A 60-year-old female patient has been experiencing shortness of breath, coughing, and blue-tinged skin. She has worked in a chemical factory for 34 years. Spirometry tests indicate reduced lung capacity and airflow. Based on her symptoms and occupational exposure history, she likely has COPD in the form of emphysema.

1. Case Study 1

2.  Patient 1 is a five foot two inch, 130-lb
60-year old female non-smoker who has
worked in a chemical factory for the past 34
years. She complains of shortness of breath
and a continual cough that produces sputum.
Her doctor notes the patient is breathing with
pursed lips and her skin that has a slight
bluish color.

3.  Environmental factors (occupational
exposure to chemicals) and other symptoms
noted, including: shortness of breath,
productive cough, pursed lips breathing, and
cyanosis, are all possible indicators for
COPD (emphysema).

4.  A stethoscope can
be used to listen
to the lungs.
 However,
sometimes the
lungs sound
normal even when
COPD is present.

5.  X-rays and CT scans
can also be useful.
 But sometimes they
look normal even
when a person has
COPD.

6.  A blood test (called
arterial blood gas) can
also be done to measure
the amounts of oxygen
and carbon dioxide in
the blood.
 The carbon dioxide
measure gives some idea
of lung function.

7.  Check for reversibility by
administrating
Bronchodilators.
 If reversibility levels are
low then => COPD.
 Body Plethysmography -
results would show
Emphysema (>120%
predicted).

8.  The spirometry results would indicate the
possibility of obstructive lung disease, which
could include a number of different things:
emphysema, chronic obstructive pulmonary
disease (COPD), and asthma.

9. Respiratory Volume or
Capacity
Expected
Values *
Test Results % of
Expected
Value
Forced Vital Capacity
(FVC)*
2.90 2.20 76%
Forced Expiratory Volume
after 1 second (FEV1)*
2.30. 1.35 59%
FEV1/FVC*, ** 81.7% 61.4%
** Normal lung function usually
produces values > 80%.

10.  FVC (forced vital capacity): maximum volume of air
a person can exhale after taking the deepest breath
possible.
 FVC results indicate a significant reduction in
normal lung capacity. Percentage of expected
value is 76%
Respiratory
Volume or
Capacity
Expected
Values *
Test
Results
% of
Expected
Value
(FVC)* 2.90 2.20 76%

11.  FEV1 (forced expired volume in 1 second): volume expired in the
first second of maximal expiration after a maximal inspiration. This
is a measure of how quickly the lungs can be emptied in 1 second.
 FEV1 results indicate a significant reduction in lung emptying.
Percentage of expected value is 59%
Respiratory
Volume or
Capacity
Expected
Values *
Test
Results
% of
Expected
Value
(FEV1)* 2.30. 1.35 59%

12.  FEV1/FVC: FEV1 expressed as a percentage
of the FVC, gives a clinically useful index of
airflow limitation.
 FEV1/FVC results indicate a reduction.
FEV1/FVC is the ability of air to move through
airways, which would be expected to
accompany obstructive lung diseases.
Respiratory
Volume or
Capacity
Expected
Values *
Test
Results
FEV1/FVC*, ** 81.7% 61.4%

13.  By looking at the symptoms it
looks like this patient has COPD
Emphysema.
 Emphysema is a lung condition
where the alveoli overinflates with
air and causes shortness of breath
(dyspnea)
 The patient is also showing
symptoms of hypoxia-induced
cyanosis or the appearance of a
blue-to-purplish discoloration of
the skin. It is due to increased
levels of deoxyhaemoglobin in the
blood.

14.  Emphysema could be due to exposure to air pollution
as the patient has worked in a chemical factory for 34
years.
 Other factors which could cause emphysema includes;
Deficiency of an enzyme alpha-1-antitrypsin and/or
other chemicals and toxins.
Smoking tobacco and/or from second-hand smoke.