Chronic Obstructive Pulmonary Disease
What data in the clinical scenario supports your diagnosis? Progressively worsening dyspnea on exertion
Minor non-productive cough
Respiratory rate of 24 (high)
O2 saturation of 89% (low)
Hyperinflation
- What risk factor(s) led to this person’s diagnosis?
Hypertension
Hyperlipidemia
Smoking (Albarrati et al., 2010)
- Describe the key pathophysiologic concepts of the diagnosis in question 1
Patients with obstructive lung disease have difficulty in exhaling all the air in the lungs, while those with restrictive disease lung disease have difficulty fully expanding their lungs with air (Kim, 2017). Obstructive lung disease patients experience dyspnea (shortness of breath) due to damage to the lungs or narrowing of the airways inside the lungs. As a result, exhalation is slower than normal, and an abnormally high amount of air may still linger in the lungs at the end of a full inhalation. The problem exacerbates during exertion or increased activity. Patients with restrictive lung disease also experience dyspnea as their lungs are restricted from fully expanding, usually from stiffness in the lungs. Other causes of restrictive lung disease include stiffness of the chest wall and weak muscles. Mrs. X suffers from obstructive lung disease, indicted by dyspnea on exertion and minor productive cough.
COPD results in insufficient expiratory time (the time available for lung emptying) during spontaneous breathing. It prevents the end expiratory lung volume (EELV) from declining to its natural relaxation volume, leading to hyperinflation. Hyperinflation results in a higher functional residual capacity (FRC). In normal subjects, EELV approximates the relaxation volume of the respiratory system. But in patients with COPD, the EELV may exceed the predicted FRC. Lung emptying is slowed, and the expiration is interrupted by the next inspiratory effort before the patient has reached the static equilibrium volume (Kim, 2017).
Total lung capacity (TLC) is the volume of air in the lungs upon the maximum effort of inspiration (Delgado & Bajaj, 2019). Vital capacity is the total amount of air exhaled after maximal inhalation. Forced expiratory volume (FEV1) is the total volume of air exhaled during forced expiration.
COPD reduces FEV1, VC, while hyperinflation increases TLC.
In COPD, the diffusion capacity of the lung decreases with the increasing severity of the disease.
COPD patients have higher levels of CO2 on arterial blood gas tests due to their reduced ability to exhale carbon dioxide adequately (Pahal & Sharma, 2019).
- X has a Barrel Chest as an effect of hyperinflation. Her lungs are overinflated with air, so the rib cage stays partially expanded all the time (Kim, 2017).
- For what actual or potential complications related to the diagnosis in question 1 does she need to be monitored?
Respiratory infections
Heart problems
Lung cancer
High blood pressure in lung arteries
Depression