Case-3: Patient History S.S. is a 37-year-old man in the clinic today for worsening shortness of breath. He first noticed decreasing activity tolerance at age 28, at which time an x-ray revealed some hyperinflation consistent with mild emphysema. He had been smoking one pack of cigarettes per day since age 15 and quit at age 28. However, his shortness of breath has continued to progress. Physical examination reveals a thin man in moderate respiratory distress. There is marked increase in the anteroposterior diameter, distant lung sounds, and occasional expiratory wheeze. Blood gases on room air are as follows: pH 7.42, PaCO2 40, PaO2 71, HCO3- 26. Pulmonary function test results are as follows: Predicted Normal Pre-Bronchodilator (Percentage of Predicted) Post-Bronchodilator (Percentage of Predicted) FEV1 3.8 L 16 18 FVC 4.8 L 29 35 FEV1/FVC >70% 44 40 TLC 7 L 130 130 Analyze this case study and answer the next two questions that follow.
What other treatment options could be offered? (select all that apply)
Supportive therapy includes adequate rest, proper hydration, and physical reconditioning programs.
Pneumococcal and yearly flu vaccines are recommended.
α1-Antitrypsin replacement therapy is an expensive option with minimal benefit at his stage of disease.
Pursed-lip breathing or abdominal breathing exercises may also be beneficial.
Considering his ABGs and PFT results, how would you categorize S.S.âs lung pathology, and what data indicate this?
He has a increased FEV and FVC, and an increased total lung capacity (TLC).
There is no need to treat his emphysema at this stage.
He presents with mild hypoxemia; otherwise ABGs appear relatively normal due to compensation by increasing respiratory rate.
FEV1/FVC ratio does not indicate that severe obstruction is present.
Case-3: Patient History S.S. is a 37-year-old man in the clinic today for worsening shortness of breath. He first noticed decreasing activity tolerance at age 28, at which time an x-ray revealed some hyperinflation consistent with mild emphysema. He had been smoking one pack of cigarettes per day since age 15 and quit at age 28. However, his shortness of breath has continued to progress. Physical examination reveals a thin man in moderate respiratory distress. There is marked increase in the anteroposterior diameter, distant lung sounds, and occasional expiratory wheeze. Blood gases on room air are as follows: pH 7.42, PaCO2 40, PaO2 71, HCO3- 26. Pulmonary function test results are as follows: Predicted Normal Pre-Bronchodilator (Percentage of Predicted) Post-Bronchodilator (Percentage of Predicted) FEV1 3.8 L 16 18 FVC 4.8 L 29 35 FEV1/FVC >70% 44 40 TLC 7 L 130 130 Analyze this case study and answer the next two questions that follow.
What other treatment options could be offered? (select all that apply)
| Supportive therapy includes adequate rest, proper hydration, and physical reconditioning programs. |
| Pneumococcal and yearly flu vaccines are recommended. |
| α1-Antitrypsin replacement therapy is an expensive option with minimal benefit at his stage of disease. |
| Pursed-lip breathing or abdominal breathing exercises may also be beneficial. |
Considering his ABGs and PFT results, how would you categorize S.S.âs lung pathology, and what data indicate this?
| He has a increased FEV and FVC, and an increased total lung capacity (TLC). |
| There is no need to treat his emphysema at this stage. |
| He presents with mild hypoxemia; otherwise ABGs appear relatively normal due to compensation by increasing respiratory rate. |
| FEV1/FVC ratio does not indicate that severe obstruction is present. |
