<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 62-year-old woman comes to the physician because of coughing and fatigue during the past 2 years. In the morning, the cough is productive of white phlegm. She becomes short of breath walking up a flight of stairs. She has hypertension and hyperlipidemia. She has recently retired from working as a nurse at a homeless shelter. She has smoked 1 pack of cigarettes daily for 40 years. Current medications include ramipril and fenofibrate. Her temperature is 36.5C 97.7F, respirations are 24min, pulse is 85min, and blood pressure is 14090 mm Hg. Scattered wheezing and rhonchi are heard throughout both lung fields. There are no murmurs, rubs, or gallops but heart sounds are distant. Which of the following is the most likely underlying cause of this patients symptoms?? A: Chronic decrease in pulmonary compliance, B: Local accumulation of kinins, C: Mycobacterial invasion of pulmonary parenchyma, D: Progressive obstruction of expiratory airflow, E: Incremental loss of functional residual capacityn,  <response>: This is a clinical vignette describing a 62-year-old woman with a 2 year history of productive cough and dyspnea on exertion. She has a significant smoking history of 1 pack per day for 40 years. On exam she has wheezing and rhonchi throughout both lung fields. Based on the chronic productive cough, dyspnea, smoking history, and wheezing, this is most consistent with chronic obstructive pulmonary disease COPD. The wheezing and rhonchi indicate airflow obstruction. COPD leads to progressive obstruction of expiratory airflow, which would explain her symptoms.Choices A and E may occur in COPD but do not explain the underlying cause. Choice B can occur in asthma but would not lead to chronic symptoms. Choice C may lead to chronic productive cough but no evidence is provided to suggest mycobacterial infection.D: Progressive obstruction of expiratory airflow 