A 68-year-old woman with a history of hypothyroidism and COPD presents for follow-up with her primary care physician. She has no complaints and denies any recent fatigue, weight loss, increase in cough or sputum production, or chest pain. Her medications include inhaled ipratropium and levothyroxine. She is normotensive with an SaO2 of 92% on room air. On examination, her lungs are hyper-resonant to percussion with some scattered wheezes and rhonchi. She has clubbing of the digits, which was not present 1 year ago.
What is the most appropriate next course of action?
A. Reassurance and regular follow-upChest imaging. Clubbing of the digits is not associated with COPD, and therefore any new onset of clubbing in a COPD patient is a red flag for another etiology such as bronchogenic carcinoma. Chest imaging is an important diagnostic step to look for cancer. Other etiologies of clubbing include interstitial lung disease, cystic fibrosis, congenital heart disease, and malabsorption. (A) Because the clubbing is unrelated to the patient’s COPD, reassurance is inappropriate. (B) This patient does not meet criteria for home oxygen therapy (SaO2 ≤ 88%). (C) The patient is not having an exacerbation and has no reason to undergo pulmonary function testing at this time.