Review Question - QID 212817

A 72-year-old man with a 60 pack-year history of smoking presents to his primary care provider to discuss a chronic cough. He has noted that for the past 5 years he has spent more than half of the year with a productive cough. The sputum is reported to be clear. Aside from his cough, he reports no other symptoms and has not noted any relationship with colds or fevers. He has not been to a doctor in over 10 years but states that he has no other medical conditions. On exam, his temperature is 98.2°F (36.8°C), blood pressure is 136/76 mmHg, pulse is 72/min, and respirations are 14/min. The patient is noted to have wheezes and crackles bilaterally. Additionally, his bilateral lower extremities are found to have 1+ edema up to the knees. Which of the following best describes the pathophysiology of this disease?