I Can’t Stop Coughing: A Case Study on the Respiratory System Mike is sitting in
ID: 58391 • Letter: I
Question
I Can’t Stop Coughing: A Case Study on the Respiratory System
Mike is sitting in his athletic training suite feeling sorry for himself. He moved from Southern California to play soccer at Northern Minnesota University (NMU) as a highly recruited player. All was well until he got sick with a miserable cold. He soon recovered, but now he finds himself with a lingering dry cough and difficulty catching his breath any time he exerts himself, which is every day! He also notices it has gotten worse as the weather has become colder. To make things worse, Mike feels, and looks, like he’s out of shape, so his coach has been criticizing him for dogging it.
A few days later, Mike relays his story to JP, the head athletic trainer at NMU. “I’m thinking my cold is coming back, or something else is wrong with me. When I’m just hanging out, like now, I feel fine. But as soon as I start to run I get winded and can’t stop coughing.” JP listens to Mike’s breathing sounds with his stethoscope, but hears nothing abnormal. So he tells Mike to come back as soon as the symptoms return during soccer practice. Twenty minutes later, Mike is back in the athletic training suite, audibly wheezing, coughing, and short of breath. The team physician, Dr. McInnis, happens to be there and performs a complete physical exam. He also does pulmonary function tests with Mike using spirometry, including a forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). He instructs Mike to take a maximal inhalation and then exhale as forcefully and maximally as possible into the spirometer.
Based on his findings, Dr. McInnis tells Mike he thinks he is experiencing cold-induced bronchoconstriction (also called cold-induced asthma), which is made worse by exertion. The doctor explains to Mike that his recent upper respiratory infection probably inflamed his airways, making them hypersensitive and reactive to irritants, such as cold and physical exertion. When Mike exercises in the cold, autumn afternoons of Minnesota, his sensitive airways temporarily bronchoconstrict, causing the symptoms he is experiencing. Asthma is almost always a reversible condition. Dr. McInnis prescribes two puffs of an albuterol inhaler, to be used 10 minutes before a bout of exercise in the cold.
Short Answer Questions:
Describe the relationship between intrapulmonary pressure, atmospheric pressure, and air flow during normal inspiration and expiration, referring to Boyle’s law.
Resistance varies in Mike’s conducting airways. Using your understanding of respiratory anatomy, explain where in his airway the resistance is highest and why.
Several physical factors that influence the efficiency of pulmonary ventilation are compliance, alveolar surface tension, and airway resistance. Briefly describe each factor and identify the one that is affecting Mike’s efficiency of breathing.
What must happen to Mike’s intrapulmonary pressure in order for him to maintain normal air flow during inhalation and exhalation when he is having one of his asthma attacks?
How does Mike’s body make the necessary changes in intrapulmonary pressure to maintain normal air flow when he is experiencing cold-induced asthma?
When Mike is experiencing an asthmatic attack, his forced vital capacity (FVC) is 65%, and his FEV1 is 65%. Are these values normal? Knowing how one performs FVC tests, explain these test results in Mike’s case. (Assume that Mike and the doctor have performed an accurate test.)
Albuterol is a selective beta-2 adrenergic agonist, which means it specifically activates beta-2 adrenergic receptors on smooth muscle in the airways. How does this improve Mike’s asthma?
Using your knowledge of the respiratory system, explain the benefit of athletes training at high altitudes when they compete at normal altitude levels?
Explanation / Answer
1. During inspiration, the volume of the thoracic cavity increases, causing intrapulmonary pressure to fall below atmospheric pressure. Since air moves from areas of high to low air pressure, air flows into the lungs. At the end of inspiration, the intrapulmonary pressure again equals atmospheric pressure, therefore, airflow stops. In contrast, during expiration, the volume of the thoracic cavity decreases, resulting the increased intrapulmonary pressure to above atmospheric pressure. Then, air flows out of the lungs until the end of expiration where again the intrapulmonary pressure equals to atmospheric pressure.
2. Bronchoconstriction is the narrowing of the airways (bronchi and bronchioles) in the lungs. Air flow is restricted by smooth muscle contraction, mucus accumulation, and inflammation of the airways.
3. Cold environment, upper respiratory tract infection that's resulting inflammation, atmospheric pressure etc. Cold is a major factor that affecting the bronchi muscle movement/intrapleural pressure and cold-induced allergy also responsible for Mike's problem of asthma.
4. Intrapleural pressure will be increased in Mike's asthma due bronchoconstriction, so it has to come down for normal inhalation and exhalation.
5.Smooth muscles in the bronchi and bronchioles of the lungs will be relaxed and intrapulmonary pressure will get reduced to maintain normal air flow.
6. No, these values are less than normal.the FVC will be decreased due to the premature closure of the airway in expiration. FVC is the volume of air that can forcibly be blown out after full inspiration that will be measured in liters. FVC is the most basic maneuver in spirometry tests.
7. It has smooth muscle relaxation activity that causes dilation of bronchial passage
8. At high altitudes, the oxygen partial pressure will be low, so training at these conditions adapts the circulatory system to retain oxygen and decreases the affinity of 2,3-BPG with Hb. It also adapts the lung smooth muscle contraction in response to low O2 pressure and FVC of lungs will be increased in athletes at high altitudes.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.