You have a 42-year-old female that presents to your office with respiratory and visual symptoms. She enjoys astronomy, but recently a visual change has made this difficult.

Question
You have a 42-year-old female that presents to your office with respiratory and visual symptoms. She enjoys astronomy, but recently a visual change has made this difficult.

She has noticed some difficulty seeing distant galaxies through her telescope. Also, she has noticed a mild, and sometimes productive cough, for 3-4 months. She has noticed worsening of the cough when she has been exposed to smoke from bonfires. You ask her additional questions and discover that she has smoked cigarettes, 1 ppd for 22 years.

In further questioning, she admits the cough has really been present closer to 1 year. She has had some shortness of breath with exercise over the last 6 months.

PMH: Hypertension. She is on lisinopril, metoprolol, and hydrochlorothiazide. Your physical exam is normal. You ordered a chest x-ray that is also normal. Her spirometry results are: – FEV1: 85% of predicted – FEV1/FVC is 65% Anything else you would ask her? What is her diagnosis? What would be your treatment plan (please be specific)?

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