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Clinical Crossroads
Clinician's Corner
November 26, 2003

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

Author Affiliations

Author Affiliation: Dr Celli is Professor of Medicine, Tufts University, and Chief, Pulmonary and Critical Care Medicine, Caritas St Elizabeth's Medical Center, Boston, Mass.

 

Clinical Crossroads Section Editor: Margaret A. Winker, MD, Deputy Editor.

JAMA. 2003;290(20):2721-2729. doi:10.1001/jama.290.20.2721

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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