Emphysema

Question : Does emphysema ever have a cough associated? Is emphysema considered with obstructive or resistive lung disease?
For the references, please use AMA format ! I will attach the case study and my original posting

HPI: Patient is a 62 year old male who is admitted to the emergency room with complaints of progressive DOE over the past day and a half. Initial medical management in the ER included administration of supplemental oxygen, and nebulized albuterol. Once stabilized, the patient was admitted to the hospital for continued management.

PMH:  COPD, CAD, MI, HTN, DJD in his spine

Social History: Married with 4 adult children, who all live in the same town. Employed as a real estate broker. 100 pk-year smoking history. Has attempted to quit multiple times but has been unsuccessful. Has 2-3 beers a night with dinner.

Lab Studies and Diagnostic Tests:

• Hct 50
• CK-MB 3.1 
• Troponin I    .3 ng/ml
• EKG - NSR 
• CXR - hyperlucency in upper lobes and opacity/infiltrate in B   

lower lobes and flattened diaphragms

• PFTs - (from 2 months ago) FEV1 - 55% of predicted, FEV1/FVC 60% 

Systems Review:

• Cardiopulmonary- temp- 98.6, HR- 100, BP- 100/80, RR-20  O2Sat 90% on 2L
• Musculoskeletal- gross movt of B UE and L LE- WFL on functional activities
• Neuromuscular- pt ambulated I without AD prior to admission 
• Integumentary- no skin integrity issues noted

Interpretation of the Lab Studies

HCT is useful in determining a person’s blood proportion with packed red blood cells. For an elder man, the recommended HCT should be between 39 and 49 percent. Therefore, the patient’s Hematocrit level of 50 is just above normal. When it comes to Serum creatine kinase levels (CK), it should range between 38 and 174 units/l in men.1 This patient’s 3.1 CK-MB is lower than the expected range. High troponin levels further indicate that the heart could be facing damage unless otherwise diagnosed. For instance, if the usual reference range appears between 0.00 and 0.40, then 0.41 could be technically healthy, albeit in a weak manner.

The normal range of Troponin I for normal individuals should be less than 0.01 ng/ml, and patients with greater ranges make cardiac injury diagnoses.2 On the other hand, decreasing values indicate recent cardiac injuries. In this patient’s case, 0.3 ng/ml is too high, an indicator of heart damage. Another crucial aspect to consider is that a normal heart rhythm should be between 60 and 100 beats per minute. 3 The hyper lucency in upper lobes and opacity/infiltrate in B indicate the past or present infection with a possibility of PTB.  Additionally, a flat diaphragm is a sign of damaged airways and lung tissues that result in a decline in lungs ability to exchange gases. If the FVC and FEV1 results range is within 80 percent, it is an indication that lungs are healthy.

With the patient’s FCV/FEV1 at 60 percent, it is evident that the patient has a severe lung abnormality. Also, the 100 HR indicates that this patient is healthy though not as fit as if it was lower than 100. The Cardiopulmonary- temp- 98.6, HR- 100, BP- 100/80, RR-20 O2 Sat 90% on 2L indicate that the patient’s health is deteriorating due to his lung condition.4 Based on the available information, the patient has pulmonary emphysema that results in shortness of breath when the alveoli experience over-inflation. 

References

1. Ham, R. J., Sloane, P. D., Warshaw, G. A., Potter, J. F., & Flaherty, E. Ham's Primary Care Geriatrics E-Book: A Case-Based Approach. Amsterdam: Elsevier Health Sciences, 2014.
2. Tsung, S. H. "Several conditions causing elevation of serum CK-MB and CK-BB." American journal of clinical pathology 75.5 (2016): 711-715.
3. Kawel-Boehm, N., Maceira, A., Valsangiacomo-Buechel, E. R., Vogel-Claussen, J., Turkbey, E. B., Williams, R., & Bluemke, D. A. "Normal values for cardiovascular magnetic resonance in adults and children." Journal of Cardiovascular Magnetic Resonance 17.1 (2015): 29.
4. Barbaresi, E., Schinzari, M., Cannizzo, M., Urso, G., Russo, A., Potena, L., Branzi, A. “Prognostic Role of Echocardiographic Variables in Patients with Moderate to Severe Organic Mitral Regurgitation, Normal Cardiopulmonary Functional Capacity and Low NT-ProBNP Level.” European Heart Journal34.suppl 1 (2013): P4745–P4745. European Heart Journal. Web.

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