Mr WONG, a 73-year-old man, made a regular visit to his general practitioner and complained of gradual deterioration in exercise tolerance, as he could only manage to climb up one flight of stairs in the recent six months in contrast to three flights of stairs one year ago. He has been a chronic smoker for the past 50 years, with an average daily consumption of one pack of cigarettes. He has been having chronic productive cough and shortness of breath almost daily in the past six months.

a) What is his most likely clinical condition? (2 marks)

Chronic obstructive pulmonary disease (COPD).

It is a chronic long-term condition. It is progressive and non-reversible.

There is difficulty breathing (dyspnoea), chronic cough, and chronic sputum production.

The main issue is emphysema which is breakdown of lung tissue.

COPD emphysema is slowly progressive and non-reversible. This is causing the advancing decline in exercise tolerance for Mr Wong and will eventually result in respiratory failure and death.

There is also chronic inflammation of the airways (chronic bronchitis) which causes coughing and mucous.

Smoking is the most common cause of COPD, and COPD is one of the leading causes of death worldwide.

Updated GOLD 2020 COPD definition:

"Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease/syndrome that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases and influenced by host factors including abnormal lung development. Significant comorbidities may have an impact on morbidity and mortality. There may be significant lung pathology (e.g., emphysema) in the absence of airflow limitation that needs further evaluation" 

Tip: In the GOLD link you can try and download the GOLD teaching slide set, near the bottom of the page which are free and easy to read.