Retrospective Change Scenario for COPD Disease Patient No. 1

Basic Information:
Age: 61
Sex: female
Disease diagnosis: COPD
Comorbid diagnoses:		Current medications:
hypertension	osteoarthritis	acetaminophen	ibuprofen
anemia	chest pain	benazepril	isosorbide
obesity		ecotrin	nitroglycerine
Visit No. 1:  6/23/95
Clinical information:
History: Patient without complaints. Losing weight (walking, eating less). Weight down 8 lbs. Denies chest pain or dyspnea on exertion. Says she walked about 6 miles last month after visiting her daughter across town. Right knee doing better; ran out of ibuprofen 2 weeks ago, which she was using twice a day. Tylenol helps some as well. No GI symptoms. Patient is a non-smoker.
Physical exam: BP 125/58, pulse 70. Weight 211 lbs. Lungs clear bilaterally. Heart with 2/6 systolic ejection murmur at apex and left lower sternal border, without radiating to carotids. Abdomen obese, non-tender. No lower extremity edema. Distal pulses 2+.
Test results: PFTs more consistent with restrictive disease.
Treatment plan: Check A7 today. Encouraged to continue weight loss for obesity. Continue isosorbide for questionable history of CAD. Use PRN NSAIDs for osteoarthritis, but encourage use of Tylenol as much as possible. Mammogram before next visit. Follow-up in 6 months to Medicine Clinic.
Changes in treatment: None.
Visit No. 2:  1/5/96
Clinical information:
History: No chest pain. Not using inhalers except as needed. Has dyspnea after 4-5 blocks of walking. Complains of decreased mobility and mild pain in right third and fourth fingers, worse in the morning but gets better during the day. Not affecting daily activities. Blood pressure stable on benazepril. Patient requesting disability forms to be completed.
Physical exam: BP 125/58, heart rate 62, weight 211 (unchanged). Lungs clear bilaterally. Heart shows 2/6 systolic ejection murmur at left lower sternal border without radiation. Extremities: right third PIP joint tender to palpation, no catching or crepitus. No edema.
Test results: Old stress test negative.
Treatment plan: Continue same antihypertensive medication. Continue prn albuterol inhaler for questionable COPD (begun in Medicine Clinic 1/5/96). Continue prn ibuprofen for osteoarthritis. Follow questionable early trigger finger on right hand. Follow-up in 6 months to Medicine Clinic.
Changes in treatment: Discontinue isosorbide and follow chest pain symptoms, but continue prn nitroglycerin and daily aspirin.
HEALTH-RELATED QUALITY OF LIFE DATA
Domains of the CHQ	Interview 1 Date: 6/30/95	Interview 2 Date: 1/05/96	Change (T2 − T1)
Dyspnea	35	25	−10
Fatigue	25	18	−7
Emotional Function	38	44	6
Mastery	26	26	0
Domains of the SF-36
Physical Functioning	0.00	45.00	45.00
Role-Physical	100.00	75.00	−25.00
Bodily Pain	72.00	52.00	−20.00
General Health Perception	72.00	67.00	−5.00
Vitality	75.00	25.00	−50.00
Social Functioning	50.00	25.00	−25.00
Role-Emotional	100.00	0.00	−100.00