A 72-year-old man presents to the clinic with progressive sh…

Questions

A 72-yeаr-оld mаn presents tо the clinic with prоgressive shortness of breаth and chronic cough with white sputum for the past 2 years. He denies chest pain, fever, or recent infections, but reports occasional wheezing and fatigue. His PMH includes hypertension and former smoker (45-pack-year history, quit 5 years ago). He takes lisinopril 10 mg daily and albuterol 1 puff PRN daily. Physical Exam:• Vitals: BP 130/80 mmHg, HR 84 bpm, RR 20/min, SpO₂ 93% on room air• Lungs: Decreased breath sounds, prolonged expiratory phase, scattered wheezing, mild pursed-lip breathing, decreased chest wall expansion and a barrel chest appearance.• Cardiovascular: No murmurs, no peripheral edemaSpirometry Results (Post-Bronchodilator Test):• FEV₁/FVC Ratio: 0.65• FEV₁: 65% of predicted• Improvement with bronchodilator: Minimal (

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