Case Study 1

Mr. A, a 60-year-old plumber, presents to the emergency department, complaining of shortness of breath. He has experienced mild dyspnea on exertion for a few years. However, he noticed recently that the dyspnea has worsened, with its onset on minimal exertion and sometimes at rest. On direct questioning, he reveals a chronic productive cough (of yellowish-brown sputum) every morning for the last few years. He denies chest pain, fever, chills, or peripheral edema. He has hyperlipidemia and hypertension on simvastatin and amlodipine. He has smoked 1 pack of cigarettes per day since the age of 20. He drinks 1 or 2 cans of beer every Saturday night. He has no other significant medical history or family history.

On physical examination, his blood pressure is 140/90 mmHg, heart rate is 95 beats per minute (with regular rhythm), respiratory rate is 29 breaths per minute and temperature is 37 degrees Celsius. He is sitting in a chair, leaning forward. He speaks in phrases with labored respirations and slightly cyanotic lips. His head and neck examination are unremarkable with normal jugular venous pressure. He is using accessory muscles of respiration and there are wheezes and rhonchi on both lungs on auscultation.

The anteroposterior diameter of the chest wall is noted to be increased with heart sounds appearing distant. There is no peripheral edema or cyanosis. He is admitted for inpatient treatment and is subsequently diagnosed to have a chronic lung condition, based on his post-bronchodilator spirometry value of FEV1 /FVC which is <0.70.

a. What is the MOST likely diagnosis of Mr. A’s condition?
b. Based on the case study, discuss the etiology, pathogenesis, clinical features, and complications of the diagnosis given in question a.
c. Explain the pharmacotherapy for acute exacerbation of this diagnosis with appropriate local drug examples.
d. Explain the maintenance pharmacotherapy of this diagnosis with appropriate local drug examples.