Case #2 67yo female with COPD with a history of smoking 50 pack years. Last LD CT 3 months ago with <6mm

Case #2 67yo female with COPD with a history of smoking 50 pack years. Last LD CT 3 months ago with <6mm polyps seen x2 in RLL. Presents with increasing shortness of breath, expectorating yellow green phlegm with some rusty attributes at times. She reports she sleeps with 4 pillows at night. She wears O2 at night 3LNC and she is able to get 4-5 hrs of solid sleep nightly but wakes wheezing and needing a nebulizer treatment around 230-am nightly which is unusual for her. She also reports chills the last few days. She took a covid test the morning of her appointment and it was negative. She denies chest pain however she does report a pain in her right lateral lower costal margin with deep inspiration. Allergies NKDA PMH COPD HTN MHLD PSurgHX Traumatic splenectomy 20 yrs ago, HX of spontaneous ptx with subsequent Pleurodesis. T: 100.9 P: 108 RR: 28 Pox on RA: 92% BP 160/90 Const: Looks fatigued, Orthopneic with tripoding and sl diaphoretic HEENT: NCAT EOMI Conjunctivae pale Nares patent Throat : No LAD Trachea midline No Thyromegally and NTTP, No carotid bruits noted, nor JVD Chest: TTP Right lower costal margin Lungs with Scattered