Obstructive Lung Disease

Question 1

Etiologies of obstructive pulmonary disease ?

Answer 1

#_ABCT
- Asthma.
- Bronchiectasis.
- Cystic fibrosis.
- Tracheal or bronchial
obstruction.

Question 2

Asthma is ?

Answer 2

Reversible airway obstruction 2° to

• bronchial hyperreactivity, - airway inflammation,
• mucous plugging, and
• smooth muscle hypertrophy.

Question 3

HISTORY/PE of Asthma ?

Answer 3

• Cough, episodic wheezing, dyspnea and/or chest tightness.
• Symptoms worsen at night or early in the morning.
• Exam reveals wheezing, prolonged expiratory duration, accessory muscles use. tachypnea, tachycardia.

Question 4

What should we suspect in children with multiple episodes of croup and URIs associated with dyspnea ?

Answer 4

Asthma.

Question 5

Diagnosis of Asthma ?

Answer 5

• ABGs: Mild hypoxia and Respiratory alkalosis.
• Spirometry/PFTs: ↓ FEV1/FVC.
• CBC: Possible eosinophilia.
• CXR: Hyperinflation.
• Methacholine challenge: Tests for bronchial hyperresponsiveness; useful
  when PFTs are normal but asthma is still suspected.

Question 6

types of chronic Asthma ?

Answer 6

• Mild intermittent (FEV >80%)
  ≤ 2 days/week
  ≤ 2 nights/month
• Mild persistent (FEV >80%)
  > 2/week but < 1/day.
  > 2 nights/month
• Moderate persistent (FEV 60-80%)
  Daily
  > 1 night/week
• Severe persistent (FEV < 60%)
  Continual, frequent

Question 7

What is the proper management of Mild intermittent asthma ?

Answer 7

• No daily medications.

- PRN short-acting bronchodilator.

Question 8

What is the proper management of Mild persistent asthma?

Answer 8

• Daily low-dose inhaled corticosteroids.

- PRN short-acting bronchodilator.

Question 9

What is the proper management of Moderate persistent asthma ?

Answer 9

• Low- to medium-dose inhaled corticosteroids + long- acting inhaled β2-agonists.

Question 10

What is the proper management of Severe persistent ?

Answer 10

• High-dose inhaled corticosteroids + long-acting inhaled β2-agonists.
• Possible PO corticosteroids.
• PRN short-acting bronchodilator.

Question 11

Meds for asthma exacerbations ?

Answer 11

#_ASTHMA
- Albuterol
- Steroids.
- Theophylline (rare) 
- Humidified O2 
- Magnesium (severe
exacerbations)
- Anticholinergics.

Question 12

When should you consider intubation in severe asthma ?

Answer 12

in patients with Pco2 > 50 mmHg or Po2 < 50 mmHg.

Question 13

Bronchiectasis is ?

Answer 13

A disease caused by cycles of infection and inflammation in the bronchi/bron- chioles that lead to permanent fibrosis, remodeling, and dilation of bronchi.

Question 14

HISTORY/PE of Bronchiectasis ?

Answer 14

• Presents with chronic cough accompanied by frequent bouts of yellow or green sputum production, dyspnea, and possible hemoptysis and halitosis.
• Associated with a history of pulmonary infections, Hypersensitivity, cystic fibrosis, immunodeficiency, localized airway obstruction, aspiration, autoimmune disease or IBD.
• Exam reveals rales, wheezes, rhonchi, purulent mucus, and occasional hemoptysis.

Question 15

DIAGNOSIS of Bronchiectasis ?

Answer 15

• CXR: TRAM LINES (parallel lines outlining di- lated bronchi as a result of peribronchial inflammation and fibrosis) and HONEYCMBING.
• High-resolution CT: DILATED AIRWAYS and ballooned cysts at the end of the bronchus.

Question 16

Treatment of Bronchiectasis?

Answer 16

• Antibiotics for bacterial infections; consider inhaled corticosteroids.
• Maintain bronchopulmonary hygiene (cough control, postural drainage,
  chest physiotherapy).
• Consider lobectomy for localized disease or lung transplantation for severe
  disease.

Question 17

Chronic Obstructive Pulmonary Disease (COPD) ?

Answer 17

Characterized by ↓ lung function with airflow obstruction. Generally 2° to chronic bronchitis or emphysema.

Question 18

How to distinguish between chronic bronchitis and emphysema ?

Answer 18

• Chronic bronchitis: Productive cough for > 3 months per year for two consecutive years.
• Emphysema: Terminal airway destruction and dilation that may be 2° to smoking (centrilobular) or to α1-antitrypsin deficiency (panlobular).

Question 19

HISTORY/PE of COPD ?

Answer 19

• Emphysema (“pink puffer”): Dyspnea, pursed lips.

- Chronic bronchitis (“blue bloater”): Cyanosis with mild dyspnea.

Question 20

DIAGNOSIS of COPD ?

Answer 20

• CXR: Hyperinflated lungs.
• PFTs: ↓ FEV1/FVC.
• ABGs: Hypoxemia with acute or chronic respiratory acidosis (↑ PCO2).
• Blood cultures: Obtain if the patient is febrile.

Question 21

Treatment of COPD ?

Answer 21

• Acute exacerbations: O2, inhaled β-agonists (albuterol) and anticholin- ergics (ipratropium, tiotropium), IV +/− inhaled corticosteroids, anti- biotics.
• Chronic: Smoking cessation, supplemental O2.