This 64-year-old man was hospitalized because of increasing shortness of breathShortness of breath is a common clinical manifestation of heart failure., cough, increasing sputum production, and fever. The patient had a 75 pack-yearA pack-year denotes smoking one pack of cigarettes per day for one year. history of cigarette smoking. On admission his respiratory rate was 20 breaths per minuteA normal respiratory rate is 10 to 20 breaths per minute. and his pulse was 110 bpmA normal pulse rate is 60 to 100 bpm.. On room air his PaO2 was 46 mm HgA normal PaO2 is 80 to 105 mm Hg., his PaCO2 was 62 mm HgA normal PaCO2 is 35 to 45 mmHg., and the pH was 7.26A normal arterial pH is 7.35 to 7.45.. He was started on 24% O2 and after 6 hours his PaO2 was 52 mm HgA normal PaO2 is 80 to 105 mm Hg., his PaCO2 was 54A normal PaCO2 is 35 to 45 mmHg. and his pH was 7.30A normal arterial pH is 7.35 to 7.45.. His hemoglobin was 17.1 g/dLNormal hemoglobin for a male is 14 to 17.2 gm/dL., his PCV was 54%A normal hematocrit for a male is 39 to 49%., and his leukocyte count was 15,300A normal white blood cell count is 4000-11,000 cells/mm³. cells/mm³ with 13% bandsBand neutrophils are immature neutrophils in the circulation that indicates an increased demand, i.e. inflammation. Normal band levels in circulation are 3 to 5%., 65% PMNs, 15% lymphocytes, 4% monocytes and 3% eosinophils. Chest x-ray showed a narrow heart silhouette, a low, flattened diaphragm, and markedly lucent regions in the upper lung fields suggesting areas of emphysemaPulmonary emphysema is a condition in which the air spaces distal to the terminal bronchioles are permanently increased in size due to either destruction of the wall or alveolar dilatation.. An electrocardiogram showed tall P waves and a right axis deviation. The patient was given broad-spectrum antibiotics and was continued on his oral and inhalant bronchodilators and was started on a diuretic. His condition improved but two days after admission he suffered acute respiratory failure and could not be resuscitated.
Pertinent autopsy findings included emphysemaPulmonary emphysema is a condition in which the air spaces distal to the terminal bronchioles are permanently increased in size due to either destruction of the wall or alveolar dilatation. with moderate mucous plugging of bronchi. Right ventricular hypertrophy and dilation were also noted.
Chronic obstructive pulmonary disease is a group of conditions that lead to dyspnea. COPD entails emphysemaPulmonary emphysema is a condition in which the air spaces distal to the terminal bronchioles are permanently increased in size due to either destruction of the wall or alveolar dilatation., chronic bronchitis, bronchiectasis, and asthma. The conditions can occur to varying degrees and there are often complex combinations and severities of each entity. Cigarette smoke and other air pollutants can irritate the lung and lead to increased leukocytes, increased release of elastases, and increased oxidants which inhibit alpha-1 antitrypsin. These and a variety of other factors lead to destruction of the elastic tissue in the lung and result in abnormal lung function and lung damage.
The lung damage resulted in pulmonary hypertension which resulted in right ventricular hypertrophy. Over a period of time the increased workload will cause the right ventricle to fail and dilate. This process of right ventricular hypertrophy due to pulmonary hypertension is called cor pulmonale.
- eMedicine Medical Library: Chronic Obstructive Pulmonary Disease and Emphysema in Emergency Medicine
- eMedicine Medical Library: Chronic Obstructive Pulmonary Disease
- eMedicine Medical Library: Nicotine Addiction
- Merck Manual: Chronic Obstructive Pulmonary Disease
- Franks TJ, Galvin JR. Smoking-Related Interstitial Lung Disease. Arch Pathol Lab Med. 2015;139:974–977.
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