50 year old overweight patient with severe dyspnea

A 50 year old man comes to your clinic with complaints of severe dyspnea associated with fever. History reveals that he is a chronic smoker for 30 years and has productive cough for several years. Physical examination reveals an enlarged chest diameter, generalized edematous state, overweight and cyanotic lips. Radiological findings show a long and narrow heart, hyperlucent lung fields with evident hyperinflation, and no infiltrates.

Diagnosis: COPD (Chronic Obstructive Pulmonary Disease)
  • COPD is commonly caused by inhalation of cigarette smoking; can be hereditary due to alpha-antitrypsin deficiency
  • Blue bloater
  1. Chronic bronchitis
  2. Overweight
  3. Edematous
  4. Cyanotic
  • Chronic bronchitis involves hypersecretion of mucus and enlarged submucous glands of the large airways, causing chronic productive cough.
  • Histology reveals mucus plugging of the bronchioles, pigmented alveolar macrophages, and fibrosis of the bronchiolar wall.
  • Spirometry and flow volume loops help to identify the type of lung disease (Restrictive Vs. Obstructive).
  • Manage the patient with bronchodilators by hand-held nebulizers, glucocorticoids and antibiotics (if there is an underlying respiratory infection). Controlled oxygen administration with nasal oxygen can help correct hypoxemia and reduce mortality.
  • Patients should also be advice to get pneumococcal immunization and annual influenza vaccination.
Things to rule out in Differential Diagnosis:
  1. Bronchiectasis
  2. Bronchitis
  3. Emphysema
  4. Chronic asthma