Pulmonary Case Studies

I have been asked by many to start including actual case studies from my personal hospital experience. I will limit these cases to those that just involve patients who had smoking related diseases, although, I may venture off every once in a while to talk about very unusual to interesting cases. I may even ask questions to see if you can figure out what may have happened to the patient.

Here's a quick case study off the top of my mind. We had a 58 y/o white male present with shortness of breath. His lung sounds included lots of crackles and wheezing, with a prolonged expiratory phase. His respiratory rate was > 25. He quit smoking 1 year prior to this admission, but had smoked 1 - 1.5 packs of cigarettes per day for 40 years. He had spiked a temperature at 101.4 F the night before. His ankles had 1+ edema (swelling). He had a history of 2 previous heart attacks (AMI). He was not a candidate for heart surgery, due to his poor baseline respiratory status. He was diagnosed with Stage 4 emphysema and was dependent on a multiple of inhalers, as well as, continuous nocturnal bipap.

This gentleman was the nicest guy around. We loved seeing him in the hospital but were sad because we only saw him as a patient, rather than a visitor. He is what you call a "frequent flyer". In other words, he found himself in our ER frequently throughout the year with the same old symptoms. His hospital stays would typically last about 10 days. His diagnosis was always the same:

1) COPD (emphysema)
2) Community acquired pneumonia
3) Congetive heart failure
4) Ischemic heart disease
5) Hypertension (high blood pressure)
6) Acute respiratory failure
7) Chronic respiratory failure

Here is an example of someone's body not tolerating the effects of a 40 pack year smoking history very well. I could also give you an example of someone who smoked just as much, but didn't have nearly the physiological devastation that this man had.

But the point is, you never know how your body will respond over time to the smoking. Which person will you turn into? Patient A who needed a machine at night to ensure he didn't stop breathing when he was asleep and continuous oxygen the rest of the time, or the other patient whose body faired a little better?

Hard core smokers are quick to point out lots of patient B examples, and tend to ignore or even deny the existence of the over couple hundred thousand patients a year that die due to smoking related illnesses. It's important to drive home the realism of smoking related disease, as often times, this is the only thing people will listen to.

I hope to share even more real life case studies in the future to offset the hum-drum nature of literature review.

Smokers Lungs

I couldn't find any good research articles today to bring to you, so I dug into my article bag. I found this article I wrote detailing the negative effects smoking has on your lungs. I call it, "Smokers Lungs" - enjoy.

Smokers Lungs

Twenty percent of all Americans smoke. The World Health Organization describes smoking as an epidemic around the world. Smoking has become a blight on those in the lower socio-economic cultures of the world. Tobacco companies have revenues in the billions. All this without advertisement on television or radio. So why?

This type of economic juggernaut must not impose very bad side-effects on its customers, right? If smoking were bad for you, then why do so many people do it?

All these are pretty good questions. The tobacco business goes all the way back to our founding fathers. Remember from history class what a cash crop was? That's right: tobacco was the king of cash crops. It wove it's way throughout the economic fabric of our bourgeoning country and it hasn’t looked back.

So here we are, 200 plus years later and we’re having to answer the question of whether tobacco is really that bad for you. Physicians and healthcare professionals can tell you the answer to the question. Yes, smoking is bad for you. Lets look at the statistics for a moment.

Roughly 90% of all lung cancers are attributable to smoking. Emphysema (COPD) is the fourth leading cause of death in the US. Smoking is listed as a primary risk factor in over 70 diseases. It’s also a contributing risk factor in hundreds more. But what about the smokers’ lungs.

COPD is the single largest preventable disease, they just have to quit smoking. COPD stands for chronic obstructive pulmonary disease. There is no cure. It is chronic and progressive which means the symptoms will begin to worsen over time. The only way to slow it down, is to stop smoking.

Lets go over 3 physiologic changes that take place in the lung after someone smokes.

1. The fine cilia in the throat begin to die off
2. The muscle that forms the airways loose their rigidity and spasm or narrow
3. The cellular walls in the tiny air sacs of the lung begin to tear apart

These 3 changes then result in the following symptoms:

1. Chronic coughing
2. Difficulty in removing secretions
3. Elevated risk of pneumonia
4. Shortness of breath
5. Wheezing
6. Poor oxygenation

These symptoms then need to be treated with medicines like expectorants, anti-biotics, inhalers, nebulizers and supplemental oxygen. Not quite the glamorous retirement you envisioned for yourself is it? Relying on inhaled steroids, nebulizers and oxygen can really put a damper on your visit with the grandkids.

So take smoking seriously. You know it’s bad for you. There are just so many great stop smoking benefits available to you if you’d only take a look. You’re a smart person and you can make this decision. But get the valuable stop smoking information you need, so you can be informed. The more educated you are, the better your chances of success.