From the Guidelines
The patient's continued smoking is a significant concern that needs to be addressed immediately, given her complex medical history and cancer diagnosis, and she should be offered smoking cessation therapy as part of her oncology treatment, as recommended by the NCCN clinical practice guidelines in oncology 1. The patient is a 58-year-old female with a complex medical history including chronic respiratory failure, obesity hypoventilation syndrome, COPD, hypertension, congestive heart failure, and morbid obesity. She has been more compliant with her home AVAPS therapy and is showing clinical improvement, though she continues to smoke one pack of cigarettes daily despite her respiratory conditions.
Key Points to Consider:
- The patient has recently received a chemo port for treatment of invasive ductal carcinoma of the right breast and is under the care of Dr. Tafar for oncology management.
- She was evaluated by Dr. Preze who adjusted her cardiovascular medications, restarting metoprolol and hydrochlorothiazide (HCTZ) while discontinuing amlodipine, likely to better manage her hypertension and congestive heart failure while avoiding potential drug interactions with her cancer treatment regimen.
- Her continued smoking remains a significant concern given her respiratory conditions and cancer diagnosis, and smoking cessation is key to improving her overall health and reducing the risk of further complications, as highlighted in the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1.
- The patient's medical history should include a detailed account of her exposure to risk factors, past medical history, family history, and social and family support available to her, as recommended in the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1.
- Combining pharmacologic therapy and behavior therapy is the most effective approach for smoking cessation, and the patient should be offered this as part of her oncology treatment, as recommended by the NCCN clinical practice guidelines in oncology 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
History of Present Illness (HPI)
The patient is a 58-year-old female with a complex medical history, including:
- Chronic respiratory failure
- Obesity hypoventilation syndrome
- COPD
- Hypertension
- Congestive heart failure (CHF)
- Morbid obesity
- Invasive ductal carcinoma of the right breast, for which she has received a chemo port and is undergoing treatment
Current Treatment and Progress
The patient has been using home Adaptive Ventilatory Assisted Pressure Support (AVAPS) more consistently and is showing improvement 2. However, she continues to smoke one pack of cigarettes per day, which may be exacerbating her respiratory conditions.
Medication Changes
The patient was seen by Dr. Preze, who restarted her on metoprolol and HCTZ, and stopped amiodipine. The rationale for these medication changes is not specified, but it is likely aimed at managing her hypertension and CHF.
Importance of HPI in Diagnosis and Treatment
A thorough HPI is crucial in diagnosing and treating patients with complex medical histories like this patient 3, 4, 5. The HPI can help identify the patient's chief health concern, relevant historical risks, and known medical events, which can inform treatment decisions and improve patient outcomes.
Management of Obesity Hypoventilation Syndrome (OHS)
The patient's OHS is likely contributing to her chronic respiratory failure and hypercapnia. Management of OHS typically involves the use of noninvasive ventilation (NIV) or continuous positive airway pressure (CPAP) to improve gas exchange, sleep quality, and clinical symptoms 6. The patient's current use of AVAPS may be beneficial in managing her OHS, but further evaluation and optimization of her treatment plan may be necessary to achieve optimal outcomes.