Simulated Patient Brief — CHARLIE (COPD)
Location: General Practice. History only — no examination. Answer in the negative to any specific question not covered below.
- Name
- Charlie
- Age
- 68 years
- Opening statement
- “This cough, wheeze and breathlessness have been going on for over a year and they’re getting worse.”
Symptoms for at least a year, gradually worsening. Cough developed about a year ago with clear sputum; never coughed blood. Now daily — constantly clearing phlegm, a lot in the morning, generally clear, not yellow or green.
Breathlessness on exertion: first noticed walking ~200 m to the shops and started driving instead. In the past 2 months breathless on one flight of stairs. Comfortable at rest. Not breathless in bed, though you do cough at night. Chest can feel tight/wheezy. No chest pain, no recent fevers or colds, no ankle swelling; sleep comfortably with one pillow. No significant weight loss (you do not weigh yourself).
Response to questions
- Open questions: describe the chronic, progressive cough, sputum and exertional breathlessness as above.
- Closed questions: no haemoptysis, no orthopnoea, no ankle swelling, sputum not purulent.
Ideas: Partner thinks it may be asthma. You have never had asthma but wonder if it could be — people you know were helped by an inhaler.
Concerns: Damage to the lungs given smoking. Cancer is a background worry — “everyone worries about the C word as they get older.” Partner has significant arthritis and is awaiting hip replacement (>1 year). You do most shopping/cooking/cleaning and are struggling with breathlessness; they rely on you.
Expectations: Chest X-ray to reassure this is not cancer. Expect an inhaler.
- Hypertension several years — well controlled
- High cholesterol — on a statin
- Amlodipine; atorvastatin
- No known drug allergies
- Parents both alive, late 90s, frail; mother has dementia; live in a care home together
- Only child
Live with partner of 30 years; no children. Partner awaiting hip replacement — you do most domestic tasks. Drive everywhere now. Retired 5 years ago; HGV driver until 10 years ago, then admin for a haulage company. Small terraced house with one flight of stairs. Alcohol only occasionally. Practice nurse has advised stopping smoking many times. Reduced from ~30/day to 5–10/day. Tried patches, vaping, gum. Smoked since teenage years. If asked: no known occupational hazards (asbestos, silica); no pets; never worked with animals; no recent travel.
Systems review: reply in the negative to any other symptoms.