[Solved] A 68-year-old Medical Case Study 2

Part 1: Case Study

This patient shows typical chronic obstructive pulmonary disease (COPD) signs. COPD. This chronic condition is a treatable and preventable disease that challenges providers daily in practice. COPD is a significant cause of chronic morbidity and mortality in the US. It is the fourth leading cause of death globally (reference, 2017). The patient has had a cough for the last two months and has a significant smoking history of 40 years. Although nonsmokers can develop COPD, smoking is one of the main risk factors. Smoking causes airway changes and parenchymal destruction by exposure to noxious particles or gases.

In addition, the patient should be screened for prostate CA as he is 68 years old, and screening should start at age 50 per current recommendations. The patient shows possible signs of prostate abnormalities, such as frequent urination, but further studies should be ordered as this symptom could be associated with other conditions. Also, further assessment is necessary. Also, the patient should be assessed further for diabetes as well.

Differential Diagnosis

COPD

This is evidenced by cough for two months, a 40-year history of smoking ½ pack per day, and comorbidities including hypertensive disease. (Global Initiative for Chronic Obstructive Lung Disease, 2017)

Congestive Heart Failure

A cough evidences this for the last two months, urinary frequency, and a history of hypertension. (Global Initiative for Chronic Obstructive Lung Disease, 2017)

Benign prostatic hypertrophy (Mohler et al., 2019)

Diagnostic testing

Spirometry

• As this is the most reproducible and objective measurement of airflow limitation. It’s non-invasive and readily available. (Global Initiative for Chronic Obstructive Lung Disease, 2017).
• CBC, BMP, TSH, AIC, PSA (Mohler et al., 2019)

Treatment

• Smoking cessation
  • Depending on the FEV1 score on the spirometry will guide the provider in developing the right treatment plan. The step-up in inhaled treatment to LABA plus LAMA plus ICS can improve lung function and patient-reported outcomes. Breztri Aerosphere 2 inhalations (budesonide 160mcg/glycopyrrolate 9mcg/formoterol 4.8mcg) twice daily. This medication is questionable and may not be considered if the patient has renal impairment and in the event of prostatic hyperplasia.

Chronic illness Case Responses

You identify benign prostatic hyperplasia as a differential diagnosis for the patient. You cite that the condition causes irregularities in the lower urinary tract to cause symptoms such as difficulty initiating a urine stream, pain, and frequent urination. According to Fu et al. (2019), benign prostatic hyperplasia causes individuals to experience a frequent or urgent need to urinate, a weak urine stream or a stream that stops and starts, and a persistent inability to empty the bladder. While your claims regarding the clinical presentation of benign prostatic hyperplasia hold, the patient in the case present symptoms that indicate irregularities in his breathing system. Although he experiences a frequent need to urinate, his smoking history and symptoms presented necessitate a clinician’s focus on his breathing system.

References

UpToDate. (2021). Budesonide, glycopyrrolate, and formoterol: Drug information

Retrieved January 17, 2022, from https://www.uptodate.com/contents/budesonide-glycopyrrolate-and-formoterol-drug-information?search=inhaled+glucocorticoids&selectedTitle=1~144&usage_type=panel&display_rank=1&kp_tab=drug_general&source=panel_search_result#F54680162

Fu, J., Ye, J., & Cui, W. (2019). The Dice measure of cubic hesitant fuzzy sets and its initial evaluation method of benign prostatic hyperplasia symptoms. Scientific reports, 9(1), 1-8. https://www.nature.com/articles/s41598-018-37228-9

Global Initiative for Chronic Obstructive Lung disease. (2017) Pocket guide to COPD diagnosis, management, and prevention. GOLD. (2021, November 23). Retrieved January 17, 2022, from https://goldcopd.org/pocket-guide-copd-diagnosis-management-prevention-2016/

Mohler, J. L., Antonarakis, E. S., Armstrong, A. J., D’Amico, A. V., Davis, B. J., Dorff, T., Eastham, J. A., Enke, C. A., Farrington, T. A., Higano, C. S., Horwitz, E. M., Hurwitz, M., Ippolito, J. E., Kane, C. J., Kuettel, M. R., Lang, J. M., McKenney, J., Netto, G., Penson, D. F., … Freedman-Cass, D. A. (2019). Prostate cancer, version 2.2019, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 17(5), 479–505. https://doi.org/10.6004/jnccn.2019.0023