Review Question - QID 100848

The patient described above is suffering from Chronic Obstructive Pulmonary Disease (COPD), specifically emphysema. In emphysema, both FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) are decreased, however, FEV1 is decreased more, therefore FEV1/FVC is decreased.

Emphysema is an obstructive lung disease in which airflow from the lung (expiration) is decreased (decreased FEV1 and FVC). It is believed that an imbalance between destructive proteases and protective anti-proteases leads to the destruction of lung elastase; leading to the enlarged airspaces. Smoking is a major risk factor for developing emphysema.

Punturieri et al. note that research has shown that bronchodilators and pulmonary rehabilitation have led to better lung function and improved quality of life, respectively, in patients with COPD. Though these treatments are beneficial, the authors state that COPD is an irreversible disease of airway obstruction.

Robins notes that emphysema is marked by a fall in the elastic recoil of the lung. In addition, there is increased lung volume in emphysema at all lung pressures. Pulmonary function testing reflect these changes with increased total lung capacity (hyperinflation) and residual volume (air trapping).

Image A is a chest X-ray showing the barrel-chest (increased A-P diameter) common in patients with emphysema. Illustration A represents a flow-volume loop of a patient with a normal lung (Left) compared to a lung with emphysema (Right).

Incorrect Answers:
Answer 1 and 3: Both increased FEV1 and decreased TLC (total lung capacity) would be more consistent with a restrictive lung disease.
Answer 4 and 5: Patients with COPD have a decreased FEV1 and a decreased FVC.