A 63-year-old self-employed plumber makes a same-day appointment for another ‘chest infection’. Case history He caught an upper respiratory tract infection from his grandchildren 10 days ago. Currently has a productive cough with green sputum, along with the breathlessness and fatigue. A diagnosis of chronic obstructive pulmonary disease (COPD) was confirmed 6 years ago, and he was started on a short-acting β2-agonist, symptoms subsided. Recently breathlessness has increased.
Recovering from exacerbations takes longer than it used to—often 2 weeks. He last attended a COPD review 6 months ago, when his FEV1 was 52% predicted. He was advised to stop smoking and given a prescription for varenicline, but he relapsed after a few days and did not return for the follow-up appointment. He attends each year for his ‘flu vaccination’. His only other medication is an ACE inhibitor for…
