After your assessment, you gather that Jay has peripheral cyanosis, barrel chest, coarse crackles, decreased breath sounds bibasally. Jay has increased accessory muscle use, clubbing and paradoxical breathing. He currently is on 2L of O2 via nasal prongs secondary to a decrease of his sp02 to 82% upon changing position into a chair. A recent pulmonary function test showed that his FEV1/FVC ratio is 0.6 and his FEV1 is 52%. The respiratory therapist says that this test was taken post-bronchodilator.  

What is your diagnosis?

You have 5 minutes to prepare for question 7