Patient case (clinical description): A 30-year-old man who is a computer scientist came to the clinic with the lab result stating azoospermia.  The patient is sexually active with his wife and does not use any contraception methods.  They have been trying to conceive for the past year with no success.  The patient has a past medical history of recurrent pneumonia, shortness of breath, and  persistent cough that produces large amounts of thick sputum. The patient had multiple lung infections during childhood. He does not smoke, use illicit drugs or alcohol.  The patient has no history of other medical conditions including allergies or any kind of surgery.  On physical examination, the digits show clubbing.  An ultrasound shows bilateral absence of the vas deferens, and FEV1 was 75% on the respiratory function test.

Patient's own account: I'm a 30-year-old computer scientist. I did some lab tests that came back quite alarming, stating that I have azoospermia?! I'm sexually active with my wife and we don't use contraception. We've been trying to have a child for the past year. I have a medical history of pneumonia and shortness of breath and regular wet cough. I had several lung infections when I was a kid. That's why I'm very careful and don't smoke, do drugs, or drink. I don't have other medical conditions including allergies or any kind of surgery. The doctor did the clubbing test on my fingers, which was positive. I also did an ultrasound and it showed that I'm missing the tubes that carry sperm around. I also had a 75% for my respiratory function test.

Clinical trial: Dyspnea Self-Management: Internet or Face-to-Face

Eligibility criteria:
Inclusion Criteria:

          -  Participants will have:

               1. a diagnosis of COPD which is clinically stable (including medications) for at
                  least one month;

               2. spirometry results showing at least mild obstructive disease defined as post
                  bronchodilator forced expiratory volume in one second (FEV1)/forced vital
                  capacity (FVC) ratio <0.70 with FEV1<80% predicted or post-bronchodilator
                  FEV1/FVC ratio <0.60 with FEV1>80% predicted;

               3. ADL limited by dyspnea;

               4. a designated primary care physician;

               5. ability to speak English and sign consent form;

               6. actively using a computer and the Internet;

               7. no formal pulmonary rehabilitation training for at least 12 months;

               8. patients receiving supplemental oxygen will be acceptable if their O2 saturation
                  can be maintained at >80% on <6L/min of nasal oxygen;

               9. understands how to and is able to rate their shortness of breath during exercise;

              10. age > 40 years.

        Exclusion Criteria:

          -  Subjects will be excluded if they have active symptomatic illness (e.g., cancer, left
             heart failure, ischemic heart disease with known coronary artery or valvular heart
             disease, psychiatric illness, and neuromuscular disease).
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 40 Years old.


Eligibility (NLI label): Contradiction