[Answered]: JS is a 74 year old man who presents to your…

JS is a 74 year old man who presents to your family medicine office with his wife complaining of shortness of breath and fever. They just moved to the area and had been planning to come to your office next week to establish care as new patients. • Due to the onset of symptoms, JS called and was given a walk-in slot today. His wife did bring records from his last physician’s office. Which of the following is not a risk factor for COPD? A. Smoking history B. Occupational exposure C. Immunization history D. History of severe lung infections as a child E. Family history of lung disease • Past Medical/Surgical History – Heart failure following myocardial infarction at age 68 years – COPD (on 2 L home oxygen) – Hypertension – Appendectomy • Family History – Father died of myocardial infarction at age 59 years (diabetes, hypertension, smoker) – Mother alive (atrial fibrillation, heart failure) – Healthy siblings • Social History – Married, 3 children – 30 pack year smoking history (quit after MI) – Worked on a farm – No alcohol or illicit drug use • Medications / Allergies – Lisinopril 20 mg twice daily – Metoprolol 50 mg twice daily – Spironolactone 25 mg daily – Furosemide 40 mg daily – Salmeterol/fluticasone 50/500 dry powdered inhaler (DPI) one puff inhaled twice daily – Tiotropium DPI one cap inhaled daily – Albuterol/ipratropium metered dose inhaler (MDI) or solution for nebulization every 6 hours as needed – Levalbuterol MDI two puffs every 4 to 6 hours as needed – Home oxygen • He is confused about what to use when, so you are not sure which medications he actually takes. • No known allergies • JS Past Record Review (brought by wife) – Echocardiogram with EF of 25% – Spirometry with FEV1 35% predicted that does not change significantly after inhaled bronchodilator