ABSTRACT
A 52-year-old male patient had recurrent hospitalizations for exacerbations of COPD associated with wheezing. Home medications included inhaled short- and long-acting β2-agonist (LABA) combined with corticosteroid, inhaled short- and long-acting muscarinic receptor antagonist, antibiotics, and tapering oral corticosteroid as needed. Chest X-ray demonstrated hyperinflation, and high resolution, thin-section lung CT was consistent with mild emphysema, predominantly in the upper lung fields. Expiratory spirometry was consistent with moderate to severe obstruction with significant response to inhaled albuterol. Static lung volumes were increased, and diffusing capacity was normal. Blood eosinophils were mildly elevated, and total IgE remained elevated consistent with Th2 eosinophilic asthma. Measurements of exhaled total airway and alveolar nitric oxide were normal. There was a childhood history of allergic asthma that persisted into adulthood and despite treatment, he continued to experience limited exercise ability. Social history was remarkable for smoking, which began at age 18 with a cumulative smoking history of 42 pack years. Serum alpha 1 antitrypsin level and Pi type were normal.
