Respiratory Case Study:

Mrs. Alma Brown (A.B.), a 62-year-old African American woman, visits your clinic seeking medical attention for increasing shortness of breath on exertion over the past 18 months, particularly noticeable today. She also reports a cough that has persisted for approximately nine weeks. Previously, she could walk 18 holes of golf with her husband every Saturday, but over the last six months, she has had to use a golf cart due to fatigue and shortness of breath. Initially, she attributed these changes to aging but is now concerned that something more may be happening.

A.B. lives in a one-bedroom apartment with her husband, which has no stairs. She manages all the housework and errands. She enjoys cooking with her husband. She is covered by Medicare/NJBC, with $360/month withdrawn from her Social Security for her supplemental insurance for herself and her husband. A.B. experiences some guilt about her church involvement because she cannot attend mass as often due to fatigue but wants to make it known that she prays daily.

Based on the EMR, in the past year, she had three emergency department visits and was diagnosed with acute bronchitis. Her primary care provider suggested she might have developed mild asthma and prescribed an inhaler for as-needed use. However, she hasn't used the inhaler much, as it makes her feel anxious and offers little symptom relief.

A.B. has a history of smoking 1.5 packs per day for about 17 years but quit 18 years ago. Her husband smokes cigars in their home two to three times per week. No other significant medical history is reported or noted in her chart.

Family history reveals her biological father died of emphysema at age 78 after smoking for 52 years. Her mother is currently living at age 82 with end-stage renal failure and a 40-year history of hypertension. Her maternal grandparents both smoked and died of myocardial infarction. Her paternal grandparent history is unknown.