Mr. Stanton. is a retired 69-year-old county attorney who was on a buying trip with his wife for old, classic cars in the high, mountainous country of Colorado when he became extremely short of breath. His alarmed wife took him to a multispecialty medical clinic for evaluation. On admission to the clinic, Mr. S. was restless and dyspneic. His chest had an increased anteroposterior dimension.

Mr. S.’s past history revealed a habit of smok­ing 2 packs of cigarettes a day for 45 years. Dur­ing the past few years, Mr. S. had noticed a cough each morning on arising. Recently, while working in his flower garden, he had to stop at times to catch his breath. Even while watching television, he had experienced dyspnea. Also, he indicated a weight loss over the last 2 months.

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.

Discuss the pathophysiological changes that occur with COPD.

What factors from Mr. S’s information justify the diagnosis of COPD?

What treatment options are feasible for this patient? (Be specific.)

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