A 52-year-old man presents to your office for an acute visit because of coughing and shortness of breath. He is well known to you because of multiple office visits in the past few years for similar reasons. He has a chronic "smoker’s cough," but reports that in the past 2 days his cough has increased, his sputum has changed from white to green in color, and he has had to increase the frequency with which he uses his albuterol inhaler. He denies having a fever, chest pain, peripheral edema, or other symptoms. His medical history is significant for hypertension, peripheral vascular disease, and two hospitalizations for pneumonia in the past 5 years. He has a 60-pack-year history of smoking and continues to smoke two packs of cigarettes a day. On examination, he is in moderate respiratory distress. His temperature is 98.4°F, his blood pressure is 152/95 mm Hg, his pulse is 98 beats/min, his respiratory rate is 24 breaths/min, and he has an oxygen saturation of 94% on room air. His lung examination is significant for diffuse expiratory wheezing and a prolonged expiratory phase of respiration. There are no signs of cyanosis. The remainder of his examination is normal. A chest x-ray done in your office shows an increased anteroposterior (AP) diameter and flattened diaphragms, but otherwise he has clear lung fields.
➤ What is the most likely cause of this patient’s dyspnea?
➤ What acute treatment(s) are most appropriate at this time?
➤ What interventions would be most helpful to reduce the risk of future exacerbations of this condition?

The most likely cause of this patients dyspnoea is chronic bronchitis due to his history of chronic smoking and the recent production of green phlegm with an increased mucus production

Therapy is generally focused on alleviation of symptoms.Toward this goal, a doctor may prescribe a combination of medications that open obstructed bronchial airways and thin obstructive mucus so that it can be coughed up more easily. Care for acute bronchitis is primarily supportive and should ensure that the patient is oxygenating adequately. Bed rest is recommended.

Acute treatment for the patient would be therapy with short-acting agonists or anticholinergic bronchodilators if there is acute exacerbation to help dilate the bronchioles and reduce inflammation. Additionally a short course of systemic corticosteroid therapy to aid with inflammation reduction and allow phlegm to be coughed up more easily

The most helpful intervention to help prevent future exacerbation is the avoidance of environmental irritants, especially cigarette smoke. and reducing the amount of smoking per day this will help control cough and sputum production in patients with chronic bronchitis