Chronic clogging pneumonic disease ( COPD ) is a progressive. non-reversible disease that makes take a breathing hard. COPD is characterized by coughing. frequently productive ; wheezing ; shortness of breath ; and chest stringency. The taking cause of COPD is cigarette smoke ( National Institutes of Health. 2013 ) . While 85 % of COPD patients are or were tobacco users. merely 10-25 per centum of tobacco users develop COPD. proposing that a familial sensitivity may besides be a factor ( Warren. 2012 ) . COPD is the 3rd prima cause of decease and major cause of disablement in the United States ( National Institutes of Health. 2013 ) .

Pathophysiology of COPD

Two primary disease processes that contribute to COPD are emphysema and chronic bronchitis. The chief difference between emphysema and chronic bronchitis is that in emphysema harm is to the walls of the air pouch in the lungs and in chronic bronchitis the harm is to the liner in the air passages. Both conditions are by and large caused by long term exposure to lung thorns. the most common of which is cigarette fume. Other typical lung thorns lending to COPD are air pollution. chemical exhausts. and dust. The lung thorns cause redness ; when redness is chronic. it causes scar tissue. Scar tissue in the air passages decreases snap. air pouch are destroyed. walls of air passages become thick and inflamed. and mucose production additions. The terminal consequence of damaged air passages and extra mucose is decreased gas exchange and decreased lung capacity doing the symptoms of COPD ( National Institutes of Health. 2013 ) .

Patient History and Physical Examination

Mrs. Jones is a new patient who is a 56 twelvemonth old Caucasic female. She has late moved from Minnesota to Arizona. She has a history of COPD and seasonal allergic reactions which she has been handling with Claritin 10mg and Albuterol MDI 2 whiffs PRN. Mrs. Jones was a tobacco user. smoking two battalions per twenty-four hours for 30 old ages and discontinue two old ages ago. Her household history is noncontributory. Mrs. Jones nowadayss with recent weariness. declining fluid nose and productive cough in the forenoon. sneeze. antsy pharynx. shortness of breath with minimum effort. hearable wheezing. and inability to kip through the dark. She has admitted to utilizing her inhalator more frequently than prescribed in an effort to cover with the deterioration symptoms. She denies alteration in the colour of her phlegm. discolored rhinal drainage. concern. facial hurting. loss of appetency. and chest hurting.

Physical test showed a well-groomed. well-fed adult female who is concerted and appropriate. Critical marks are blood force per unit area: 128/72. pulsation: 88 and regular. and respirations: 20. Lungs have bilateral basilar wheezing. Heart is regular and without mutters. Abdomen is soft and non-tender with intestine sounds present. It is noted that she has dark circles under both eyes. Current O impregnation was 92 % on room air at remainder. Spirometry consequences were FEV1=45 % and FEV1/FVC=65 % .

Clinical Diagnosis

It appears that Mrs. Jones is holding an aggravation to her environmental allergic reactions as evidenced by the sneeze. antsy pharynx. and fluid olfactory organ. The Claritin that was working in Minnesota is non working every bit good with the allergens alone to Arizona. The dark circles under her eyes are frequently grounds of increased allergic reaction known as allergic black eyes. However. the reduced O impregnation and spirometry values are more declarative of terrible ( stage III ) COPD. defined by the GOLD criterion as FEV1/FVC