Case #30

Shou Ling Leong, M.D.
Assistant Professor
Department of Family & Community Medicine
Penn State University College of Medicine

Acknowledgements:

• The Pulmonary Testing Lab at the Milton S. Hershey Medical Center for sample Pulmonary Function Reports.
• Dr. Hartman, Department of Radiology, Penn State College of Medicine for radiology images.
• Dr. Frauenhoffer and the Department of Pathology, Penn State College of Medicine for pathology images.

Learning Objectives:

Upon completion of this case, the student should have learned to:

1. Develop a differential diagnosis for dyspnea and be able to refine the differential based upon a patient’s history and physical exam.
2. Understand the spirometry differences between obstructive and restrictive lung disease.
3. Understand the pharmacologic and nonpharmacologic treatment options for COPD.
4. Understand the etiology and epidemiology of COPD, including relationship between cigarette smoking and COPD and alpha-1-antitrypsin deficiency.
5. Be able to discuss the typical presentation and course of COPD.

References:

1. American Academy of Family Physicians. Chronic Obstructive Pulmonary Disease (COPD). July 2006. Available at http://familydoctor.org/706.xml
2. American Lung Association. Chronic Obstructive Pulmonary Disease (COPD) Fact Sheet (Chronic Bronchitis and Emphysema). July 2007. Available at http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35020
3. American Lung Association. Confronting COPD in America: Executive Summary. February 2001. Available at http://www.lungusa.org/atf/cf/{7A8D42C2-FCCA-4604-8ADE-7F5D5E762256}/EXESUM.PDF
4. Anthonisen, Nicholas R MD; Skeans, Melissa A MS; Wise, Robert A MA; Manfreda, Jure MD; Kanner, Richard E MD; Connett, John E PhD. The effect of a smoking cessation intervention on 14.5 year mortality. Ann Intern Med. 142(4): 233-239. February 15, 2007. Available at http://www.annals.org/cgi/content/full/142/4/233
5. Bowes, Mark PhD; Abercrombie, Stoney MD; Donohue, James F MD; Michels, Dale E MD D-ABFP; Guzman, Susanna E. AAFP Video CME Program: Management of COPD: An Update. Available at http://www.aafp.org/PreBuilt/videocme/copdupdate_mono.pdf
6. Evans, Scott E. MD; Scanlon, Paul D. MD Current Practice in Pulmonary Function Testing. Mayo Clinic Proceedings. 78(6):758-763, June 2003.
7. Global Initiative for Chronic Obstructive Lung Disease. Pocket Guide to COPD Diagnosis, Management, and Prevention. 2006. Available at http://www.goldcopd.org
8. Gross, Thomas. Interpretation of Pulmonary Function Tests: Spirometry. University of Iowa Virtual Hospital. June 2002. Available at http://www.vh.org/adult/provider/internalmedicine/Spirometry/SpirometryHome.html
9. Hunter, Melissa H. MD; King, Dana E. MD. COPD: Management of Acute Exacerbations and Chronic Stable Disease. American Family Physician. 64(4): 603-612. August 15, 2001. Available at http://www.aafp.org/afp/20010815/603.html
10. Madison, J Mark; Irwin, Richard S. Chronic Obstructive Pulmonary Disease. The Lancet. 352:467-473. August 8, 1998.
11. Man, S. F. Paul MD; McAlister, Finlay A. MD, MSc; Anthonisen, Nick R. MD, PhD; Sin, Don D. MD, MPH Contemporary Management of Chronic Obstructive Pulmonary Disease: Clinical Applications. JAMA. 290(17):2313-2316, November 5, 2003.
12. Mannino, David M MD; McGonigle, Kathryn Marie. COPD in the Never Smoker. Pulmonary and Critical Care Update. 2003. Available at http://www.chestnet.org/education/online/pccu/vol16/lessons23_24/lesson23/print.php
13. Martinez, Fernando J. Diagnosing chronic obstructive pulmonary disease: The importance of differentiating asthma, emphysema, and chronic bronchitis. Postgraduate Medicine. 103(4):112-25. April 1998.
14. Morgan, Walter C MD; Hodge, Heidi L MD. Diagnostic Evaluation of Dyspnea. American Family Physician. 57(4):711-718, February 15, 1998. Available at http://ww.aafp.org/afp/980215ap/morgan.html
15. National Heart, Lung, and Blood Institute. Chronic Obstructive Pulmonary Disease: Data Fact Sheet. March 2003. Available at http://www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf
16. Pamet, Sharon MS; Lynm, Cassio MA; Glass, Richard M MD. JAMA patient page. Chronic Obstructive Pulmonary Disease. JAMA. 290(17): 2362. November 5, 2003. Available at http://jama.ama-assn.org/cgi/content/full/290/17/2362
17. Pride, N B Smoking cessation: effects on symptoms, spirometry and future trends in COPD. Thorax. 56 Supplement II:ii7-ii10, September 1, 2001.
18. Seidel, Henry M; Ball, Jane W; Dains, Joyce E; Benedict, G William. 2003. Mosby’s Guide to Physical Examination. 5th Edition. Mosby, St. Louis. Chapter 12.
19. Sutherland, E. Rand; Cherniack, Reuben M. Current Concepts: Management of Chronic Obstructive Pulmonary Disease. New England Journal of Medicine. 350(26):2689-2697, June 24, 2006.
20. Yunis, Nidal A; Crausman, Robert S. Cor pulmonale. eMedicine. November 18, 2006. Available at http://www.emedicine.com/med/topic449.htm

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