CASE STUDY SCENARIO Julie is a 52yearold female who has come

CASE STUDY SCENARIO

Julie is a 52-year-old female who has come to a local walk-in clinic to discuss her COPD and specifically the problem she is having with exacerbations and time ‘off sick’. She is a heavy smoker, and her progressively deteriorating lung function suggests that she has moderate COPD, although she also has a history of childhood asthma, and had allergic rhinitis as a teenager.

She has a sedentary office job and, although she is breathless on exertion, this generally does not interfere with her lifestyle. The relatively frequent exacerbations are more troublesome. They are usually triggered by an upper respiratory infection and can take a couple of weeks to recover. She has had three exacerbations this winter, and as a result her employer is not happy with her sickness absence record and has asked her to seek advice from her general practitioner.

Julie is on a short-acting 2-agonist, although she rarely uses it except during exacerbations. In the past, she has used an inhaled steroid, but stopped that some time ago as she was not convinced it was helping.

While auscultating Julie’s lungs, the nurse hears expiratory wheezes throughout. Her vital signs are as follows: blood pressure 110/82; pulse 116; respiratory rate 39; oxygen saturation on room air is 88%. Recent spirometry showed a typical COPD flow-volume loop, although she had some reversibility (250ml and 20%) with a post-bronchodilator FEV1 of 60% predicted.

Question:

1.            What are some of the questions that you might ask Julie, when gathering a health history, to get a better sense of what triggered Julie’s frequent exacerbations? Explain your answer. Indicate your answer with References, references must be in Canada. references.

Solution

1). To get the health history of Julie, the physician would likely to ask the following questions:

a). The frequency of asthma attacks

b). Incidents when she probably suffer from asthma attack

c). Ask the patient to list her regular activities, foods she take and the incidents of asthma attacks

Reference: http://www.atsjournals.org/doi/abs/10.1164/rccm.200906-0896oc