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    Arnold, 67, visited his doctor for the first time in about ten years because he had noticed an increasing shortness of breath during gentle exercise. He has found this shortness of breath most noticeable whilst climbing stairs or walking up hills. Arnold had smoked one packet of cigarettes per day for about 50 years, but he recently gave up smoking because of his shortness of breath.

    Arnolds doctor firstly noted that Arnold seemed thin and had a good skin colouration. On questioning it seemed that Arnold had developed a chronic cough that produced only a relatively small amount of sputum. However, he apparently suffered no chest pains, no wheezing or any noticeable changes in normal breathing. On examination, Arnold showed no cyanosis, but some edema of the extremities. He had a pulse of 110, a respiration rate of 18 (unlaboured), and a blood pressure of 115/86 and an oral temperature of 37 degrees C. Examination of Arnolds chest revealed hyper resonation and decreased breath sounds without wheezing or crackles. Pulmonary function tests revealed:

    (see chart in attached file)

    After further laboratory tests Arnold was diagnosed as suffering from Emphysema.

    Overview Arnold's history and answer the following questions:

    Explain how Arnold's history as a smoker may have influenced progression of his disease.

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    Solution Preview

    Emphysema: It is known from scientific research that the normal lung has a remarkable balance between two classes of chemicals with opposing action. The elastic fibers in the lung allow the lungs to expand and contract. When the chemical balance is altered, the lungs lose the ability to protect themselves against the destruction of these elastic fibers. This is what happens in emphysema.
    <br>There are a number of reasons this chemical imbalance occurs. Smoking is responsible for the majority (80% - 90%) of COPD (chronic obstructive pulmonary disease) cases, including emphysema.
    <br>In addition, it is estimated that 50,000 to 100,000 Americans living today were born with a deficiency of a protein known as alpha 1-antitrypsin (AAT) which can lead to an inherited form of emphysema called alpha 1-antitrypsin (AAT) deficiency-related emphysema. Emphysema begins with the destruction of air sacs (alveoli) in the lungs where oxygen from the air is exchanged for carbon dioxide in the blood. The walls of the air sacs are thin and fragile. Damage to the air sacs is irreversible and results in permanent "holes" in the tissues of the lowerlungs.
    <br>As air sacs are ...