Facilitator resources: Spirometry interpretation (Geeky Medics); normal ECG; normal FBC & BNP; COPD (Geeky Medics); NICE CKS – Stable COPD and Acute exacerbation.
You have been getting short of breath on exertion for the last 8 months. It became very noticeable 1 month ago when the lift at work broke down and you had to pause at each floor; breathing was quite wheezy. No new chemicals or environmental triggers. You do not get short of breath lying flat, do not wake at night gasping, can sleep lying flat, and have no ankle swelling. No chest pain. No unanticipated weight loss, no haemoptysis. No asbestos exposure. No close exposure to birds or bats.
The lift is working again, but it prompted a visit to a locum GP 4 weeks ago. The GP thought it might be a lung problem and arranged CXR, spirometry, bloods and ECG. You are here for the results. Your partner is worried it could be something serious such as lung cancer given your past smoking.
Ideas: There might be something wrong with your heart or lungs.
Concerns: Partner fears something serious (e.g. lung cancer) in light of past smoking.
Expectations: A diagnosis, advice on how to improve health, and reassurance for your partner.
You are happy to follow whatever treatment plan is suggested and are receptive to treatment — you just want to feel better.
Opening statement: “I have a horrible cough doctor.”
Diagnosed with COPD 6 months ago; compliant with treatment and had been improving (better exercise tolerance, enjoying dog walks again). Over the last 7 days: productive cough (green/yellow sputum), hot and cold chills, increasing SOB (stairs and around the house), wheeze returned. Using blue inhaler more — 4 times in last 24 hours (2 puffs); helps initially then symptoms return.
Negatives: No chest pain, no leg swelling, sleeping with 2 pillows, no nocturnal SOB, no haemoptysis, no dizziness. Eating/drinking well, passing urine normally. Coping at home but SOB makes getting around difficult at times.
Steroid negotiation: If offered prednisolone, say you are worried about steroids (heard someone broke their hip after falling because of steroids). If the student explains short-course risk is low, accept. If not clearly explained, refuse steroids and stick with whatever else is prescribed (e.g. antibiotics). Happy to take antibiotics alone if that is all that is offered.