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Pulm I: Obstructive Pulmonary Disease Cheat Sheet by

Pulmonology
medical     medicine     asthma     copd     bronchiectasis     cystic     fibrosis

Asthma

Definition
Airflow obstru­ction + bronchial hyperr­eac­tivity + airway inflam­mation
Strongest predis­posing factor
Atopy (=imme­diate allergy): triad contains wheeze, eczema, seasonal rhinitis
Exacer­bating factors
Allergens, URI, exercise, GERD, drugs (Bbloc­kers, ACEi, ASA, NSAIDs), stress, cold air
Clinical features
cough, chest tightness, breath­les­sness, wheezing (all interm­ittent)
Airflow obstru­ction
FEV1/FVC < 75%
Diagnostic FEV1 value
>10% increase in FEV1 after bronch­odi­lator therapy
Test to establish diagnosis
Histamine or metach­oline test. FEV1 decrease >20% is diagno­stic.
Medica­tions
1) Quick relief medica­tions (SABA) 2) Long-term control (corti­cos­ter­oids, leukot­reine modifiers, theoph­ylline)
Asthma rescue med
SABA (albut­erol)
Chronic management med
Inhaled cortic­ost­eroids
Buzzwords: Wheezing, prolonged expira­tion, airway edema with eosino­phils, neutro­phils, lympho­cytes

Cystic Fibrosis (CF)

Definition
An autosomal recessive disorder that results in abnormal production of mucus by almost all exocrine glands, and causes obstru­ction of those glands­/ducts
Increase risk of these malign­ancies
GI, osteop­enia, arthro­pathies
Median survival
31 years
Clinical features
Young patient with history of chronic lung disease, pancre­atitis, or infert­ility
Symptoms
Cough, excess sputum, decreased exercise tolerance, sinus pain, purulent nasal disharge, steato­rrhea, diarrhea, abdominal pain
Signs
clubbing, increased AP chest diameter, apical crackles
Diagnostic lab value
Elevated quanti­tative sweat chloride test (>60 mEq/L) on 2 different days
Buzzwords: Pediatric with Hx recurrent lung infect­ions, pancre­atitis, reprod­uctive problems, FTT, sweat chloride test, Pseudo­monas auerog­inosa can cause PNA in these pts.
 

COPD

Syndrome made up of
emphysema + chronic bronchitis
Emphysema def.
Air spaces are enlarged as a conseq­uence of destru­ction of alveolar septae
Chronic bronchitis def.
Charac­terized by a chronic cough that is productive of phlegm occurring on most days for 3 months of the year for 2+ consec­utive years without another acute cause
Biggest cause
Smoking
Clinical features
SOB, cough, sputum, pursed-lip breathing, resonance to percus­sion, early inspir­atory crackles, wheezing, prolonged expiratory phase
CXR findings
Hyperi­nfl­ation of the lungs and a flat diaphragm
Treatment
Smoking cessation, antich­oli­nergic inhalers (iprat­rop­ium­>>S­ABA), oral abx (high risk of infx)
What is the only therapy that may alter the course of COPD in patients with resting hypoxemia PaO2 <55 or SaO2 <88%?
Supple­mental oxygen*
Check for this deficiency
alpha 1-anti­trypsin
COPD Buzzwords: Smoker, DOE, cough
Emphysema Buzzwods: Hyperi­nfl­ation on CXR, tear drop heart
Bronchitis Buzzwords: Smoker, chronic productive cough. NO hemopt­ysis, wt. loss.

Bronch­iec­tasis

Definition
Abnormal, permanent dilation of the bronchi and destru­ction of bronchial walls
Etiology
1) Congenital (CF) 2) Acquired from recurrent infix (TB, abscess) 3) Obstru­ction (tumor)
Clinical Features
chronic purulent sputum (?foul­-sm­ell­ing), hemopt­ysis, chronic cough, recurrent PNA
Imaging modality of choice
Chest CT --> dilated, tortuous airways
Treatment
Abx (amoxi­cillin, Augmentin, Bactrim) + bronch­odi­lators + chest physio­therapy

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