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A 52 year old man presents to your office for an acute visit because of
coughing and shortness of breath.He is well known to you because of multiple
office visits in the past few years for similar reasons.He has a chronic
“smoker’s cough”,but reports that in the past 2 days his cough has
increased,his sputum has changed from white to green in color,and he has
had to increase the frequency with which he uses his albuterol inhaler.He
denies having a fever,chest pain,peripheral edema,or other symptoms.His
medical history is significant for hypertension,peripheral vascular disease,and
2 hospitalizations for pneumonia in the past 5 years.He has a 60 pack year
history of smoking and continues to smoke 2 packs of cigarettes a day.
Normal spirometry
I: Mild COPD
FEV1/FVC ‹ 70%
FEV1/FVC ‹ 70%
FEV1/FVC ‹ 70%
FEV1 ‹ 30% predicted or FEV1 ‹ 50% predicted plus respiratory failure or clinical
signs of right heart failure
GOLD, Global Initiative for Chronic Obstructive Lung Disease; COPD, chronic
obstructive pulmonary disease; FEV1, forced expiratory volume in one second;
FVC, forced vital capacity; respiratory failure, arterial partial pressure of oxygen ‹
60 mm Hg with or without arterial partial pressure of carbon dioxide greater than
or equal to 50 mm Hg while breathing air at sea level.