Question

Mr. B is an 82 year old patient who comes to the dental hygiene clinic for removal of tobacco stain resulting from 50 years of smoking two packs a day. He quit smoking several years ago but is still short of breath when he has to climb stairs or walk any distance. His physician had been treating him for asthma with a short-acting albuterol metered-dose inhaler; however, Mr.B did not get any relief from his symptoms and was becoming increasingly tired and short winded. Upon recommendation from his daughter, a health professional, he went to see a pulmonologist, who diagnosed him as having COPD. His medication was changed to a long-acting B2-agonist salmeterol and a long-acting inhaled anticholinergic agent tiotropium bromide. He had almost immediate relief of his shortness of breath and reports that his energy level increased dramatically, which is important to him because he still works as the owner of a painting business. His other medications include clopidogrel, simvastatin, and hydrochlorothiazide. His BP is 140/90, heart rate is 94, and respiratory rate is 16 breaths per minute. His oral hygiene is fair, and he wears an upper denture. Upon removal of his denture, the hygienist notes that he appears to have a fungal infection on his plate. He also complains that he has had a bad taste in his mouth since starting these medications.

Which is the most probable etiology of his COPD?
A. Smoking
B. Genetics
C. Sequela of long-term asthma problems
D. Long-term exposure to paints in the workplace

Answer 1

Smoking is the most probable etiology of Mr. B's COPD.

Step-by-step explanation:

The most probable etiology of Mr. B's COPD is A. Smoking. Smoking is the major cause of COPD, with other factors such as air pollution and genetics playing smaller roles. Mr. B's 50 years of smoking two packs a day would have significantly contributed to the development of his COPD. The most probable etiology of Mr. B's chronic obstructive pulmonary disease (COPD) is A. Smoking. Having smoked two packs a day for 50 years, Mr. B's long-term exposure to tobacco smoke is the primary cause of the lung damage leading to COPD. Tobacco smoke contains harmful compounds, such as carbon monoxide and cyanide, which reduce the elasticity of the alveoli and lead to chronic inflammation. This results in the breakdown of connective tissues in the lungs, reduced number and elasticity of alveoli, and the characteristic symptoms of COPD including chronic poor airflow. Of individuals who smoke over a lifetime, about half will eventually develop COPD. While other factors like genetics, asthma, and environmental exposures such as workplace chemicals can be contributing factors, Mr. B's history strongly points to smoking as the chief culprit. Mr. B's symptom relief achieved with medications like the long-acting B2-agonist salmeterol and the anticholinergic agent tiotropium bromide further suggest that the treatment targets the pathophysiological changes associated with smoke-induced COPD rather than asthma. Although exposure to paints in the workplace could contribute to respiratory issues, the significant history of smoking remains the most likely cause of his COPD.