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CLINICIAN'S CORNER
A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease
Bartolome R. Celli, MD, Discussant
JAMA. 2003;290:2721-2729.
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INTRODUCTION
DR REYNOLDS: Mrs D is a 62-year-old woman with advanced chronic obstructive pulmonary disease (COPD). Mrs D is a widow and lives with one of her 7 children. She has Medicare and Medicaid insurance.
Mrs D was well until she began experiencing shortness of breath in her early 40s, when she was a heavy smoker. By her mid 40s, she was diagnosed as having COPD and was already receiving oxygen by nasal cannula. Over the ensuing 2 decades, her pulmonary disease worsened steadily. She now has severe COPD and uses oxygen, 4 L by nasal cannula, around the clock. Her activities are limited by her severe dyspnea on exertion. She has frequent exacerbations, often induced by upper respiratory tract infections. She has been hospitalized more than 20 times in the past 5 years; she has been intubated twice.
Mrs D's most recent hospitalization . . . [Full Text of this Article]
MRS D: HER VIEW
DR K: HER VIEW
AT THE CROSSROADS: QUESTIONS FOR DR CELLI
COPD: A Modern-Day Epidemic Natural History of COPD and Effect of Smoking Cessation Treatment of COPD Pharmacological Therapy Exacerbations of COPD Pulmonary Rehabilitation Surgery for COPD Advance Directives and End-of-Life Issues in COPD Recommendations for Mrs D Conclusion
QUESTIONS AND DISCUSSION
Author Affiliation: Dr Celli is Professor of Medicine, Tufts University, and Chief, Pulmonary and Critical Care Medicine, Caritas St Elizabeth's Medical Center, Boston, Mass.
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