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Clinical Crossroads | Clinician's Corner

A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease

Bartolome R. Celli, MD, Discussant
JAMA. 2003;290(20):2721-2729. doi:10.1001/jama.290.20.2721.
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DR REYNOLDS: Mrs D is a 62-year-old woman with advanced chronic obstructive pulmonary disease (COPD). Mrs D is a widow and lives with one of her 7 children. She has Medicare and Medicaid insurance.

Mrs D was well until she began experiencing shortness of breath in her early 40s, when she was a heavy smoker. By her mid 40s, she was diagnosed as having COPD and was already receiving oxygen by nasal cannula. Over the ensuing 2 decades, her pulmonary disease worsened steadily. She now has severe COPD and uses oxygen, 4 L by nasal cannula, around the clock. Her activities are limited by her severe dyspnea on exertion. She has frequent exacerbations, often induced by upper respiratory tract infections. She has been hospitalized more than 20 times in the past 5 years; she has been intubated twice.

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Figure 1. Recommended Treatments for Chronic Obstructive Pulmonary Disease (COPD)
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Figure 2. Algorithm Describing Treatment Pathways for Patients With Chronic Obstructive Pulmonary Disease (COPD) Presenting With an Exacerbation
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FEV1 indicates forced expiratory volume in 1 second; PaCO2, arterial carbon dioxide partial pressure.

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