Barrel Bart — COPD
Barrel chest, pursed-lip breathing, low-flow O₂ — his drive to breathe is low oxygen
Bart has smoked two packs a day for forty years and now can't finish a sentence without stopping to breathe. His chest looks rounded like a barrel, and he purses his lips every time he exhales.
Decades of smoking leave Bart with a barrel chest, hyperinflated lungs and chronically high CO₂. His body has adapted to rely on low oxygen — not high CO₂ — as the trigger to breathe, so high-flow oxygen can blunt that drive and cause dangerous hypoventilation. Pursed-lip breathing keeps his airways open longer on exhalation, and low, titrated oxygen (1–2 L/min, target SpO₂ 88–92%) is the safe standard.
Read Barrel Bart's full story →The story arc
The setup
Forty years of smoking destroy Bart's alveoli, trapping air and hyperinflating his lungs.
The turn
His chest has become rounded and barrel-shaped, and he instinctively purses his lips on every exhale to keep air from getting trapped.
The crisis
A well-meaning family member puts Bart on high-flow oxygen for his breathlessness, and within the hour he becomes drowsy and difficult to arouse.
The save
The nurse switches Bart to low-flow oxygen at 1–2 L/min titrated to an SpO2 of 88–92%, reinforces pursed-lip and diaphragmatic breathing, and monitors his level of consciousness closely.
NCLEX study section — COPD
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Respiratory
Take this chapter into practice questions on the same topic.