Bernie Sullivan is a 73-year old retired seamstress who has never married. She w

Question

Bernie Sullivan is a 73-year old retired seamstress who has never married. She worked in the alterations department of a men's clothier for 48 years. Bernie is a chain smoker. On the job, she was never found without a cigarette hanging from her lips. When her employer announced that smoking was no longer allowed in the store, Bernie retired. Since her retirement three years ago, Bernie has not been feeling well. She fatigues easily, even with light exertion. She has shortness of breath and recently has begun to sleep on two pillows. However, despite these problems, she has refused to stop smoking. Ms. Sullivan made an appointment with her physician, who noted a prolonged expiratory phase in her breathing, expiratory wheezes, and increased anteroposterior (AP) chest diameter. Her nail beds were cyanotic, and she had moderate pitting edema at her ankles. Based on these observations and results of laboratory and pulmonary tests, the physician concluded that Ms. Sullivan has a combination of emphysema and bronchitis, called COPD, which resulted from her long history of smoking. The results of pulmonary function and laboratory tests are given below. Vital Capacit Residual Volume Functional Residual Capacit FEVi; Expiratory Flow RateDe Decreased Increased Increased Decreased 14.5 g/dL (normal is 12-15 85% 45 mm H 70 mm H 34 mEq/L (normal is 24 mEa/L g/dL Hemoglobin O2 saturation Arterial Po2 Arterial Pco bicarbonate

Explanation / Answer

1. Alpha 1 Antitrypsin is a protease inhibitor protein, responsible for maintaining the elasticity of the lung (alveolar) sac also prevent WBC damaging from normal tissue. Smoking causes a deficiency of Alpha 1 Antitrypsin which damages the liver tissue, causing the sac to lose the elasticity and get squeezed a condition called Emphysema.

2. Vital Capacity (VC): is the maximum amount of air the lungs can hold, normally 3000 – 4600 mL. In smokers, the lungs losses the capacity to hold air since its losses it's elasticity causing lower VC.

Residual Volume (RV): is the amount of air left after exhaling completely, normal value 1200 mL. In smokers, the lungs cannot push the air out as sac loosens, causing more air to stay in the lungs thus increasing the RV levels.

Functional Residual Capacity (FRC): is the amount of air remaining in the lungs at the end of a normal exhalation, normal value 1800 – 2200 mL. Similar to Residual Volume, the air stays in normal exhalation causing a high level of FRC.

Forced Expiratory Volume-one second (FEV1):  is the amount of air that is exhaled in one second after a deep inhalation, normal value is equal to or greater than 80%. Similar to vital capacity the amount air to hold decrease when a lung losses its capacity causing lower FEV1.

3.

Mild : 50-79%

Severe : <50%

4. Arterial PO2  is the amount of oxygen in the arterial blood. The oxygen binding capacity decreases due to smoking causing the lower PO2. Since her Hb level is higher her Hct level is normal.

Measure Healthy Abnormal Forced Vital Capacity (FVC) Equal to or greater than 80% Mild : 70-79%
Moderate : 60-69%
Severe : less than 60% Peak Expiratory Flow rate (PEFR) 80-100%

Mild : 50-79%

Severe : <50%

Residual Volume (RV) 1200 mL <60% of normal value

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