CHEST CLINICAL COPD & ASTHMA IMMERSION PROGRAM - AUGUST 14, 2024-Asthma COPD Overlap PBL

Asthma COPD Overlap PBL
Pdf Summary
**Problem-Based Learning Exercise 1: Asthma & COPD Diagnosis**<br /><br />### Learning Objectives:<br />- Identify key information from patient history to diagnose asthma or COPD.<br />- Discuss the distinguishing features between asthma and COPD.<br /><br />**Patient Overview:**<br />Susan, a 49-year-old woman with a history of allergic rhinitis and childhood asthma, presents with worsening dyspnea and wheezing. <br /><br />### **Initial Considerations:**<br />Susan recalls being asymptomatic two years ago. Further inquiry about her current symptoms might include:<br />- Duration and frequency of dyspnea and wheezing.<br />- Triggers for symptoms.<br />- Impact on daily activities and physical exertion.<br /><br />### **Initial Diagnosis Considered:**<br />Given her history, both asthma and COPD are potential diagnoses.<br /><br />**Current Lifestyle:**<br />- Lives in a 2-story home; feels tired after climbing stairs.<br />- Has had 3 urgent care visits in the past 4 months for shortness of breath.<br />- Prescribed inhaled steroids and albuterol with mild improvement.<br />- Good and bad symptom days.<br />- Experiences chest tightness but no chest pain or fainting.<br />- Stays at home and is not currently working.<br /><br />### **Family and Social History Inquiries:**<br />- Confirm smoking history.<br />- Explore family history of asthma or COPD.<br />- Assess environmental exposures that could exacerbate symptoms.<br /> <br />### **Further Considerations:**<br />- Reports 20 years of smoking (1 pack/day), now reduced to 10-15 cigarettes/day.<br />- Family history: mother and sister have asthma.<br />- Personal history of difficult-to-control allergic rhinitis and eczema.<br />- No pets.<br />- Tiotropium (LAMA) provided symptom improvement but had another exacerbation requiring ER visit.<br /><br />### **Revised Diagnosis:**<br />- Given the smoking history, persistent symptoms despite treatment, and family history, COPD becomes a stronger consideration.<br />- However, the history of allergic conditions and asthma make Asthma-COPD Overlap Syndrome (ACOS) a probable diagnosis.<br /><br />### **Conclusion:**<br />**Most Likely Diagnosis:**<br />1. Asthma<br />2. COPD<br />3. **Asthma-COPD Overlap (ACOS)**<br />4. Asthma mimicking diagnosis<br /><br />Susan's history of smoking, combined with her asthma and allergic symptoms, points towards Asthma-COPD Overlap Syndrome. Further diagnostic tests such as spirometry could support this diagnosis.
Keywords
Asthma
COPD
Asthma-COPD Overlap Syndrome
dyspnea
wheezing
smoking history
allergic rhinitis
spirometry
inhaled steroids
tiotropium