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) < 80% predicted and the ratio between Forced Expiratory Volume 1 (FEC1) and Forced Vital Capacity (FVC) < 0.60.  Symptom severity is 8 out of 10.

Introduction:

This case study examines the medical history and symptoms of a 70-year-old male patient presenting with cough and wheezing. The patient has a long-standing diagnosis of asthma and is currently using Albuterol as a medication. However, over the past year, the patient reports worsening symptoms, increased inhaler use, and a decline in overall health. The patient also has a history of smoking, multiple lung infections, and recent weight loss. The purpose of this analysis is to evaluate the possible causes of the patient’s symptoms and discuss potential treatment options based on the available information.

Discussion:

The patient’s long-standing diagnosis of asthma suggests that his current symptoms of cough and wheezing may be related to this condition. Asthma is a chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, coughing, shortness of breath, and chest tightness. It is often triggered by allergens, air pollution, exercise, or respiratory infections (Global Initiative for Asthma, 2020). In this case, the patient’s symptoms have worsened over the past year, indicating a decline in asthma control.

Several factors may be contributing to the worsening of the patient’s symptoms. Firstly, his smoking history is a significant risk factor for the development and progression of respiratory diseases, including asthma (Global Initiative for Chronic Obstructive Lung Disease, 2020). Smoking can cause acute bronchospasm, airway inflammation, and damage to the cilia that line the respiratory tract, impairing mucociliary clearance and leading to increased susceptibility to respiratory infections (Rabe et al., 2020). The patient’s 40-pack year history of smoking suggests that his respiratory symptoms may be exacerbated by ongoing smoking.

Furthermore, the patient reports a history of multiple lung infections over the past 10 years. Recurrent respiratory infections can lead to chronic bronchitis, a condition characterized by persistent cough and sputum production. Chronic bronchitis is often associated with airflow obstruction and can coexist with asthma, leading to a more severe disease phenotype known as asthma-COPD overlap syndrome (ACOS) (Miravitlles et al., 2017). The patient’s symptoms of cough and wheezing, along with his history of recurrent infections, may indicate the presence of ACOS in addition to his underlying asthma.

The patient’s recent weight loss of 20 pounds over the past year raises concerns about his overall health status. Unintentional weight loss can be a significant sign of systemic illness and may point towards a more serious underlying condition. In the context of respiratory symptoms, unintentional weight loss can be associated with increased metabolic demands due to chronic inflammation or an increased energy expenditure from respiratory effort (Nemoto et al., 2020). Additional investigation and evaluation are warranted to determine the exact cause of the weight loss and its potential impact on the patient’s respiratory symptoms.

The patient’s use of accessory respiratory muscles, such as the sternocleidomastoid (SCM), scalene, and trapezius, during breathing is indicative of increased work of breathing and respiratory muscle fatigue. This suggests that the patient may be experiencing significant airflow obstruction, which can be assessed further through spirometry testing. The pulmonary specialist’s findings of a Forced Expiratory Volume in 1 second (FEV1) less than 80% predicted and a FEV1/FVC ratio less than 0.60 support the presence of airflow limitation (Miller et al., 2005).

The severity of the patient’s symptoms, rated as 8 out of 10, indicates a significant impact on his daily life and highlights the urgent need for appropriate treatment. As the patient’s condition has worsened despite current medication use, it is crucial to reevaluate his treatment plan and consider additional interventions to improve symptom control and overall lung function.

Conclusion:

In summary, this case study examines a 70-year-old male patient with a long-standing diagnosis of asthma who presents with worsening symptoms of cough and wheezing. The patient’s history of smoking, recurrent lung infections, recent weight loss, and use of accessory respiratory muscles suggest a complex interplay of factors contributing to his current condition. The severity of his symptoms and abnormal spirometry findings indicate a need for a comprehensive assessment and adjustment of his treatment plan. The next steps in managing the patient’s condition will involve a multidisciplinary approach, including smoking cessation, optimization of asthma therapy, evaluation for ACOS, and further investigation into the cause of weight loss.