SESSION TITLE: Obstructive Lung Disease
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM
INTRODUCTION: A 59 year old with chronic obstructive lung disease (COLD) presents with symptoms of acute infective exacerbation. The radiological findings and management are reviewed.
CASE PRESENTATION: A 59 year old Eurasian male with an 80 pack-year smoking history presented with coryzal symptoms for two days, with worsening dyspnea and productive sputum. He has ischaemic heart disease and is receiving anti-platelet therapy. He also has COLD for which he has not been compliant with outpatient reviews and medications. Initial assessment showed SpO2 93% on room air, and his arterial blood gas was pH 7.42 pO2 62 mmHg, pCO2 34 mmHg and HCO3 22 mmol/L. His chest radiograph demonstrated areas of lucency in bilateral upper lobes; this raised clinical suspicion of bilateral pneumothoraces. His CT thorax demonstrated extensive bullous disease with no pneumothorax. He received antibiotics, corticosteroids and nebulized bronchodilators but developed worsening respiratory distress. A trial of non-invasive ventilation was unsuccessful and he was intubated. The patient was extubated after 3 days of mechanical ventilation. Swabs performed on admission confirmed Influenza A infection. He progressed well in the ward, was initiated on Tiotropium and Symbicort inhalers and discharged.