Controlling Respiratory Distress in a Smoker " Marty is a 63-year-old life-long smoker "

Case study ( 6435 views as of April 14, 2024 )

Marty is a 63-year-old life-long smoker who had to retire 6 years early from his job as a longshoreman, as "he got the emphysema". He doesn't much like going to see his doctor, as "as she wants to do is give me pills and puffers". He has cut down his smoking from 2 packs per day to 1 pack per day, with the expectation that this will improve his breathing problems.

Marty has very poor exercise tolerance, and has to sit on available benches to rest and catch his breath when doing errands at the mall. He is no longer able to do anything active, and regrets this, as he used to be an enthusiastic hiker and outdoorsman. Early retirement forced him to sell his boat, and his disability benefits do not cover his monthly expenses. He has had to rely on a 'reverse mortgage' to support his admittedly limited lifestyle.

Marty may benefit from reconnecting with his primary care provider, and finding a common set of health goals to improve his quality of life. He has many of the manifestations of severe, possibly end-stage lung disease. He would almost certainly benefit from seeing respiratory illness specialists, learning about the role and proper use of medications and pills. He may also benefit from seeing a cardiologist for risk stratification for cardiac disease, which commonly accompanies these diagnoses.


Conversation based on: Controlling Respiratory Distress in a Smoker " Marty is a 63-year-old life-long smoker "

Controlling Respiratory Distress in a Smoker " Marty is a 63-year-old life-long smoker "

  • In the past, lung cancer was broadly categorized into two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). These classifications were based on histological and microscopic characteristics of the cancer cells. However, advancements in research and technology have allowed us to delve deeper into the underlying biology of lung cancer, leading to a more refined understanding of the disease. Currently, lung cancer is classified into several subtypes based on specific molecular and genetic alterations found within the cancer cells. These alterations can be identified through various diagnostic tests, such as genetic sequencing and biomarker analysis. The identification of these specific alterations has enabled the development of targeted therapies that can selectively inhibit the cancer cells' growth and survival, leading to improved treatment outcomes. For example, in NSCLC, mutations in the epidermal growth factor receptor (EGFR) gene and rearrangements in the anaplastic lymphoma kinase (ALK) gene have been identified as important drivers of the disease. Targeted therapies, such as EGFR inhibitors and ALK inhibitors, have been developed to specifically target these genetic alterations, resulting in more effective treatment options with fewer side effects compared to traditional chemotherapy. In addition to targeted therapies, immunotherapy has also emerged as a promising approach for treating lung cancer. Immune checkpoint inhibitors, such as drugs targeting programmed cell death protein 1 (PD-1) or its ligand PD-L1, have shown significant benefits in a subset of patients by enhancing the immune system's ability to recognize and attack cancer cells. Overall, the improved understanding of the molecular drivers of lung cancer has paved the way for personalized medicine approaches, where treatment can be tailored to the specific characteristics of an individual's cancer. This progress has significantly impacted the field of lung cancer research and has the potential to improve patient outcomes in the future.
  • Blocked arteries also lead to stroke; blocked arteries in the legs can lead to pain on walking, and ultimately, to amputation. Smoking is a critical risk factor. Smoking is even more important as a risk factor if we consider when smoking starts.
  • I would be interested to know how Marty's other daily living activities are impacted. Lung conditions like his can make a lot of things difficult to do, even eating. If he needs to take a seat during errands, he might also have a difficult time preparing and consuming food. Eating soft, moist foods may help if he feels breathless when eating, as they are easier to chew and swallow. Another good trick is to make larger portions of meals at a time so they can be frozen and warmed up at a later date - this cuts down on future meal preparation and resulting breathlessness. Reducing his symptoms through diet might be more realistic for Marty at this point, since he does not like seeing his doctor. It may also help Marty transition to being more open to visiting the doctor if he feels he has some control (ie diet) in his treatment.
  • Marty sounds a lot like my father. He had a number of health issues and was a life long smoker. Several years ago he required surgery and developed post surgical pneumonia after not heeding the doctor's advice to quit before the surgery. He too hates going to the doctor because he doesn't like when he receives advice that means he has to make changes to what he views as "his comforts"
  • It sounds from this case study as though Marty needs some proper education around his respiratory symptoms, and the probable consequences of his lifestyle choices. Between his family doctor and other specialists, Marty could certainly be a good candidate for wellness coaching, particularly to support him in smoking cessation. His hesitation to stick to his medications is also a concern that could be addressed through working with a wellness coach.
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