Pulmonology
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Definition
Airflow obstruction + bronchial hyperreactivity + airway inflammation
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Strongest predisposing factor
Atopy (=immediate allergy): triad contains wheeze, eczema, seasonal rhinitis
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Exacerbating factors
Allergens, URI, exercise, GERD, drugs (Bblockers, ACEi, ASA, NSAIDs), stress, cold air
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Clinical features
cough, chest tightness, breathlessness, wheezing (all intermittent)
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Airflow obstruction
FEV1/FVC < 75%
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Diagnostic FEV1 value
>10% increase in FEV1 after bronchodilator therapy
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Test to establish diagnosis
Histamine or metacholine test. FEV1 decrease >20% is diagnostic.
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Medications
1) Quick relief medications (SABA) 2) Long-term control (corticosteroids, leukotreine modifiers, theophylline)
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Asthma rescue med
SABA (albuterol)
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Chronic management med
Inhaled corticosteroids
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Definition
An autosomal recessive disorder that results in abnormal production of mucus by almost all exocrine glands, and causes obstruction of those glands/ducts
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Increase risk of these malignancies
GI, osteopenia, arthropathies
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Median survival
31 years
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Clinical features
Young patient with history of chronic lung disease, pancreatitis, or infertility
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Symptoms
Cough, excess sputum, decreased exercise tolerance, sinus pain, purulent nasal disharge, steatorrhea, diarrhea, abdominal pain
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Signs
clubbing, increased AP chest diameter, apical crackles
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Diagnostic lab value
Elevated quantitative sweat chloride test (>60 mEq/L) on 2 different days
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Syndrome made up of
emphysema + chronic bronchitis
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Emphysema def.
Air spaces are enlarged as a consequence of destruction of alveolar septae
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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
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Biggest cause
Smoking
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Clinical features
SOB, cough, sputum, pursed-lip breathing, resonance to percussion, early inspiratory crackles, wheezing, prolonged expiratory phase
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CXR findings
Hyperinflation of the lungs and a flat diaphragm
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Treatment
Smoking cessation, anticholinergic inhalers (ipratropium>>SABA), oral abx (high risk of infx)
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What is the only therapy that may alter the course of COPD in patients with resting hypoxemia PaO2 <55 or SaO2 <88%?
Supplemental oxygen*
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Check for this deficiency
alpha 1-antitrypsin
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Definition
Abnormal, permanent dilation of the bronchi and destruction of bronchial walls
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Etiology
1) Congenital (CF) 2) Acquired from recurrent infix (TB, abscess) 3) Obstruction (tumor)
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Clinical Features
chronic purulent sputum (?foul-smelling), hemoptysis, chronic cough, recurrent PNA
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Imaging modality of choice
Chest CT --> dilated, tortuous airways
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Treatment
Abx (amoxicillin, Augmentin, Bactrim) + bronchodilators + chest physiotherapy
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