R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia.

1.What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD?

2.Interpret RS’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia?

3.What is the rationale for treating RS with theophylline and a β2 agonist?

4.What effects would his respiratory disease have on his cardiovascular function?

5.Considering both his COPD and pneumonia, in what position would RS have the worst ventilation-perfusion matching?