1. A 55-Year-Old Woman With Frequent Pulmonary Exacerbations and Endobronchial Lesions
- Author
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Meghan Koch, Robert W. Baird, Tiana R. Endicott-Yazdani, Alastair J. Moore, and Ariel M. Modrykamien
- Subjects
Pulmonary and Respiratory Medicine ,Budesonide ,medicine.medical_specialty ,Exacerbation ,Critical Care and Intensive Care Medicine ,Pulmonary function testing ,03 medical and health sciences ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Asthma ,COPD ,business.industry ,Bronchial Neoplasms ,Tiotropium bromide ,Middle Aged ,medicine.disease ,respiratory tract diseases ,Dyspnea ,030228 respiratory system ,Granular Cell Tumor ,Heart failure ,Female ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business ,medicine.drug - Abstract
A 55-year-old woman with COPD, heart failure with preserved ejection fraction (congestive heart failure), diabetes mellitus, and hypertension presented with baseline dyspnea at rest that had worsened over the last week. She reported associated runny nose, congestion, and cough productive of green sputum. She smoked six cigarettes per day and denied alcohol, drugs, or occupational exposure. She was admitted and initiated on treatment for acute exacerbation of COPD; however, her condition did not improve with steroid, ceftriaxone, and nebulized albuterol and budesonide treatments. She had been diagnosed with asthma and COPD without ever undergoing pulmonary function testing. She presented 11 times to the ED with six hospital admissions in the last 1.5 years for worsening dyspnea at rest, wheezing, and lower extremity edema deemed secondary to exacerbation of her COPD or congestive heart failure. She reported medication compliance, which included fluticasone-vilanterol, tiotropium bromide, and furosemide. She repeatedly demonstrated mild vascular congestion on imaging without hyperinflation, a normal to mildly elevated brain natriuretic peptide (10 to 200 pg/mL), and dyspnea without hypoxia. She was treated normally for both COPD and congestive heart failure exacerbations simultaneously with methylprednisolone, albuterol, and furosemide with rapid improvement over the course of 1 to 2 days. No significant improvement was noted with steroid therapy, despite receiving them as an inpatient and outpatient. At the time of discharge, her symptoms would be at her baseline.
- Published
- 2020