In 2008, a 65-year-old white man presented to the emergency department of a community hospital for the third time in 2 months with recurrent complaints of shortness of breath, productive cough, and pleuritic, constant chest pain. The patient described no additional symptoms other than anxiety. He denied fever, chills, or sweating. His medical history included COPD (manifested as chronic bronchitis), recurrent pneumonia, type 2 diabetes mellitus, Lewy body dementia, bipolar disorder, and colitis. He resided at a skilled nursing facility as a result of his progressive dementia. Medications used by the patient at time of presentation were albuterol sulfate nebulizers (as needed), amantidine hydrochloride, amitriptyline hydrochloride, donepezil hydrochloride, fluticasone propionate/salmeterol xinafoate inhaler, lithium carbonate, loperamide hydrochloride, olanzapine, omeprazole, quetiapine fumarate, and tiotropium bromide inhaler.
The patient reported that he had a history of cigarette smoking (about 30 packs/year), but he quit 47 years ago. He denied alcohol or intravenous drug abuse. He was not oxygen-dependent at the time of presentation.