Obstructive Lung disease Flashcards
Risk factors for COPD exacerbation
Best predictor: previous exacerbation
Other patient factors:
- Age
- GERD
-Previous abx use
- Previous hospitalization in the last year for COPD
Disease factors:
- Severity of disease
- Hyper-secretion of mucus
- productive cough
- Eos >300
- PH
Effects of COPD exacerbation
- Increase in disease progression
- Increase in mortality
- Reduction in quality of life
Interventions in COPD that reduce mortality
LABA/LAMA/ICS Combo
LTOT
LVRS
NIPPV (in stable hypercapnic COPD)
Pulmonary rehab
Smoking Cessation
Indications for oxygen in COPD
PaO2 <55 or SaO2 <88
PaO2 <59 AND
- Cor pulmonale
- Right heart failure
- HCT >55%
- improves mortality in these patients
Indications for NIPPV in COPD
PCO2 >52 with pH >7.35
- decrease PaCO2 by greater than 20% from baseline or to less than 48mmHg
- improves mortality
- decreases time to next exacerbation
Lung Volume Reduction Surgery Indications
Mortality benefit in patients
- With low exercise capacity
- Upper lobe predominant disease
- Severe dyspnea despite max medical therapy
- Trial of pulmonary rehab
- FEV <45% predicted
- DLCO NOT less than 20% predicted
- Lung volumes showing air trapping and hyperinflation.
- Post rehab walk distance >140m
Silicosis
Acute Silicosis
- months to years
- PAP- crazy paving with GGO
- PFTs: restriction with reduced DLCO
Chronic Silicosis:
- Upper lobe predominant nodules
- Fibrotic nodules
- Egg shell calcifications
Test for TB
Bronchothermoplasty
Reduces smooth muscle mass
Will have increased risk of exacerbations 3m following the procedure
Uncontrolled asthma on high dose ICS with 2 oral pred requirements in the last year.
Reduces asthma exacerbations
ED visits
Hospitalizations in patients with severe asthma
absolute contraindications
– the presence of an active implantable electronic device
— acute myocardial infarction in the prior 6 weeks
— sensitivity to anesthetics required to perform bronchoscopy
— coagulation dysfunction
— patients previously treated with BT
EDAC and tracheobronchomalacia
Airway collapse with expiration:
- >70% collapse
Sx:
- Wheezing
- Whooping cough
- difficulty clearing secretions
- recurrent infections
Can be focal:
- Prolonged intubation
- extrinsic compression with tumor
Diffuse:
- RP
- GERD
- ICS (prolonged)
- inhaled chemicals
Dx:
- Moderate sedation bronch
- Dynamic CT (effort dependent)
Treatment:
- Only if symptoms are present
- First treat underlying disorders
—– GERD
—– COPD
—– OBESITY
—– VCD
CPAP
STENTS - trial to see if tracheobronchoplasty would be beneficial
Work related Asthma
- HIGH molecular weight antigens
- Asthma with latency (immunogenic)
- Flour
- animal proteins (murine urine)
- Rubber latex (health care worker)
- IgE mediated
- Atopy is a risk factor
- RAST positive testing (likely)
Work related asthma
- Low molecular weight antigens
- asthma with latency (immunogenic)
- Metals, salts, nickel
- Isocyanates (paint) - airway sensitizer therefor can cause severe sensitivity in hx of no atopy
- Red cedar dust (saw mills)
- Acid anhydrides (epoxy)
- Colophony - solderers
- Non-IgE mediated
- No hx of atopy
- Bind to native protein carrier and Acts as a hapten (stimulates response)
Reactive airway dysfunction Syndrome
In response to irritant
- single exposure
- Reactive airway disease with positive methacholine challenge
May cause temporary (1year) or permanent airway dysfunction.
NERD
Nsaid exacerbated respiratory disease
Eosinophilic Asthma
CRSwNP
- Starts with chronic rhinitis worsens overtime to loss of smell due to nasal polyps
- Asthma - uncontrolled
- Non-IgE mediated - pseudo-allergic
—– thought to be related to altered pro-inflammatory cytokines in response to NSAID
—– HLA DPB1 0301 component
Treatment:
- LTRA
- regular asthma treatment
- if desensitized to asthma - have to CONTINUED WITH ASA DAILY
—- shown to have reduced NP growth
—- improved asthma control
ICS in Asthma
Reduced decline in lung function
Improve lung function
Prevent airway remodeling
Improved mortality
reduced exacerbations
improve QOL with improved Sx
Reduced EIB
Adding LABA-
— better than increasing intensity of ICS
- improves lung function, symptoms
- reduces exacerbations
Adding LAMA
— TO ICS/LABA
– not recommended to add to ICS (ICS/LAMA) unless you have to
– not as monotherapy - due to increased risk of severe exacerbations
ICS/LAMA/LABA
- Reduce excerbations
- improve lung function
LTRA in Asthma
Improve lung function
Improve QOL and symptoms
Reduce need for rescue SABA
Reduce risk of exacerbations
Greater response in EIB and NERD
*** SABA still preferred in EIB
