A 60-year-old woman with a 3-year history of diabetes presented with worsening dyspnea and cough. She has had a chronic obstructive pulmonary disease (COPD) since age 55. She now has dyspnea with walking one-third of a block and a persistent cough. Her type 2 diabetes has been managed with diet and exercise. Her last glycosylated haemoglobin measured 1 month ago was 6.8% (normal 4–6%). Physical exam Blood pressure 130/70 mmHg, Pulse 120 Respiratory rate 24 Weight 180 lb Lungs are clear to percussion, but wheezing is present bilaterally.
No accessory muscles are being used No cyanosis is present. Lab reports: ABG: 7.46; pO2: 60; pCO2: 40; O2 Sat: 88%. Chest X-ray: flat diaphragms hyperinflated, no infiltrates. Spirometry: forced vitality capacity (FVC): 3.2; forced expiratory time in 1 second (FeV1): 1.4. She was started on albuterol and begun on a course of prednisone at 40 mg/day for 3…
