A 60-year-old Caucasian male presents to your office because of recent onset dyspnea on exertion. He is physically active, but his dyspnea now restricts his physical activities. He can hardly climb a flight of stairs without having to stop to rest. He denies any chest pain, palpitations, leg swelling and loss of consciousness. He has frequent coughing, sometimes with yellowish or greenish sputum. He has been smoking one-and-half to two packs of cigarettes daily for the last 35 years. He does not consume alcohol. He is currently not taking any medications. The physical examination is significant for bilateral scattered expiratory wheezes. Pulmonary function testing shows the following findings (as percentage of predicted values): His airway response to bronchodilators is poor. What is the best indicator of this patient's poor prognosis?

Question

A 60-year-old Caucasian male presents to your office because of recent onset dyspnea on exertion.  He is physically active, but his dyspnea now restricts his physical activities.  He can hardly climb a flight of stairs without having to stop to rest.  He denies any chest pain, palpitations, leg swelling and loss of consciousness.  He has frequent coughing, sometimes with yellowish or greenish sputum.  He has been smoking one-and-half to two packs of cigarettes daily for the last 35 years.  He does not consume alcohol.  He is currently not taking any medications.  The physical examination is significant for bilateral scattered expiratory wheezes.  Pulmonary function testing shows the following findings (as percentage of predicted values):  His airway response to bronchodilators is poor.  What is the best indicator of this patient's poor prognosis?

Quizplus · Accepted Answer

Explanation: This patient has manifestations of advanced chronic obstructive pulmonary disease (COPD). A FEV1 below 40% of predicted indicates severe obstruction. The prognosis of patients with COPD varies with each individual. The two most important predictors of survival are FEV1 and age. After adjusting for age, FEV1 remains as the single most important factor in determining the prognosis. (Choices B, C and D)Other prognostic indicators described in several studies are airway responsiveness, cigarette smoking, decreased exercise capacity, decreased BMI, airway bacterial load and HIV status. (Choice E)Although increased residual volume is characteristic for COPD, it has little prognostic value. Educational Objective: After adjusting for age, FEV1 remains as the single most important factor in determining the prognosis of patients with COPD.

A 60-Year-Old Caucasian Male Presents to Your Office Because of Recent