Chronic Suppurative Lung Diseaes Flashcards
What is the definition of chronic suppurative lung disease
Chronic productive cough begins in infancy /childhood
Variety of causes congenital/acquired
Radiological evidence of bronchial dilation or bronchiecatsis
Causes of CSLD developed countries
CF Impaired immune function ( IgG and subclass def) Ciliary dyskinesia Aspiration Congenital airway abnormalities Post infection <10% ( pneumonia /adeno virus Obstruction airway FB/mass Bronchilolitis Toxic exposure
In ATSI/Maori/ Eskimo what are the causes of CSLD
Post infection 40-60% eg measles, pertussis/ recurrent pneumonia/ TB
Unknown
Stages of Bronchiecasis
1 cylindrical. (Reversible so very NB to diagnose early)
2 Varicose
3 Cystic NON REversible
How does Bronchiectasis present
Chronic recurrent productive moist cough Wheeze 60% SOB on exertion Sputum production Haemopytisis (RUL in CF) FTT
Examination findings in a child with bronchiecatisis
Moist productive cough Persistent crackles >75% Wheeze 33% Clubbing 10% early sign in CF FTT Ear infections/ sinus infections ( primary ciliary dyskinesia) Sever cases cyanosis /Cor pulmonary
Investigate which children for CSLD
Chronic cough >4/52 Relapsing or NO response to antibiotics Poor response to asthma treatment Recurrent pneumonia Sputum grows stap A/ H influenza/ pseudomonas/ atypical Pneumonia not completely resolved Pertussis like illness that persists
Investigations of children with chronic persistent moist cough
CF sweat Cl/ genetic testing delta 508 90% Australian children Sputum MCS Immune function Ba swallow Airway screening Bronchoscopy Ciliary biopsy Degree of Bronchiectaisis. HRCT Spirometer obstructive pattern 6 years of age
Management of bronchiectasis
1 accurate diagnosis 2 physiotherapy 3 antibiotics MCS so use the right ones 4 regular review 5 manage co morbities 6 surgery for local disease 7 team approach
Medical management of bronchiectaisis
Antibiotics oral / iv / inhaled Chest physio PEP mask Mucolycitics hypertonic saline 3-6% Bronchodilator / steroids sometimes needed Immunizations
CF
95% diagnosed at birth in Australia delta 508
98% dx by age one year in Australia
5% missed esp different genes
Chronic incurable disease
Genetic conditions that effects exocrine secretions so sweat chloride >60
Thick mucus causes obstruction in lungs and gut meconium ileus 15%( pancreas pancreatic insufficiency
Effects respiratory and pancreas
95-100% males no sperm
Focal Bilary effects
Mucoide sputum that grows pseudomonas assume ???CF
Management of CF
See every 3/12
From age 6 years do FEV1 %
Decrease lung function 3-4% /yr in CF ( compared with normal child 1-2% )
Medical management of the respiratory side of CF
1 antibiotics oral /inhaled/IV
2 mucolytics hypertonic saline 3yrs 3%-6% ( Kalydiko IRISH CF G55id)
3 anti inflammatory azithromycin low dose M,W,F ( decreases the progression of the disease)
GIT Increased calories, increased protein, increased fat Pancreatic enzymes Vit ADEK Manage complications
Immunizations
Oxygen end stage and as a bridge to lung transplantation
Which antibiotics in CF and why
Flucolacillin in infancy for prophylaxis staph aureus
Then depends on the MCS
When they treat pseudomonas aim to irradiate
When do you do lung transplant in CF
What are the outcomes
Consider FEV1 <30%
Poor QOL
Oxygen dependant
Poor exercise tolerance
Risk factors for lung transplant. Psychosocial poor
Surgical rates after lung transplant
90% one yr
60-70% 5 yr
