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CONDITION/DISORDER SYNONYMS
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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
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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
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PREFERRED PRACTICE PATTERNS
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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
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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
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