Asthma and COPD Q 57

---

A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions?

  

     A. Adult respiratory distress syndrome (ARDS)

     B. Asthma

     C. Chronic obstructive bronchitis

     D. Emphysema

    

    

Correct Answer: C. Chronic obstructive bronchitis

---

Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis. Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that is defined as a productive cough of more than 3 months occurring within a span of 2 years. Patients typically present with chronic productive cough, malaise, and symptoms of excessive coughing such as chest or abdominal pain.

---

Option A: Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by poor oxygenation and non-compliant or “stiff” lungs. The disorder is associated with capillary endothelial injury and diffuse alveolar damage. Once ARDS develops, patients usually have varying degrees of pulmonary artery vasoconstriction and may subsequently develop pulmonary hypertension.

Option B: Clients with asthma tend not to have a chronic cough or peripheral edema. Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger.

Option D: Most patients present with very nonspecific symptoms of chronic shortness of breath and cough with or without sputum production. As the disease process advances, the shortness of breath and cough progressively gets worse. Initially, there is exertional dyspnea with significant physical activity, especially arm work at or above shoulder level with progression to dyspnea with simple daily activities and even at rest. Some patients may present with wheezing because of the airflow obstruction.

---