N 95 Mask As Screening For COPD?

Brian Johnson is a janitor at the nursing home in town. He’d been wearing a regular mask at work, but last week he and all the other staff were told to wear N 95 masks.

Today he was in my schedule. I had never met him before, but he had requested a same-day appointment in hopes of being excused from wearing this type of mask because it bothered his breathing.

A smoker, he had never been on any inhalers and the only chest X-ray I could find on him was a normal study from 2016.

Autumn said she got his oxygen saturation at 87% when he walked in from the parking lot with his N 95 on. When I saw him, I recorded 95% with the paper mask the front desk had given him at his request. I asked him to put the N 95 back on and took him for a walk down the clinic halls, but I couldn’t get his saturation below 92%.

His lungs were clear. I excused myself and got my Wright peak flow meter from my top right desk drawer. He removed his mask and blew into the device, twice: 230 each time.

“That’s half of what you would expect a man your size and age to be able to do”, I told him. “It looks like you’ve got COPD. So even that mask is pushing you over the edge to where you feel acutely short of breath. I’d like to give you a sample inhaler. It’ll last you two weeks – so if you see your regular doctor before it runs out, we can see what it does for you by testing your breathing again.

The sample I gave him was Stiolto, a once-a-day, long acting anticholinergic-beta2 agonist combination. I think he’ll be able to work with that N 95 if he stays with the inhaler – unless he has another agenda.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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