Description

J.C. is a 66 y.o. W.M. who presents with complaints of worsening SOB and cough. Onset of symptoms approximately 10 years ago but becoming progressively worse in the last 5 years. PMH pertinent for HTN, D.M. (controlled), and Seasonal allergies. He is a 40-pack-year former smoker with a known occupational history of asbestos exposure. He reports associated symptoms of wheezing, persistent productive cough (thick white sputum) that is worse at night, bilateral pedal edema, increased fatigue, and worsening exertional dyspnea. States his SOB is now impacting his functional ability and QOL. He denies C.P., palpitations, syncope, dizziness, numbness, recent illness, and exposure to sick contact. No recent travel. Denies fever/ chills, H.A., numbness/ tingling, and GI/GU symptoms. Patient is afebrile on arrival with O2 sats 94% on R.A. at rest. B.P. elevated. Exam reveals increased work of breathing with accessory muscle use and persistent cough. No hyperresonance or evidence of hyperinflation or clubbing is noted, but he exhibits BLL wheezing and diffuse crackles. HR regular with Mitral valve regurgitation noted on auscultation. There is a family hx significant for heart disease, his brother is deceased from CA.