Question

A 37-year-old man is 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 a 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. PFT 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 In view of the pre- and post-bronchodilator data, does he have airways that are likely to respond to β2-agonist drug therapy?

          A 37-year-old man is 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 a 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. PFT 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
In view of the pre- and post-bronchodilator data, does he have airways that are likely to respond to β2-agonist drug therapy?

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 consisten 82548

Added by Thomas E.

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