Question

R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia.

What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD?

Answer 1

R.S. with COPD likely presents with coughing, increased mucus production, wheezing, and shortness of breath due to chronic bronchitis. The condition leads to airflow limitation, inflammation, and mucus blockage in bronchial tubes. Clinical findings differ from emphysematous COPD, which primarily involves alveolar damage and air trapping.

Step-by-step explanation:

Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent respiratory symptoms and airflow limitation due to alveolar and airway abnormalities usually caused by significant exposure to noxious particles or gases. In the case of R.S., who has smoked for many years, we would expect to see clinical findings such as coughing, chronic mucus (sputum) production, wheezing, and shortness of breath, which worsen over time. Due to chronic bronchitis, a type of COPD, the bronchial tubes become inflamed and narrower and the lungs produce more mucus, which can cause further blockage of the airflow.

With his history of coronary artery disease and peripheral arterial vascular disease, R.S. might also present with elevated heart rate and low blood oxygen levels (hypoxemia). His ABG values indicate respiratory acidosis, as evidenced by the low pH, high PaCO2, and compensated high HCO3-. His elevated hematocrit could be a response to chronic hypoxemia, increasing the number of red blood cells to carry more oxygen. In comparison to emphysematous COPD, which involves the destruction of alveoli and decreased elastic recoil of the lungs, leading to hyperinflation and air trapping, chronic bronchitis primarily affects the airways rather than the alveoli. In emphysema, one might expect to see a barrel-chested appearance, diminished breath sounds, and prolonged expiration.