Case Study and Discussion – A 70-year-old Female Patient with Dyspnea and Cough The selected case scenario for this discussion is the one involving a 70-year-old female patient presenting with dyspnea and cough.

Hospital vs. Community-Acquired Pneumonia

Hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) are two distinct types of respiratory infections with different etiology, risk factors, and management. HAP occurs in individuals who are hospitalized for other medical conditions. Multi-drug-resistant bacteria often cause it due to prolonged hospital stays and frequent exposure to healthcare facilities. Contrariwise, CAP is acquired outside healthcare settings and is usually caused by typical respiratory pathogens like Streptococcus pneumoniae, Haemophilus influenzae, or atypical pathogens like Mycoplasma pneumonia (Hespanhol & Bárbara, 2020).

Patients with HAP often have underlying comorbidities and may be older, as in the case scenario. CAP can affect individuals of all ages, and the risk factors are generally associated with community exposure, such as living conditions and recent viral infections (Hespanhol & Bárbara, 2020). Further, patients with HAP may have a slower onset of symptoms and are more likely to present with fever, cough, and shortness of breath. Conversely, CAP symptoms tend to appear suddenly and are characterized by fever, productive cough, and chest pain (Hespanhol & Bárbara, 2020).

Subsequently, HAP is often caused by bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. On the other hand, CAP is caused by Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumonia. (Hespanhol & Bárbara, 2020). Treatment for HAP often includes broader-spectrum antibiotics due to the risk of multidrug-resistant pathogens. On the other hand, CAP can be managed with narrower-spectrum antibiotics based on the likely pathogens and severity (Hespanhol & Bárbara, 2020).

Ventilation-Perfusion Matching

Good gas exchange in the lungs relies on adequate ventilation and perfusion matching. Ventilation refers to air movement in and out of the alveoli, while perfusion is the blood flow through the pulmonary capillaries (Dunican et al., 2021). The ideal condition for gas exchange is when ventilation and perfusion are well-matched.

Increasing FiO2 and Hypoxia Improvement

FiO2 (Fraction of Inspired Oxygen) represents the concentration of oxygen in the air a person breathes. Increasing FiO2 can improve hypoxia (low oxygen levels) because it raises the partial pressure of oxygen in the alveoli. This increased oxygen concentration allows for more efficient diffusion of oxygen into the bloodstream, ultimately improving oxygen saturation (Dunican et al., 2021). In the case presented, the patient has a low oxygen saturation of 84% on room air and 90% with a nasal cannula. Increasing the FiO2 through supplemental oxygen delivery helps compensate for the impaired gas exchange caused by conditions like pneumonia and chronic obstructive pulmonary disease (COPD), improving oxygen levels in the bloodstream and alleviating symptoms of hypoxia.

Emphysema vs. Pneumonia

Emphysema and pneumonia are both respiratory conditions but differ significantly in etiology, pathology, and clinical presentation. On the one hand, emphysema is primarily a COPD characterized by the destruction of lung tissue, typically due to long-term exposure to cigarette smoke or environmental pollutants (Dunican et al., 2021). On the other hand, pneumonia is an acute infection of the lung parenchyma, commonly caused by bacteria, viruses, or fungi (Hespanhol & Bárbara, 2020).

Further, emphysema involves the gradual destruction of the alveoli, leading to the loss of lung elasticity and air trapping, resulting in difficulty exhaling (Dunican et al., 2021). Contrariwise, pneumonia is characterized by inflammation, consolidation, and impaired gas exchange within the affected lung tissue (Hespanhol & Bárbara, 2020). Lastly, emphysema patients typically present with chronic symptoms, such as progressive dyspnea, cough, and wheezing (Dunican et al., 2021). Conversely, Hespanhol & Bárbara (2020) note that pneumonia presents acutely with symptoms like fever, productive cough, chest pain, and shortness of breath.

References

Dunican, E. M., Elicker, B. M., Henry, T., Gierada, D. S., Schiebler, M. L., Anderson, W., & Fahy, J. V. (2021). Mucus plugs and emphysema in the pathophysiology of airflow obstruction and hypoxemia in smokers. American Journal of Respiratory and Critical Care Medicine, 203(8), 957-968. https://doi.org/10.1164/rccm.202006-2248OC