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Submitted To:
Mrs. Jacqueline G. Ocampo

Submitted By:
Alvarez, Debbie Anne P.
Blay, Gizelle R.

Chronic Obstructive Pulmonary Disease (COPD): A Case Study

Patient M is a 55 year old driver used to life on the road. As a driver, he always drives all day to
earn money. He was diagnosed of COPD in 2006 and came as a total shock. As the disease progressed,
his doctor told him he had to stop driving if he wanted to keep his quality of life. At first, he was depressed
at the thought of having COPD. He was worried about the emotional, physical, and financial impact it
would have on his life.
He was constantly having cough during the last 3 weeks before he was brought to the hospital by
his youngest daughter. Lately, he has been experiencing troubles in breathing. He described it as a
difficulty in expiration during breathing. For this reason, he asked his youngest daughter who is living just
two blocks away from him to take him to the hospital. He had a history of recurrent respiratory infections
that had resulted in three hospitalizations in the past year. This 55-year old man admits to be a chronic
smoker, consuming two packs per day and drinks alcoholic beverages regularly with his friends.
Like many diseases, COPD is not caused by one particular source. Air pollution, occupational
dusts and chemicals can also cause COPD when the exposures are sufficiently intense or prolonged.
Family history revealed that both parents had been smokers and were diagnosed with emphysema; the
patients mother died of lung cancer at the age of 64.
The patient reports loss of appetite and continuing weight loss. His ideal weight supposed to be is
75 kg but it drop off to 62 kg at last check-up. He depends on his daughter for food shopping and most of
his meal preparation. He acknowledges the need to be on low-salt diet, but has never discussed his
dietary requirements with his daughter. He rarely can consume full meals and his intake is inadequate.
Dietary recall suggests a high proportion of carbohydrate calories.
Patient M find breathing more difficult when he is lying down, he often sleep in an upright position.
But sitting up makes it hard to fall asleep and stay asleep. He also has sleep apnea, which is when his
breathing is interrupted during sleep. Sleep apnea can result in loud snoring, frequent awakenings, and
severe sleepiness in the daytime. His doctor prescribed a sleep medication that will help him sleep better.
He is well developed but obviously underweight with reduced muscle mass and strength. Exam
is remarkable for distant heart sounds, distant and decreased breath sounds with prolonged expiratory
wheezing. After undergoing a thorough examination, his physician ordered a series of sputum tests and
other lung tests. Chronic infection was detected in the lungs most probably due to smoking which irritates
the bronchi and bronchioles. There was also obstruction of the airways which is responsible for patient's
difficulty in expiration. The chronic infection as is seen in patient M's case is caused by his excessive
smoking or other substances which irritate the bronchi and the bronchioles. The principal reason for the
chronic infection is that the irritant seriously deranges the normal protective mechanisms of the airways,
including partial paralysis of the cilia of the respiratory epithelium by the effects of nicotine; as a result,
mucus cannot be moved easily out of the passageways.
Finally, he realized that the most important aspect of treatment is avoiding tobacco smoke and
removing other air pollutants from the patients home or workplace. Symptoms such as coughing or
wheezing can be treated with medication. Respiratory infections should be treated with antibiotics, if


The respiratory system consists of all the organs involved in breathing. These include the nose,
pharynx, larynx, trachea, bronchi and lungs. The respiratory system does two very important things: it
brings oxygen into our bodies, which we need for our cells to live and function properly; and it helps us
get rid of carbon dioxide, which is a waste product of cellular function. The nose, pharynx, larynx, trachea
and bronchi all work like a system of pipes through which the air is funnelled down into our lungs. There,
in very small air sacs called alveoli, oxygen is brought into the bloodstream and carbon dioxide is pushed
from the blood out into the air. When something goes wrong with part of the respiratory system, such as
an infection like pneumonia, chronic obstructive pulmonary diseases, it makes it harder for us to get the
oxygen we need and to get rid of the waste product carbon dioxide. Common respiratory symptoms
include breathlessness, cough, and chest pain.
The Upper Airway and Trachea
When you breathe in, air enters your body through your nose or mouth. From there,
it travels down your throat through the larynx (or voicebox) and into the trachea (or windpipe) before
entering your lungs. All these structures act to funnel fresh air down from the outside world into your body.
The upper airway is important because it must always stay open for you to be able to breathe. It also
helps to moisten and warm the air before it reaches your lungs.
The Lungs
The lungs are paired, cone-shaped organs which take up most of the space in our chests, along
with the heart. Their role is to take oxygen into the body, which we need for our cells to live and function
properly, and to help us get rid of carbon dioxide, which is a waste product. We each have two lungs, a
left lung and a right lung. These are divided up into lobes, or big sections of tissue separated by fissures
or dividers. The right lung has three lobes but the left lung has only two, because the heart takes up some
of the space in the left side of our chest. The lungs can also be divided up into even smaller portions,
called bronchopulmonary segments.

These are pyramidal-shaped areas which are also separated from each other by membranes.
There are about 10 of them in each lung. Each segment receives its own blood supply and air supply.

How they work

Air enters your lungs through a system of pipes called the bronchi. These pipes start from the
bottom of the trachea as the left and right bronchi and branch many times throughout the lungs, until they
eventually form little thin-walled air sacs or bubbles, known as the alveoli. The alveoli are where the
important work of gas exchange takes place between the air and your blood. Covering each alveolus is a
whole network of little blood vessel called capillaries, which are very small branches of the pulmonary
arteries. It is important that the air in the alveoli and the blood in the capillaries are very close together, so
that oxygen and carbon dioxide can move (or diffuse) between them. So, when you breathe in, air comes
down the trachea and through the bronchi into the alveoli. This fresh air has lots of oxygen in it, and some
of this oxygen will travel across the walls of the alveoli into your bloodstream. Traveling in the opposite
direction is carbon dioxide, which crosses from the blood in the capillaries into the air in the alveoli and is
then breathed out. In this way, you bring in to your body the oxygen that you need to live, and get rid of
the waste product carbon dioxide.

Blood Supply
The lungs are very vascular organs, meaning they receive a very large blood supply. This is
because the pulmonary arteries, which supply the lungs, come directly from the right side of your heart.
They carry blood which is low in oxygen and high in carbon dioxide into your lungs so that the carbon
dioxide can be blown off, and more oxygen can be absorbed into the bloodstream. The newly oxygen-rich
blood then travels back through the paired pulmonary veins into the left side of your heart. From there, it
is pumped all around your body to supply oxygen to cells and organs.
The Work of Breathing
The Pleurae
The lungs are covered by smooth membranes that we call pleurae. The pleurae have two layers,
a visceral layer which sticks closely to the outside surface of your lungs, and a parietal layer which lines
the inside of your chest wall (ribcage). The pleurae are important because they help you breathe in and
out smoothly, without any friction. They also make sure that when your ribcage expands on breathing in,
your lungs expand as well to fill the extra space.
The Diaphragm and Intercostal Muscles
When you breathe in (inspiration), your muscles need to work to fill your lungs with air. The
diaphragm, a large, sheet-like muscle which stretches across your chest under the ribcage, does much of
this work. At rest, it is shaped like a dome curving up into your chest. When you breathe in, the diaphragm
contracts and flattens out, expanding the space in your chest and drawing air into your lungs. Other
muscles, including the muscles between your ribs (the intercostal muscles) also help by moving your
ribcage in and out. Breathing out (expiration) does not normally require your muscles to work. This is
because your lungs are very elastic, and when your muscles relax at the end of inspiration your lungs
simply recoil back into their resting position, pushing the air out as they go.

The Respiratory System and Ageing

The normal process of ageing is associated with a number of changes in both the structure and
function of the respiratory system. These include the enlargement of the alveoli. The air spaces get bigger
and lose their elasticity, meaning that there is less area for gases to be exchanged across. This change is
sometimes referred to as senile emphysema. The compliance (or springiness) of the chest wall
decreases, so that it takes more effort to breathe in and out. The strength of the respiratory muscles (the
diaphragm and intercostal muscles) decreases. This change is closely connected to the general health of
the person. All of these changes mean that an older person might have more difficulty coping with
increased stress on their respiratory system, such as with an infection like pneumonia, than a younger
person would.

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