In this case, the patient probably has a degree of airflow obstruction in relation to his previous smoking history, which may indicate early COPD. This typically indicates a degree of airflow obstruction and is typically seen in patients with emphysema and spirometric evidence of airflow obstruction (FEV 1/FVC ≤70%). The flow–volume loop demonstrates concavity of the expiratory loop. Lung function tests were within normal limits for the patient's age, height and gender. It is important to note that prior work has demonstrated that up to 42% of patients with a normal chest radiograph will have abnormalities on CT of the thorax. This is particularly relevant in smokers. However, CT imaging is important to exclude other serious pathologies, including malignancy, bronchiectasis, interstitial lung disease and emphysema, that may coexist. The majority (71%) of patients with productive chronic cough in real world data from our clinic have normal CT imaging. In view of the history of haemoptysis, particularly in a former smoker, he underwent a computed tomography (CT) of the thorax, lung function and bronchoscopy ( figures 1, ,2, 2, tables tables1, 1, ,2 2).ĭ. He underwent a laryngoscopy which revealed heightened laryngeal sensitivity, but no evidence of nasal disease, subglottic oedema or hyperaemia which would suggest ongoing reflux. His chest was clear, and he had no peripheral stigmata of lung disease. On examination, his body mass index (BMI) was 31 kg His reflux symptoms were well controlled. His past medical history included depression and gastro-oesophageal reflux disease for which he took mirtazapine 30 mg once daily and omeprazole 20 mg once daily. He had also trialled high-dose proton-pump inhibitor therapy (omeprazole 40 mg twice daily) with regular Gaviscon advance, which did not ameliorate his cough symptoms. He had previously trialled inhaled and oral corticosteroids, and inhaled nasal steroids, none of which had any impact on his cough. He reported a sensation of burning in his throat, which preceded coughing bouts. He had no concomitant symptoms of breathless, wheeze or chest infections. His subjective cough severity score was 8/10, where 0 is no cough and 10 is the worst possible cough. He reported expectorating an egg cupful of white sputum per day with occasional streaks of haemoptysis. He had a smoking history of 60 pack-years and reported his cough began when he stopped smoking. A 54-year-old male with an 8-year history of productive cough was referred to the tertiary cough clinic.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |