By Duncan M. Geddes MD, MRCP (auth.)
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The P0 2 is usually above 60 mm Hg and the Pco 2 10w. This is partly because of the differences in gas exchange. Cardiac Output Cardiac output tends to fall as the pulmonary capillary bed is attenuated. However, since the P0 2 is well maintained, hypoxic vasoconstriction does not occur and pulmonary hypertension and cor pulmonale are unusual. Compliance Loss of alveolar walls makes the lungs more compliant. As a result they expand more under the influence of a negative intrathoracic pressure. Total lung capacity is therefore increased and the chest is overinflated.
There is often an element of left ventricular failure as well and breathlessness may improve with adequate diuresis. Digoxin is probably of little benefit unless uncontrolled atrial fibrillation coexists. Digoxin can be dangerous during an exacerbation when hypoxia, acidosis and hypokalaemia all sensitize the myocardium to arrhythmias. 30 Airways Obstruction Long-term controlled oxygen for 12 to 15 hours daily has been shown to reduce pulmonary artery pressure. This may improve cor pulmonale and therefore mortality.
3. Pancreatic insufficiency. Genetics Transmission is by a recessive gene. The homozygote has the disease, while the heterozygote is entirely healthy. The gene is carried by about one in 25 caucasians and about one in 2000 live births is a homozygote with the disease. Cystic fibrosis is therefore the commonest inherited disease among Europeans. The basic biochemical defect is unknown and at present there is no reliable way of identifying heterozygotes. Pathology Sputum accumulates in the bronchi.
Airways Obstruction by Duncan M. Geddes MD, MRCP (auth.)