R.S. has smoked for many years and has developed chronic bronchitis, a chronic o

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.

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

2.Interpret RS’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia?

3.What is the rationale for treating RS with theophylline and a 2 agonist?

4.What effects would his respiratory disease have on his cardiovascular function?

5.Considering both his COPD and pneumonia, in what position would RS have the worst ventilation-perfusion matching?

Explanation / Answer

1: COPD is related to chronic bronchitis and emphysema. The patient is supposed to have chronic cough that can sustain from 3 months to two years. Additionaly, he is likely to suffer from bearthlessness during exertion, production of sputum and frequent episodes of hypoxemia leading to cyanosis. It differ from emphysema as the latter suffer from defeciency of alpha1-antitrypsin and reduced size of bronchioles.
2: The patient is suffering from compensated respiratory acidosis and have symptoms of moderate hypoxemia and mimld polycythemia. Acidic pH indicated presence of compensation. Chronic hypoxemia is causing the polycythemia.
3: -agonists have lesser side effects than theophylline. Theophylline are used to control the mild persistent asthma. -agonists treat it by promoting bronchodialation through increased cAMP by increased activity of adenyl cyclase.
4: There is contriction of pumonart arteries, more pressure on right chambers of heart leading to RV hypertrophy and RV heart failure.

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