Question

A 67-year-old man presents to the doctor’s office with worsening cough, sputum production, and shortness of breath. He has been a cigarette smoker for the past 50 years, smoking approximately 1 pack a day. He has a chronic AM cough productive of some yellow sputum but generally feels ok during the day. He was in his usual state of health until two weeks ago when he developed a cold. Since then, he has had a hacking cough and increased thick sputum production. He also has had difficulty walking more than a block without stopping due to shortness of breath. Physical examination reveals prolonged expiration and audible wheezing. Chest x-ray shows hyperinflation of both lungs with a flattened diaphragm.

1. What are the two major clinical syndromes classified as chronic obstructive pulmonary disease? How do they differ?

2. Of the two syndromes above, which is predominant in this patient? What are the epidemiology and predisposing factors for this condition? What is the most important identified genetic risk factor for the evolution of COPD?

3. What might be pulmonary function tests show in this patient since he shows “prolonged expiration” i.e FEV1/FVC?

4. What does ventilation-perfusion mismatch mean? How do arterial blood gases different in chronic bronchitis and emphysema and related it to “pink puffer” or “blue bloater”?

Answer 1

1)Emphysema and chronic bronchitis are the two major clinical syndromes classified as COPD ( **copd is a umbrella term for asthma, emphysema and chronic brochitis** )

Emphysema= (air sac damage) is a chronic condition in which there is distension of alveoli and distension of the bronchioles and loss of elasticity so that inspired air cannot b expired. Bronchitis(inflammed air way) =is an inflammation of mucous membranes of the bronchi and cough that produces sputum for 3 months for 2 consecutive years

2) pt has chronic bronchitis predominantly but emphysema is also developing with a pace.Epidemiology of the chronic bronchitis is that it occurs most in chronic smokers, older adults , coal mine workers , it is generally caused by smoking etc . Predisposing factors are may b breathing irritant substances like chemicals fog, smoke , virus, bacterias. α1-antitrypsin deficiency is the the genetic cause of the copd

3) the pft test

FEV1/FVC ( forced expiratory volume) in one second....will show 40-60% that means the person has a moderate copd

4) the ventilation perfusion mismatch means that the air reached to alveoli and blood reached to alveoli are not according to the ventilation - perfusion ratio (normal is 1:1 ) this mismatch may b due to obstruction to air flow or obstruction of blood vessel

ABG for emphysema the oxygen level in the blood will b dropped as the damage is in the air sacs and in bronchitis the oxygen levels will b less than emphysema as the entry to air is blocked

Pink puffer occurs in emphysema means puffing to breathe (hyperventilation) and pink complexion ( maintain oxygen level with rapid breathing) , blue bloaters occurs in bronchitis = cynosis ( blue) and edema (bloating)