Regular production of sputum for 3 or more months in

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Regular production of sputum for 3 or more months in 2 consecutive years § In absence of other conditions that explain it § Presence of purulent sputum reflects an increase in inflammatory mediators
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Additional Features in Severe Disease § Fatigue § Weight loss § Anorexia § Cough syncope § Depression § Anxiety
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“I’m having a hard time working in the field. I have to take breaks every 30 minutes or so because it’s hard to breathe.” § HPI: ML is a 58 y/o HM with an unknown medical history. He is a migrant worker and will occasionally receive acute care at free clinics wherever he may be working; he has no records. ML notes that he has had some limitations due to difficulty breathing for many years. He has not been able to play soccer for some time but it never significantly impacted his ability to work until this summer where he has to take a break every 30 minutes or so. He is upset because he gets SOB when hurrying to keep up with the other workers. He denies any CP, nausea, diaphoresis, or SOB at rest. Rest alleviates the dyspnea. He reports that has had daily chronic cough for 25 years with sputum. § SH: Smoker 60 year pack history (1.5 ppd x 40 yrs); ROS: + SOB, + DOE, + productive cough PE: Parameter Predicted Actual Percent Predicted (%) FEV1 (L) 3.14 2.0 64 FVC (L) 4.14 3.0 72.5 FEV1/FVC (%) 77.3 66.7 86
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Aspects of disease that need to be assessed § NEEDS TO BE MULTIFACTORIAL § Symptoms § Degree of airflow limitation § Risk of exacerbation § Comorbidities
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Assessing Symptoms § Two tools § COPD Assessment Test § Broader coverage of the impact of COPD on daily life and well-being § Modified British Medical Research Council (mMRC) § Assesses disability due to breathlessness
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“I’m having a hard time working in the field. I have to take breaks every 30 minutes or so because it’s hard to breathe.” § HPI: ML is a 58 y/o HM with an unknown medical history. He is a migrant worker and will occasionally receive acute care at free clinics wherever he may be working; he has no records. ML notes that he has had some limitations due to difficulty breathing for many years. He has not been able to play soccer for some time but it never significantly impacted his ability to work until this summer where he has to take a break every 30 minutes or so. He is upset because he gets SOB when hurrying to keep up with the other workers. He denies any CP, nausea, diaphoresis, or SOB at rest. Rest alleviates the dyspnea. He reports that has had daily chronic cough for 25 years with sputum. § SH: Smoker 60 year pack history (1.5 ppd x 40 yrs); ROS: + SOB, + DOE, + productive cough PE: Parameter Predicted Actual Percent Predicted (%) FEV1 (L) 3.14 2.0 64 FVC (L) 4.14 3.0 72.5 FEV1/FVC (%) 77.3 66.7 86
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Assessing Severity of Airflow Limitation § Based on Post – Bronchodilator FEV1 GOLD 1 Mild FEV1 ≥ 80% predicted GOLD 2 Moderate 50% ≤ FEV1 < 80% predicted GOLD 3 Severe 30% ≤ FEV1 < 50% predicted GOLD 4 Very Severe FEV1 < 30% predicted
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“I’m having a hard time working in the field. I have to take breaks every 30 minutes or so because it’s hard to breathe.” § HPI: ML is a 58 y/o HM with an unknown medical history. He is a migrant worker and will occasionally receive acute care at free clinics wherever he may be working; he has no records. ML notes that he has had some limitations due to difficulty breathing for many years.
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  • Fall '12
  • lipsh
  • Chronic cough, Chronic obstructive pulmonary disease, cough, Alpha 1-antitrypsin deficiency, daily chronic cough

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