chronic obstructive pulmonary disease

Case Study #3_10
A 67-year-old man presents to your office with worsening cough, sputum
production, and shortness of breath. He has been a cigarette smoker for the past 50
years, smoking approximately 1 pack a day. He has a chronic AM cough productive
of some yellow sputum but generally feels okay during the day. He was in his usual
state of health until two weeks ago when he developed a cold. Since then, he has had
a hacking cough and increased thick sputum production. He also has had difficulty
walking more than a block without stopping due to shortness of breath. Physical
examination reveals prolonged expiration, audible wheezing, and diffuse rhonchi
throughout both lung fields. Chest x-ray shows hyperinflation of both lungs with a
flattened diaphragm.
Questions:
1. What are the two major clinical syndromes that are classified as chronic
obstructive pulmonary disease? How do they differ?
2. Of the two syndromes above, which is predominant in this patient? What is the
epidemiology and predisposing factors for this condition?
3. What might the pulmonary function tests show in this patient?