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He was evaluated by the Pulmonary Clinic and given daily eye drops andcorticosteroid therapy for his laryngeal and conjunctival irritation. Theresidual symptoms included mild dry cough, increased work of breathing,and hypoxia. He was initially placed on medications for obstructive airway disease (COPD) and bronchialspasm (e.g., Albuterol, Xopenex, and Spiriva). His physicians whoneeded to rule out other medications for COPD and consider other etiologies forhis symptoms. PFTs were not done initially because of a discontinuedtemporarily deferred study protocol. The patient completed a modified five-question conjuntival irritation questionnaire at the clinic visit in which hereported that his symptoms had resolved and he rated his overall pain score as1 out of 10. Since he had a similar outpatient course in his past where hissymptoms cleared without therapy, he was discharged with a diagnosis of“exercise-induced irritant chemical exposure” and instructed to avoid direct exposureto chemicals and irritants for the next six months. Follow-up in six months wasunsuccessful, and the patient initiated a complaint so that he could obtain a PFTstudy at W.H.M.C. Outpatient Clinic.
The recently acquired data indicated that he had mild obstructive airways disease and no evidenceof significant impairment in spirometry values, other than for a mild reduction in V25,a value for which a large negative value was not expected. We know of only oneother study using the PFT at night. The findings in that study suggested thatthe duration of mechanical ventilation in the ICU following cardiopulmonaryresuscitation was shortened by this simple and effective measure
Although a 48-year-old Caucasian female patient refractory to conventionalmanagement was referred to the Rehabilitation Medicine for intensive pulmonary rehabilitation,her medical history provided evidence of a complex final diagnosis of idiopathically-acquiredobstructive lung disease. Her medical problems included general fatigue and post-menopausal deterioration ofmood characterized by audiovisual bias. d2c66b5586