An african american man comes to the ER with SOB. His breathing rate is of 40 per minute and fainted in the way to the hospital. He says that he was having sex with a 17 yearold girl 1 hour ago, he was trying a new positon and got exhausted. You suspect he might be using drugs. He tells you that is harder for him to breathe in than out despite that his lung tests show significant expiratory airflow obstruction. Why does the pt. complain more about inhalation than exhalation?
a- he has inspiratory obstruction as well
b- the drugs might be affecting his breathing
c- he is suffering from anxiety due to the sex
d-he has pneumonia
e-he is hyperinflated
f-he has a neurological problem
g-he does not understand the physiology of his disease
h-he probably also have asthma
CCCCCCCC-fear , anxiety ,worry if he can satisfy his partner
how he s gonna think of satisfying his partner wid SOB in the ER???????????????
In pulmonary emphysema and chronic bronchits due to cigarette smoking, or collectively COPD do have a problem with expiration. Air that is being expired gets trapped aka air trapping in the lung because of dynamic airway collapse from lost of elastic recoil and an increase in parasympathetic airway smooth muscle tone. You are correct that the INSPIRATORY capacity (IC) aka your ability to take in a deep breath is often compromised in COPD because of the increase in air trapping. The FRC increases, therefore decreasing the IC. Early stages of COPD are often associated with normal or slightly decreased IC but with exercise (and most importantly, an increase in respiratory rate), there is a decrease in the time to expire and your patient's FRC begins to increase. This adds to FRC in COPD patients and they very quickly become short of breath, i. e. they can not take a deep breath. However, they can breathe in and this is represented by the flow volume loop which shows that often there is extrathoracic upper airway obstruction at all. The FVC is often decreased (this parallels IC) but the FEV1 is decreased to a much greater extent in COPD, hence the importance of screening people for obstructive airways disease with FEV1% measurements, i. e. when FEV1% or FEV1/FVC x 100% is less than 70% ask 3 questions, do you smoke, do you smoke, do you smoke cigarettes. Hope this helps.