Answer

Pathophysiology of COPD

Introduction

            The purpose of this essay is to explain pathophysiologic basis of clinical signs and symptoms presented by a 45-year-old woman with history of chronic obstructive pulmonary disease (COPD). These clinical manifestations include 3-day duration of shortness of breath, fevers, and cough with thick green sputum production. The cough interferes with her sleep and the sputum is growing much thicker and difficult to expectorate.  These clinical manifestations can be explained by the disease cardiovascular and pulmonary pathophysiologic processes.

Pathophysiology of COPD

            COPD is a treatable condition characterized by progressive tissue destruction and airflow limitation. The disease is associated with chronic inflammation of the lungs leading to structural change due to prolonged exposure to noxious gases or particles. Chronic inflammation results in decreased lung recoil and causes airway narrowing. The inflammation involves the pulmonary vasculature, lung parenchyma, and the airways. Signs and symptoms of COPD are similar to those presented by the patient and include dyspnea (shortness of breath), cough, and sputum production (Agarwal, Raja, & Brown, 2020).

            Chronic airway inflammation and progressive destruction of the alveolar air sacs is associated with obstructive pathophysiology with presented of symptoms such as dyspnea and sputum production. Inflammation leads to recruitment of macrophages and neutrophils as well as release of various inflammatory mediators. Release of excess proteases and oxidants is the basis for destruction of the air sacs. Pulmonary hypertension can be observed as a result of diffuse vasoconstriction from hypoxemia (Agarwal, Raja, & Brown, 2020).

            COPD patients may also have chest tightness and wheezing which explains the rationale for detection of coarse rales and rhonchi throughout all the lung fields. Patients can also present with history of exacerbations, reduced level of activity, and nighttime awakenings (Agarwal, Raja, & Brown, 2020). Signs and symptoms such as chest pain, paroxysmal nocturnal dyspnea, palpitations, orthopnea or ankle swelling in COPD patients can indicate cardiovascular involvement or heart disease. In case, of cardiovascular involvement the patient should be assessed for heart sounds, jugular venous pressure, and fluid status. In stable COPD, chest hyper-inflation with hyper-resonant percussion and reduced breath sounds are observed. Crackles indicate possibility of an infection (Conway, Majeed, & Easton, 2015). Chest X-ray may indicate flattened diaphragm, hyperinflation, and increased anterior-posterior diameter (Agarwal, Raja, & Brown, 2020).  Epidemiological determinants of mortality and morbidity of COPD is influenced by socioeconomic status, ethnicity, and race. The disease is highly prevalent among African Americans and the poor (Cheatham & Marechal, 2018).

Summary

            COPD is associated with cardiovascular and pulmonary pathophysiological processes. Chest tightness, production of green sputum, and difficulty of sleeping reported by the patient are all associated with pathophysiology of COPD. The disease is common among African Americans than any other racial group and is associated with significant morbidity and mortality.