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Clinical Case Study 3

Clinical Case Study in Occupational and Environmental Medicine 

A nurse with persistent cough and wheeze

    A 35 year-old nurse is troubled by a persistent cough and wheeze which gets worse as the day goes by. She has had 3 admissions to hospital with acute exacerbations of this problem in the last 3 years. Her problem is perceived to be persistent and troublesome.

First you need to consider the differential diagnosis: bronchial asthma is by far the likeliest explanation, but would you think of anything else? (Chronic obstructive pulmonary disease, bronchiectasis maybe?)

What pathological process is likely to underlie this? Inflammation with bronchospasm leading to airway narrowing perhaps?

What are the consequences of breathlessness? Does she have a disability that may result in a  handicap as regards her capacity ...  to work? ... or ... to look after her family ? ... or ... to enjoy life? 

Why did this come about? Bear in mind that inflammation is most commonly the body's pathological response to injury - often caused by an external agent. Therefore in any patient of working age with an inflammatory illness which started in employment you must consider whether the work environment might be affecting health. What questions would you ask to pursue such a possibility?

First ask a few more questions. What do they reveal?

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