Skip to Main Content

++

CONDITION/DISORDER SYNONYMS

++

  • Nonseptic obstructive airway disease

  • Septic obstructive airway disease

++

ICD-9-CM CODES

++

  • 490 Bronchitis, not specified as acute or chronic

  • 491 Chronic bronchitis

  • 492 Emphysema

  • 493 Asthma

  • 494 Bronchiectasis

  • 495 Extrinsic allergic alveolitis

  • 496 Chronic airway obstruction, not elsewhere classified

  • Associated physical therapy diagnoses

    • 780.7 Malaise and fatigue

    • 786.0 Dyspnea and respiratory abnormalities

    • 786.05 Shortness of breath

++

ICD-10-CM CODES

++

  • F17 Nicotine dependence

  • J44 Other chronic obstructive pulmonary disease

  • J41 Chronic simple and mucopurulent chronic bronchitis

  • J42 Unspecified chronic bronchitis

  • J43 Emphysema

  • J45 Asthma

  • J47 Bronchiectasis

  • Z57.31 Occupational exposure to environmental tobacco smoke

  • Z72.0 Tobacco use

  • Z77.22 Exposure to environmental tobacco smoke

  • Z87.891 Personal history of nicotine dependence

++

PREFERRED PRACTICE PATTERNS

++

  • 6C: Impaired Ventilation, Respiration/Gas Exchange, and Aerobic Capacity/Endurance Associated with Airway Clearance Dysfunction1

  • 6F: Impaired Ventilation and Respiration/Gas Exchange Associated with Respiratory Failure2

++

PATIENT PRESENTATION

A 60-year-old man presents to your office with a prescription of functional decline. The patient complains of frequent coughing and shortness of breath (SOB). He is well known to you because of multiple office visits in the past few years for similar reasons. He has a chronic “smoker’s cough,” but reports that in the past 2 days his cough has increased, his sputum has changed from white to green in color, and he has had to increase the frequency with which he uses his Albuterol inhaler. He denies having a fever, chest pain, peripheral edema, or other symptoms. His medical history is significant for hypertension, peripheral vascular disease, and two hospitalizations for pneumonia in the past 5 years. He has a 60-pack-year history of smoking and continues to smoke two packs of cigarettes a day. Patient reports decreased ability to walk inside his home and difficulty with all ADLs due to fatigue and SOB. He denies having any assistive device at home and denies use of supplemental O2.

On examination, patient appears with barrel chest. He is in moderate respiratory distress. His temperature is 98.4°F, his blood pressure is 152/95 mm Hg, his pulse is 98 beats/min, his respiratory rate is 24 breaths/min, and he has an oxygen saturation of 91% on room air at rest. His lung examination is significant for diffuse expiratory wheezing, use of accessory muscles of respiration and a prolonged expiratory phase of respiration. There are no signs of cyanosis. Patient presents with impaired strength in bilateral LEs. Endurance is impaired and by demonstrated a decreased 2MWT with increased, tachycardia, tachypnea, and decreased O2 saturation after performance requiring 5 min to recover. Patient presents with increased labor of breathing after minimal activity. Patient requires increased time for bed mobility, transfers, and gait with multiple rest breaks. A chest X-ray shows an increased anteroposterior (AP) diameter and flattened diaphragms, but otherwise he has clear lung fields.3

++
FIGURE 72-1

Chest CT scan of a ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.