Respiratory Case Study

Case Two – Joseph

Facts/Allegations

  • 38 year old; 8th grade education

Employment History

  • HVAC Technician
  • Excellent, steady work history

Impairments Alleged

  • Breathing difficulty; upper back and chest pain; depression and anxiety
  • History of disease:
  • working in an attic that had recently been sprayed with foam insulation; noticed strong pungent smell but worked 6 hours
  • Ill the next day. SOB gradually worsened over one month. Given prednisone one month without improvement
  • PFT 3 months after incident showed mild obstructive pattern with no response to bronchodilators.
  • Six months later SOB worsened; SOB on minimal exertion. Oxygen saturation 86% w/o oxygen; uses supplemental oxygen.
  • Obese 6’ 243#
  • Used to smoke 2 packs a day; has cut back to ¾ pack

Medications (for respiratory disorder)

  • Oxygen
  • Fioricet, every 4-6 hours
  • Prednisone – 10 mg., BID
  • Fionase spray, once daily as needed
  • Albuterol sulfate
  • Nebulization solution every 4 hours as needed

Symptoms

  • SOB limits mobility
  • Must use oxygen occasionally
  • Cold air exacerbates symptoms
  • Used to job one mile a day and walk with no limitations; can no longer fish or go camping or ride snowmobile

Summary of Medical Evidence

  • Consultative examination ordered by Social Security
  • History of breathing problems for one year after exposure to unidentified chemicals
  • On continuous oxygen bilaterally through nose
  • Wheezing through auscultation with slight SOB during exam; percussion normal.
  • Opinion: moderate to severe limitations due to lung disease
  • Treating Source: Occupational Health Services
  • Chest CT scan speaks against hypersensitivity pneumonitis
  • Likely an inhalation injury best characterized as obstructive bronchiolitis
  • Evidence of hypoxemia is consistent with this diagnosis
  • Likely a consequence of inhalation of isocyanates
  • No medication prescribed
  • Might improve symptomatically with inhaled steroids
  • Opines patient is totally disabled and meets listing 3.02
  • Pulmonary Function Test Results
  • FVC = 4580 ml (81% predicted)
  • FEV1 = 3420 ml (76% predicted)
  • FEV1/FVC = 75%
  • MVV 33% (severely reduced)
  • Diffusing Capacity = 73% predicted
  • Summary: likely bronchiolitis obliterans. Disease characterized by an abnormality in gas exchange. Pulmonary mechanics show mild obstructive lung disease with a reduction in carbon monoxide diffusing capacity

Questions to Dr.

  • Explain the key findings?
  • Does the condition meet a respiratory listing?
  • What limitations in functioning might result from this condition?
  • Would discontinuing smoking completely have any effect?
  • Is there any other treatment that might improve his functioning?
  • Will his limitations likely improve over time?

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