Chronic Obstructive Pulmonary Emphysema
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Some bugs also may occur together as primary entities or as secondary conditions to one another. Proper patient and disease management requires a comprehensive assessment of both objective and subjective clinical manifestation to come up with the correct diagnosis. Identification of patients disease is not only limited to primary diagnosis. Differential diagnosis has to be made since several diseases present with similar clinical symptoms. Differential diagnosis helps in preventing misdiagnosis and improper treatment. It, therefore, requires a proper assessment to identify the primary disease and make differential diagnoses for patients presenting with multiple signs and symptoms involving more than one system.

The patient mentioned above presents with both respiratory and cardiovascular symptoms. There is coughing, shortness of breath, sputum production, wheezing, increased anteroposterior diameter, flattened diaphragm, and increased blood pressure, history of smoking and peripheral vascular disease. To manage this patient properly, both primary and differential diagnosis has to be made based on the clinical presentation and diagnostic tests.

Differential Diagnosis

Chronic bronchitis

Chronic bronchitis is an inflammatory disease of the airways characterized by the presence of cough and production of sputum for over three months. Shortness of breath and increased respiratory rate are other primary characteristics of these conditions (Kim & Criner, 2015). It is common in children but also affects adults. Both the past and present history of smoking and pneumonia can lead to the development of bronchitis. The patient mentioned above in the case study presentation with a chronic cough, sputum production, shortness of breath, current history of smoking and history of pneumonia. With all these signs and symptoms, chronic bronchitis can be considered as one of differential diagnosis.

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Asthma is an upper respiratory condition that is characterized by acute shortness of breath due to the narrowed airway. The narrowing of the airway is either due to obstruction by foreign objects such as secretions or inflammation of the airway structures (Postma, Dirkje, & Klaus, 2015). A cough and sputum are present in a patient with asthma, and any trigger can result in an increased rate of respiration. The disease is most common with a patient with a history of smoking and other pathological conditions involving both respiratory and cardiovascular systems. For the above case study, there is shortness of breath, coughing and sputum production. Smoking has also been reported with a history of pneumonia and hypertension. Therefore, asthma should be considered as a diagnosis for this patient.

Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease is a disease defined by acute airway narrowing or total obstruction by either inflammation, different objective or secretions such as blood and mucus (Divo et al., 2015). The symptoms of this disease include chronic productive cough, shortness of breath, wheezing, prolonged respiratory phases, increased anteroposterior diameter and a higher rate of respiration (Bradstreet, & Parkman, 2016). History of smoking, respiratory conditions and cardiovascular disease increases the risk of developing this disease. The present case involves a patient with similar characteristics of the chronic obstructive respiratory condition and therefore should be considered during diagnosis.


Emphysema is a lower respiratory disease characterized by an abnormal enlargement, distention of the alveolar, and narrowing of the airway. This distention leads to increased dead space in the lungs reducing pulmonary capillary bed. This result in increased pulmonary blood supply, therefore, raising the blood pressure (Pahal & Sharma, 2018). Patients will have increased blood pressure, shortness of breath, cough and respiratory distress (Divo et al., 2015). The risk for alveolar impairment is increased by smoking and a history of respiratory disease. For the above patient, the signs of emphysema are present and therefore should be considered as one of the diagnosis.

Asthma-COPD Overlap Syndrome

This is a condition in which the symptoms of both asthma and COPD are present or overlapping. The symptoms include a cough, sputum production, tachypnea, apnea, and wheezing. The causes of these symptoms include infections, the presence of secretions in the airway or inflammatory obstruction due to an allergic reaction (Postma, Dirkje, & Klaus, 2015). Lifestyle practice such smoking can lead to these conditions. The present case has all the symptoms, and predisposing factors hence should be considered as one of the diagnosis.

Primary diagnosis

The primary diagnosis for the patient in the case study is emphysema. The characteristic symptom of this condition is damaged alveoli and narrowed airway resulting in impaired gaseous exchange in patients (Pahal & Sharma, 2018). Signs and effects of abnormal gaseous exchange are observed in patients such as shortness of breath, productive cough, increased respiratory rate, wheezing and respiratory distress (Bradstreet, & Parkman, 2016). Factors such as respiratory infections, and smoking increase the chance of one getting this disease (Tran et al., 2015). The presented case meets all the signs and symptoms of emphysema.

Diagnostic Tests

Diagnostic tests to confirm the presence of this condition include radiological and arterial blood gases. A chest X-ray is performed to visualize the patency of the airway and other pulmonary structures, and, to rule other chest conditions. (Hellbach et al., 2015). Arterial Blood Gases test are performed to measure the effectiveness of gaseous exchange in the lungs. Sputum analysis is done to identify the cause of pulmonary impairment. Pulmonary Function Test is done to assess the performance of the lungs.

Treatment and management

The goal of treating emphysema is to eliminate symptoms and prevent complications. Treatment involved both pharmacological and non-pharmacological approaches. The pharmacological approach includes the use of corticosteroid sand bronchodilators to clear secretions and prevent inflammations that cause airway narrowing (Pahal & Sharma, 2018). Antibiotics are also given to eliminate infectious agents from the respiratory system. Antihypertensive drugs are also provided to reduce elevated systolic blood pressure (Hillas, Perlikos, Tsiligianni, & Tzanakis, 2015). Non-pharmacological approaches are aimed at preventing the symptoms from progressing. They include suctioning of secretions if present. Advising the patient to quit smoking is also one of the methods of reducing the severity of the condition.