A 19-year-old female college student presents to the emergency department complaining of chest tightness and dyspnea. She was cutting and trimming the lawn when these symptoms developed.

A 19-year-old female college student presents to the emergency department complaining of chest tightness and dyspnea. She was cutting and trimming the lawn when these symptoms developed. Rhinorrhea and tearing began soon after she went outside and preceded the chest discomfort. Going inside did not relieve her symptoms. During the physical examination, she said, “I have had asthma since childhood, and my mother and brother also have asthma.” Her respiratory rate was 30 breaths per minute, and she exhibited the use of accessory muscles for respiration. Breath sounds were decreased, except for expiratory wheezes. Heart sounds were distant with tachycardia but regular.

Identify appropriate laboratory tests. Indicate what therapies might be initiated. What worsening signs and symptoms may manifest?

CASE STUDY II

Mr. S. is a retired 69-year-old county attorney who was on a buying trip with his wife

looking for old, classic cars in the high, mountainous country of Colorado when he

became extremely short of breath, much more than usual. His alarmed wife took him

to a multispecialty medical clinic for evaluation.

Upon admission, Mr. S. was restless and dyspneic. His history revealed a habit

of smoking two packs of cigarettes a day for 45 years (90 pack years). During the past

few years, Mr. S. noticed a cough each morning on arising. Recently, while working in

his flower garden, he had to stop at times to catch his breath. He stated, “Even while

I’m watching television, it is sometimes hard to breathe.”

On examination, the anteroposterior diameter of his chest was enlarged, and upon

percussion, his chest exhibited a hyperresonant sound. A chest radiograph was

taken, and pulmonary function tests were done. The chest radiograph revealed a

flat, low diaphragm with lung hyperinflation, but clear fields. Pulmonary function tests

showed decreased tidal volume and vital capacity, increased total lung capacity, and

prolonged forced expiratory volume.

Which pulmonary disease is exhibited by Mr. S.’s symptoms? Justify your answer.