Medications: Albuterol Chief Complaints: Cough and wheezing Patient states his cough and wheezing have been steadily getting worse for the past year. He was diagnosed with asthma when he was 9 and has had to use his inhaler more often in the past three months. He is a 40-pack year smoker and continues to smoke. Patient admits to more lung infections than “he can count” over the past 10 years. The cough and wheezing are worse in the morning (more frequent but non-productive) but occurs throughout the day. He finds that breathing through pursed lips helps. You notice as he is speaking with you that he uses his SCM, scalene and trapezius to breathe. He admits he has lost 20 pounds over the last year. Patient states his symptoms are alleviated when he sits up and aggravated while lying down. He sees a pulmonary specialist who “wants to give him more medications but the patient just does not want to take them.” The pulmonary specialist’s findings are as follows: Forced Expiratory Volume in 1 second (FEC1)

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The case of the 70-year-old male presents several challenges related to chronic respiratory issues, particularly asthma exacerbated by his longstanding smoking habit and recent weight loss. To understand the management and treatment options for this patient, it is important to dissect his chief complaints, existing medication regimen, and the latest diagnostic findings from his pulmonary specialist.

Understanding Asthma and Its Exacerbation

This patient has a significant history of asthma, diagnosed at a young age, which has likely contributed to the chronic nature of his pulmonary symptoms. Asthma exacerbations can be triggered by various factors, including environmental pollutants, allergens, and smoking. The continuous use of an inhaler implies that the patient experiences frequent episodes of bronchoconstriction characterized by wheezing and cough, which have progressively worsened over the past year.

Given that the patient has a 40-pack year smoking history, it's essential to consider the negative impact of smoking on his lung health. Smoking not only worsens asthma symptoms but also contributes to chronic obstructive pulmonary disease (COPD), which could be a consideration given the patient’s significant pack years.

Clinical Findings and Diagnostic Imaging

The pulmonary function tests indicate a Forced Expiratory Volume in 1 second (FEC1) of less than 80% of the predicted values and a ratio of FEC1 to Forced Vital Capacity (FVC) of less than 0.60. These findings point toward obstructive airway disease, potentially indicating asthma, but also suggest possible COPD due to his smoking history (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2021).

Symptom Management

The patient reports that the cough and wheezing are more pronounced during the morning hours. This temporal pattern may suggest the presence of bronchial hyperreactivity or underlying inflammation. He also mentions alleviation of symptoms by sitting upright, which indicates possible postural effects on lung volumes and airways. Sitting up can improve diaphragmatic function and airway patency, which is crucial in managing dyspnea and wheezing (Parry et al., 2022).

The patient has lost significant weight, which may exacerbate his respiratory issues due to decreased muscle mass necessary for effective breathing. Additionally, the use of accessory muscles for breathing (sternocleidomastoid and scalene) indicates respiratory distress and should be addressed promptly.

Treatment Considerations

Despite the recommendations from his pulmonary specialist for additional medications, the patient appears reluctant to initiate new treatments. There are several management strategies that should be discussed:

• Inhaled corticosteroids (ICS) to reduce inflammation in the airways
• Long-acting beta-agonists (LABAs) for sustained bronchodilation
• Reviewing the patient's current use of Albuterol, ensuring he understands its role as a rescue inhaler
• Consideration of a smoking cessation program as quitting smoking may considerably improve lung function and overall health.
• Educating the patient on recognizing exacerbation symptoms and when to seek assistance.

Addressing Patient Concerns and Compliance

A collaborative approach to care is crucial. Since the patient has voiced his concerns about taking more medications, it is vital to address these feelings head-on. Discussing the potential benefits and risks of proposed treatments, as well as alternative strategies, may help the patient feel more engaged in his treatment plan (McGowan et al., 2021).

Regular follow-ups and continuous monitoring of his pulmonary status will be important given the exacerbation of his symptoms and concerns related to his health condition. Additionally, lifestyle modifications, including diet and pulmonary rehabilitation, could support weight maintenance and overall lung function improvement (Yogurtcu et al., 2020).

Conclusion

This 70-year-old male presents a complex case of asthma potentially complicated by COPD due to smoking. His symptoms, diagnostic results, and reluctance to pursue medication highlight the need for a patient-centered approach. Addressing his smoking, managing his asthma, and engaging him in his treatment plan must be prioritized. This multidisciplinary approach to care will help improve his quality of life and mitigate ongoing respiratory distress.

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). Global Strategy for the Diagnosis, Management, and Prevention of COPD. Available at: https://goldcopd.org
• McGowan, E. et al. (2021). Patient engagement in asthma management: a review of the literature. Journal of Asthma, 58(6), 633-640.
• Parry, A. et al. (2022). The impact of posture on lung function. Physical Therapy, 102(5), pzab006.
• Yogurtcu, R. et al. (2020). The role of diet in lung health. Journal of Nutrition in Clinical Medicine, 12(4), 221-229.
• National Heart, Lung, and Blood Institute. (2022). Asthma Management. Available at: https://www.nhlbi.nih.gov
• Fitzgibbon, F. et al. (2020). Managing chronic obstructive pulmonary disease: the role of the pharmacist. Pharmacy Practice, 18(1), 1773.
• Rabe, K. F. et al. (2018). Global strategy for the diagnosis, management, and prevention of asthma: the GINA pocket guide. Available at: https://ginasthma.org
• Gibson, P. G. et al. (2017). The role of secondary care in asthma management: a review. Thorax, 72(2), 151-158.
• GOLD, Global Initiative for Chronic Obstructive Lung Disease. (2021). Available at: https://goldcopd.org
• Verbeek, P. R. et al. (2019). Smoking cessation in COPD: The importance of best practice. Respiratory Medicine, 159, 105-111.