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.

R.J. is a 15-year-old boy with a history of asthma diagnosed at age 8. His asthma episodes are triggered by exposure to cats and various plant pollens. He has been using his albuterol inhaler 10 to 12 times per day over the last 3 days and is continuing to wheeze. He normally needs his inhaler only occasionally (2 or 3 times per week). He takes no other medications and has no other known medical conditions. Physical examination reveals moderate respiratory distress with a respiratory rate of 32, oximetry 90%, peak expiratory flow rate (PEFR) 60% of predicted, and expiratory wheezing.

S.S. is a 37-year-old man in the clinic today for worsening shortness of breath. He first noticed decreasing activity tolerance at age 28, at which time an x-ray revealed some hyperinflation consistent with mild emphysema. He had been smoking one pack of cigarettes per day since age 15 and quit at age 28. However, his shortness of breath has continued to progress. Physical examination reveals a thin man in moderate respiratory distress. There is marked increase in the anteroposterior diameter, distant lung sounds, and occasional expiratory wheeze. Blood gases on room air are as follows: pH 7.42, PaCO₂ 40, PaO₂ 71, HCO₃– 26. Pulmonary function test results are as follows:

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