What additional information do you need to appropriately treat this patient (such as clinical findings, laboratory test results, etc.)?
.A., a 51-year old white female smoker, presents with a daily cough and mild dyspnea on exertion with strenuous activity. She had noticed that walking up two flights of stairs bothers her when previously it did not. She has had a slight amount of worsening wheezing despite using an albuterol inhaler on an as-needed basis. She denies chest pain. She has no know chronic medical problems. She has smoked 1.5 packs/day for 34 years, and she continues to smoke that amount. Her physical examination reveals mild wheezing. A CXR is unremarkable. Office spirometry demonstrates an FEV1/FVC ratio of 0.54 and an absolute FEV1 of 2.0L or 60% of predicted. Postbronchodilator treatment demonstrated an FEV1 increase of 100 mL, a 5% increase. QUESTIONS: 1) What additional information do you need to appropriately treat this patient (such as clinical findings, laboratory test results, etc.)? 2) Using the GOLD criteria, what T.A’s stage of COPD? 3) What would other diagnostic tests be necessary before initiating therapy? 4) What should therapeutic interventions be recommended at this point?
