Obstructive Diseases (2)

Question 1

Emphysema (Treatment/Management)

Answer 1

1) Low flow FiO2 oxygen therapy at 1-2L/min (24-28%)

• Consider oxygen conservation devices (i.e. reservoir cannula, transtracheal catheters, etc. for home use)
• Consider NIPPV for acute exacerbation (ventilatory failure)
• Annual flu injection
• Smoking cessation programs & nicotine replacement therapy
• Pulmonary Hygiene

2) Antibiotics as indicated by sputum culture
3) Pulmonary Rehab & Home Care

4) Aerosolized meds
a) Short acting Beta2 agonists
b) Anticholinergics
3) Long acting Beta2 agonists
4) Inhaled corticosteroids

Question 2

Bronchitis (Treatment/Management)

Answer 2

1) Pulmonary hygiene therapy
2) Antibiotics for infection
3) Oxygen for hypoxemia

4) Aerosolized meds
- Short acting Beta2 agonists
- Anticholinergics
- Long acting Beta2 agonists
- Inhaled corticosteroids

• Consider NIPPV for acute exacerbation (ventilatory failure)
• Smoking cessation programs
• Reduce risk factors

Question 3

Bronchiectasis (Treatment/Management)

Answer 3

1) Pulmonary hygiene
2) Antibiotics for infection

3) Aerosolized meds
- Short acting Beta2 agonists
- Anticholinergics
- Inhaled corticosteroids

4) Surgical resection of involved segments if necessary
5) Oxygen for hypoxemia

Question 4

Sleep Apnea (Treatment/Management)

Answer 4

CENTRAL APNEA

1) Drug therapy
- REM inhibitors (Vivactil)
- Carbonic anhydrase inhibitors (Diamox)
- Respiratory stimulants (Aminophylline, caffeine)

2) Phrenic nerve pacer
3) Nocturnal ventilation

OBSTRUCTIVE APNEA

1) Weight loss
2) Sleep posture (lateral/upright)
3) Oxygen therapy for hypoxemia
4) NIPPV, Nasal CPAP, BiPAP
5) Oral Surgery
6) Tracheostomy
7) Oral appliances
8) Neck collar

Question 5

Asthma (Treatment/Management)

Answer 5

1) Environmental control
2) Oxygen therapy
3) Bronchopulmonary hygiene

4) Aerosolized meds
RESCUE MEDS
-Short acting Beta2 agonists
-Anticholinergics
CONTROLLER MEDS
-Long acting Beta2 agonists
-Inhaled corticosteroids
-Mast cell stabilizers (for prevention)

5) Systemic meds
- Corticosteroids
- Leukotriene modifiers
- Xanthines
- Immunomodulators

6) Peak flow monitoring
7) Eliminate asthma triggers

EMERGENCY ROOM ACUTE TX

• O2 therapy
• aerosol therapy with a SABA & anticholinergic (consider continuous aerosol therapy)
• Steroids (oral or IV)
• Close monitoring
• Intubation & mechanical ventilation if respiratory arrest occurs
• Consider adjunct therapies: Heliox, magnesium sulfate, subcutaneous epinephrine