I.M, a 58-year-old male farmer, presents to the local clinic with complaints of chronic cough, increased sputum production, and difficulty breathing that has progressively worsened over the past two years. He reports that his symptoms are more pronounced in the early morning and are aggravated by physical exertion.

I.M's symptoms began with a persistent cough that he initially attributed to his
smoking habit. Over time, he noticed that the cough became more productive,
producing thick, yellowish sputum. He experiences shortness of breath, especially when tending to his crops or walking long distances. He has also had several episodes of acute bronchitis in the past year, which were treated with antibiotics at the local clinic.

I.M has been a smoker since his early twenties, averaging about 15 cigarettes per day. He lives in a small, poorly ventilated house with his wife and grandchildren. The family uses biomass fuel (wood and charcoal) for cooking, which produces significant indoor smoke exposure. There is limited access to healthcare facilities, and he has not received regular medical check-ups.

- General: Cachectic appearance, moderate respiratory distress
- Vitals: BP 130/85 mmHg, HR 98 bpm, RR 24 breaths/min, SpO2 89% on room air.
- Respiratory: Barrel chest, use of accessory muscles for breathing, decreased
breath sounds bilaterally, prolonged expiratory phase, diffuse wheezing, and crackles at lung bases.

- Spirometry: FEV1/FVC ratio of 0.60, FEV1 at 45% of predicted value
- Chest X-ray: Hyperinflated lungs, flattened diaphragm, and increased
anteroposterior diameter.
- Blood Tests: Elevated white blood cell count (indicative of possible infection),
polycythaemia (secondary to chronic hypoxia).

Chronic Obstructive Pulmonary Disease (COPD), likely exacerbated by acute
bronchitis and chronic exposure to biomass smoke.

1. Smoking Cessation: Immediate cessation of smoking with support for nicotine withdrawal.
2. Medications:
- Inhaled bronchodilators (e.g., salbutamol) to relieve bronchospasm.
- Inhaled corticosteroids to reduce inflammation.
- Antibiotics for possible acute bacterial bronchitis.
3. Oxygen Therapy: Supplemental oxygen to maintain SpO2 above 90%.
4. Pulmonary Rehabilitation: Breathing exercises and physical therapy to improve respiratory function.
5. Education and Support: Counselling on reducing indoor smoke exposure,
including improved ventilation and alternative cooking methods.

Isaac is scheduled for regular follow-up visits to monitor his symptoms, adjust his treatment plan as necessary, and provide ongoing support for smoking cessation and environmental modifications.This case highlights the multifactorial nature of COPD in sub-Saharan Africa, where tobacco use and exposure to biomass smoke are significant contributing factors.