Bernie Martin is a 65-year old retired auto worker, married with 3 adult children and 7 grandchildren. He worked in a c

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Bernie Martin is a 65-year old retired auto worker, married with
3 adult children and 7 grandchildren. He worked in a car
manufacturing plant for 43 years. Bernie is a chain
smoker.
Bernie made an appointment with his physician because he was
having difficulty breathing. The Dr. noted a prolonged expiratory
phase in his breathing and expiratory wheezes. His nail beds
were cyanotic, and he had moderate pitting edema of his
ankles. Based on these observations and results of his
pulmonary function (Table 1) and laboratory (Table 2) tests, the
physician concluded that Bernie has a combination of emphysema and
bronchitis, called chronic obstructive pulmonary disease (COPD),
which resulted from his long history of smoking.
Table 1: Pulmonary Function Results:
Respiratory Rate
20 breaths per minute
Tidal Volume
600 ml (normal for age and gender)
IRV
2200 ml (normal for age and gender)
ERV
800 ml (decreased for age)
RV
2490 ml (increased for age)
FEV1
1730 ml (decreased for age)
Vital Capacity
3000 ml (decreased for age)
Functional Residual Capacity
Increased
Expiratory Flow Rate
Decreased
Table 2: Laboratory Test Results
Hemoglobin
16.5 g/dl (normal for men, 14-17
g/dl)
PaO2 (arterial
PO2)
48 mmHg (normal 100 mmHg)
PaCO2 (arterial
PCO2)
69 mmHg (normal, 40 mmHg)
HCO3-
34 mEq/L (normal 24 mEq/l)
Oximetry
78% saturation