<p>J'ai vu ce jour M. PAYET Jean Ren&eacute; n&eacute; le 01/12/1959.</p>
<p>Ce monsieur a 2 enfants.Il s'agit d'un ancien concierge actuellement sans emploi.</p>
<p>Il fume actuellement 7 cigarettes /jour et fumait auparavant 2paquets/j.Il totalise environ plus de 60PA.</p>
<p>Dans ses ant&eacute;c&egrave;dents on note une hernie inguinale droite op&eacute;r&eacute;e.Il a &eacute;t&eacute; hospitalis&eacute; pour une pancreatite chronique au CHGM de Saint Paul.</p>
<p>Le patient tousse le matin avec expectorations blanchatres.</p>
<p>Il pr&eacute;sente une dyspn&eacute;e grade III de l'&eacute;chelle du Modified Medical Research Council.</p>
<p>L'auscultation pulmonaire retrouve un assordissement des bruits pul&ugrave;monaires stethacoustiques.</p>
<p>Il a eu un TDM thoracique et abdominal le 17/12/2013.cet examen a montr&eacute; qulques calcifications coronaires et aortiques.</p>
<p>Ses EFR retrouvent un trouble ventilatoire obstructif Gold II avec un VEMS &agrave; 61% de la norme et un Tiffeneau &agrave; 69%.</p>
<p>Il existe une distension pulmonaire avec CPT &agrave; 118% VGT &agrave; 151% et VR &agrave; 207%.Les resistances des voies a&eacute;riennes sont augment&eacute;es &agrave; 0.97.Il n'existe pas de trouble du transfert.</p>
<p>Je lui ai represcrit :Alvesco 1B/j;Spiriva Respimat 2B/j;Zyban LP 150 mg pdt 6 jrs puis 150 mgX2 pdt 7 semaines associ&eacute;es &agrave; Onbrez 150/j.</p>
<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l'assurance de mes sentiments distingu&eacute;s,</p>
<p>Dr. B. TANGUY.</p>
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