Penelope Wang

Clinical Summary

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Patient Snapshot: Penelope Wang, DOB 03/14/1945, 81-year-old female with end-stage COPD (GOLD stage IV) and cor pulmonale, oxygen-dependent at rest.
Narrative Summary: Long-standing COPD with progressive dyspnea now at rest, on continuous home oxygen at 3 L/min. Two hospitalizations for hypoxic respiratory failure in the last 90 days, each requiring BiPAP. Between exacerbations she remains dyspneic with minimal exertion.
Recent Context: Most recent discharge 04/19/2026 after a 5-day admission for a COPD exacerbation; started on a scheduled opioid for air hunger and referred for home-based comfort care.
Social & Environmental: Widowed, lives with her daughter who provides most hands-on care; second-floor apartment with stairs is a noted access barrier. Former smoker (50 pack-years).

Potential Decline: Increasing frequency of exacerbations, escalating oxygen requirement, and unintentional weight loss suggest end-stage pulmonary disease with limited reversibility.
Key Events: Admissions 02/2026 and 04/2026 for hypoxic respiratory failure, both requiring non-invasive ventilation; recurrent lower-respiratory infections.
Trend Clarification: Resting SpO2 82–88% on 3 L; documented cor pulmonale on echo. Post-exacerbation recovery is progressively incomplete — she has not returned to her prior baseline after either recent admission.

Potential Primary: Pulmonary — end-stage COPD with cor pulmonale — is the best-supported primary hospice diagnosis.
LCD Criteria Reference: Consistent with LCD guidance for hospice in pulmonary disease: disabling dyspnea at rest, poorly responsive to bronchodilators, with progression of end-stage disease (recurrent ED/hospital visits), resting hypoxemia on supplemental oxygen, and cor pulmonale.
Relevant imaging: Chest CT 04/2026: severe emphysema with hyperinflation and no discrete mass; echocardiogram shows right ventricular dilation consistent with cor pulmonale.
Secondary conditions: Cor pulmonale, chronic hypoxemic respiratory failure, and mild protein-calorie malnutrition.

ADLs: Dyspnea limits all activity; requires assistance with bathing and dressing and uses a bedside commode. Ambulates only within the room with frequent rests. PPS 40% — a declining functional trajectory that supports hospice eligibility.