#28 Wheezing, Dyspnea, and Pulmonary Function Testing Flashcards
Patient has a 13% drop in FEV within 30 minutes of exercise. Dx?
Exercise induced bronchospasm
Positive test require 10% drop in FEV from baseline within 30 minutes of exercise
How would you treat EIB?
1 - SABA 15 minutes before exercise
2- if SABA is not enough: 2a - Daily administration of an inhaled corticosteroid (ICS) [No LABA]
2b - Daily leukotriend receptor antagonist
or
2c - Mast cell stabilizing agent (rarely used)
Identify.
Vocal Cord Dysfunction
Note flattening on bottom
Wheezing louder over the neck
PFT is normal
Identify
Obstructive Flow-Volume Loop
Note steep peak and rounded bottom
Problem in exhalation
Identify
Restrictive Flow-Volume Loop
+ decreased DLCO = Intrinsic restrictive disease
or
+ normal DLCO = Extrinsic restrictive disease
Identify
Variable Intrathoracic
Note: Flat top
Upper airway obstruction inside chest
COPD + Hyperinflation + Air Trapping + Decreased DLCO
Emphysema
Bronchodilator Response +/- hyperinflation +/- air trapping + increased (or normal) DLCO
Asthma
Restrictive pattern + Decreased DLCO
Intrinsic Restrictive Lung Disease
IPF
Restrictive Pattern + normal DLCO
Extrinsic restrictive lung disease
Scoliosis
Myasthenia Gravis
Obstructive Pattern + Decreased TLC
Mixed disease
WHO classifies pulmonary hypertension into 5 groups. Your patient has portal hypertension. What group would he be classified as?
Group 1: Pulmonary Arterial Hypertension
Idiopathic
Also: HIV infection
Drug or toxin induced
Congenital Heart Disease
Connective Tissue Disease
WHO classifies pulmonary hypertension into 5 groups. Your patient has systolic dysfuncion. What group would he be classified as?
Group 2: Pulmonary Hypertension owing to Left Heart Disease
Also: diastolic dysfunction
Valvular heart
WHO classifies pulmonary hypertension into 5 groups. Your patient has COPD. What group would he be classified as?
Group 3: Pulmonary hypertension owing to lung diseases or hypoxemias
WHO classifies pulmonary hypertension into 5 groups. Your patient has sarcoidosis. What group would he be classified as?
Group 5: Pulmonary hypertension with unclear multifactorial mechanisms
Hematologic disorders
Systemic disorders
Metabolic disorders
WHO classifies pulmonary hypertension into 5 groups. What is group 4?
Group 4: Chronic Thomboembollic Pulmonary hypertension
Your patient has a right sided cardiac cath and was diagnosed with pulmonary arterial hypertension. What was the patient’s PAP (pulmonary arterial pressure)? PCWP (pulmonary capillary wedge pressure)?
PAP >= 25 mmHg
Normal PCWP (less than 15 mmHg)
There are 6 steps to interpreting pulmonary function tests (PFT). Can you list them?
- FEV1/FVC ratio
- Gold criteria
- Broncodilator response
- TLC (hyperinflation vs. restrictive)
- RV/TLC
- DLCO
PFTs are determined by what criteria?
Sex, age, height and race
NOT WEIGHT
Complete PFTs include what 4 assessments?
Spirometry
Lung Volume
DLCO
ABGs
Step 1. FEV1/FVC Ratio
less than 70%?
greater than 70%
less than 70%? = COPD
greater than 70% = normal or restrictive
Step 2: Gold criteria
What are the 5 GOLD stages and their FEV1s?
Mild Stage 1: FEV1 80 - 100%
Moderate Stage 2: FEV1 50 - 79.9%
Severe Stage 3: FEV1 30 - 49.9%
Very Severe Stage 4: FEV1 less than 30%
or FEV1 less than 50% with right sided heart failure
Step 3 Bronchodilator response (hyperactive airways)
Criteria?
Significant Response is >= 12% increase and an absolute improvement of at lease 200 ml after inhaling a beta agonist in the FEV1 or FVC
Step 4 TLC
Criteria?
Normal 80 - 120%
Hyperinflation > 120%
Restrictive less than 80%
Mild (70-80)
Moderate (60-70)
Moderately severe (under 60)
Step 5 RV/TLC ratio
Criteria?
Normal: less than 40% or less than predicted
Air trapping: > 40%
Step 6: DLCO (Diffusion Capacity of the Lung for Carbon Monoxide)
Criteria?
Normal: 80 - 120%
If it is an Obstructive disease:
Decreased in emphysema
Normal in chronic bronchitis
Normal or increased in asthma
If it is in Restrictive disease:
decreased in intrinsic restrictive disease
increased in extrinsic restrictive disease
