Chronic Bronchitis
Subjective
The patient mentions a regular cough with sputum production, especially in the morning. He also notes that he has been a smoker for 20 years. According to the information provided, the cough is exacerbated during seasonal illnesses, and difficulty in breathing is a common symptom. The patient notes the absence of common allergic reactions and blood in the sputum, although, according to him, severe coughing spells sometimes cause nausea.
Objective
According to the results of the X-ray examination, the patient does not have pneumonia or chronic obstructive pulmonary disease. To assess respiratory failure, blood gases and acid-base status have been checked. To determine the activity of the inflammatory process, a clinical blood test has been carried out to assess the possibility of developing pulmonary insufficiency. Sputum testing has also been performed to identify potential cough pathogens.
Assessment
Based on the clinical analysis and evaluation of laboratory tests, chronic bronchitis is considered the primary diagnosis. The assessment of the leukocyte formula proves a stable inflammatory process in the bronchi, and the aggravation of the problem during seasonal infections is due to increased pressure on the immune system. Initially, chronic asthma was considered a differential diagnosis, but there is no evidence of small airway involvement.
Plan
Particular emphasis should be placed on respiratory care to reduce the burden on the respiratory system. In addition to the strong advice to quit smoking, the patient should be offered guaifenesin formulations. According to Ohar et al. (2019), such drugs “help loosen phlegm (mucus) and thin bronchial secretions in patients” (p. 341). Compliance with household hygiene standards (the ventilation of premises, personal protective equipment, and proper nutrition) is also recommended as self-care principles.
Emphysema
Subjective
The patient’s complaints relate to a strong cough with slight sputum production, especially after physical exertion. She confirms a long history of smoking (about 15 years) and notes that she sometimes experiences shortness of breath at night, accompanied by excessive sweating. The patient denies recent travel to countries with a high risk of respiratory infections. In her family history, there were no relatives with tuberculosis or asthma.
Objective
To make an accurate diagnosis, an X-ray examination has been taken. Another laboratory test is spirometry, which allows for clarifying the volume of inhaled and exhaled air. A clinical blood test has been performed to assess the presence of an inflammatory process in the body, as well as its intensity. Additional laboratory tests have been conducted to evaluate the condition of the internal organs, namely the heart and liver, to exclude concomitant diagnoses.
Assessment
Based on the results of the clinical tests performed, emphysema is the primary diagnosis for the patient due to impaired gas exchange and pathological expansion of the air spaces of the alveoli. The evaluation of the state of the airways shows insufficient bronchial patency and respiratory failure. Chronic bronchitis could theoretically be considered a differential diagnosis if it were not for pathological changes in the alveolar structure of the bronchi.
Plan
To treat the patient’s problem, she should be prescribed remedies to eliminate respiratory failure and restore bronchial patency. As a targeted drug, Prolastin can be used as a potent inhibitor because, as Seyama et al. (2022) state, it is well tolerated and safe. Quitting smoking is a mandatory recommendation for the patient. In addition, she should pay more attention to self-care to control coughing attacks, for instance, avoid physical activity during treatment and observe household hygiene carefully.
References
Ohar, J. A., Donohue, J. F., & Spangenthal, S. (2019). The role of guaifenesin in the management of chronic mucus hypersecretion associated with stable chronic bronchitis: A comprehensive review. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 6(4), 341-349.
Seyama, K., Suzuki, M., Tasaka, S., Nukiwa, T., Sato, T., Konno, S., Sorrells, S., Chen, J., Aragonés, M. E., & Minamino, H. (2022). Long-term safety of Prolastin®-C, an alpha1-proteinase inhibitor, in Japanese patients with alpha1-antitrypsin deficiency. Respiratory Investigation, 1-9.