BOF: 14
A 54-year-old male has a
longstanding cough productive of sputum and breathlessness on exertion. The
breathlessness increases following upper respiratory tract infections. He has
been smoking 20 cigarettes a day over a period of 30 years.
On examination, there is no clubbing the patient is breathless with use of
accessory muscles and resting activation of the abdominal muscles. The chest is
barrel shaped and cardiac dullness is reduced. Breath sounds are reduced on
auscultation and a few rhonchi are audible.
In your assessment of the patient which one of the following is known to be a
predictor of mortality?
a) The degree of breathlessness
b) The presence of pursed lip breathing
c) The body mass index (BMI)
d) Spirometry
e) Blood gas analysis
Answer:
c)
The patient has chronic
obstructive pulmonary disease.
A low body mass index is a known predictor of mortality in patients with chronic
obstructive pulmonary disease.
A change in BMI with treatment suggests a better prognosis.
Ankle swelling is also an important prognostic feature.
This is because ankle swelling suggests the development of right ventricular
failure.
