Mini Case study Chapter 1

A 60-year-old male patient came to the clinic with a history of difficulty in breathing and chronic
productive cough (cough with mucus). He complains of getting tired and breathless with mild exertion.
The patient has thirty years of cigarette smoking history.
1. Physical examination: Overweight male with cyanosis (skin appears slightly blue). Breathing rate is 30
breath/min (Normal 14 -18 breath/min)
2. Listening to chest – Wheezing (abnormal breathing sounds) heard on both lungs.
Normal Bronchial Breathing: https://depts.washington.edu/physdx/audio/b_breath.mp3
Wheezing: https://depts.washington.edu/physdx/audio/wheeze.mp3
3. Imaging: Chest X-Ray shows inflammation in bronchi (air tubes).

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4. Pulmonary Function Tests: shows decreased movement of air.
5. Laboratory Findings;
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Test Patient Normal

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Blood Oxygen 76% 97% - 99%

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saturation
Blood CO2 level 50 35 -45 mmol/dl
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After the history, physical examination, lab tests, and imaging, diagnosis of COPD (Chronic Obstructive
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Pulmonary Disease) is established.

As a health care provider, you want to understand how the body would respond upon facing the above
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changes.
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COPD is a chronic condition that can be caused by smoking in addition to other causes. Continuous
smoking acts as a persistent irritant, which can cause:
a. It can damage air sacs making them less elastic.
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b. It can slowly damage the walls of the airways.

c. Chronic inflammation can make the airways thick.
d. Due to chronic inflammation, the airways produce more mucus than usual and become clogged.

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 Mini Case study Chapter 1

The above disease process, irreversibly damages the airways, decreasing their diameter. Less air flows
in and out of the lungs that result in less oxygen diffusing into the blood, and as a result, the blood
oxygen level decreases, and similarly, less CO2 diffuse from the blood into the lungs and blood CO2
level increases. Chemoreceptors, located in large blood vessels, detect the change in blood gases. The
message of change is sent to the brain (Pons and Medulla). After evaluation of this change, the
response is sent to the respiratory muscles to speed up the process of breathing, increasing the
breathing rate, but the blood gas level does not reverse back to normal.
Q1. Blue skin discoloration is a sign or a symptom?
Blue skin discoloration is a sign.

Q2. Click the above links to listen and compare normal bronchial breathing and wheezing. How do they
differ in their sound quality, and what caused wheezing?

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The sound quality of the normal breathing is smooth and regular pitched. The wheezing sound quality

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seems to have an added high-pitched noise with each breathe. The wheezing was caused by thicker,

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clogged airways caused by mucus and inflammation.

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Q3. The chest X-Ray image is taken in which plane?
The chest X-Ray image is taken in the coronal/frontal plane.
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Q4. Which controlled condition is changed in this patient?

The controlled condition changed in this patient is normal blood levels of O2 and CO2.
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Q5. What type of receptors detected the change in the blood levels of O2 & CO2, and where are they
located?
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The chemoreceptors in the brain stem detect this change.

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Q6. Which organ is acting as the control center in this situation?

The lungs act as the control center in this situation.
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 Mini Case study Chapter 1

Q7. What type of feedback loop is employed to correct the change?

A negative feedback loop is employed to correct the changed by increasing breathing, working towards
reversing the low levels of oxygen.

Q8. Was the change in blood gases level reversed? Yes / No - If NOT, what was the reason?
No, the change was not reverse according to the patient results. The reason it was not reverse is because
the lungs were not functioning properly due to the patient’s condition. The air passages were inflamed
and thickened because of COPD caused by smoking.

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