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COPD
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Features
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· Both emphysema and chronic bronchitis are manifestations of COPD.
· Pulmonary function tests show obstructive physiology (reduced FEVI/FVC, increased RV and TLC)
· DLCO is normal in chronic bronchitis and decreased in emphysema.
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S/S
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SOB – Productive Cough
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Dx
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Clx –> PFT
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Tx
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Stable pt:
1˚ Ipratropium
2˚ Albuterol (may precipitate HF through ⤴️ HF)
3˚ Theophyline
–Stop smoking
-Home O2 (Start if: PaO2 <55 / O2 <88%)
-Vaccine: Pneumococcus q5 ys / Flu q1y
Exacerbation 🚨
· Get: O2 Saturation + ABG + CXR
· Give O2
· Ipratropium + Albuterol TOGETHER
· Systemic Corticosteroids (PO = IV)
· ABx
If pt is on theophylline → check levels & DON’T D/C!
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Acute Exacerbation of COPD
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S/S
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· ⤴️ SOB
· ⤴️ Cough (more frequent or severe)
· Sputum (change in color or volume)
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Dx
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CXR: Hyperinflation
ABG: Hypoxia, C02 retention (chronic &/or acute)
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Tx
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· Oxygen (target Sp02 of 88%-92%)
· Inhaled bronchodilators
· Systemic GCS
· Abx if? ≥2 cardinal sx
· oseltamivir if? evidence of influenza
· Non-invasive positive pressure ventilation if ventilatory failure
· Tracheal intubation if NPPV failed or contraindicated
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Asthma
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Features
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Reversible AW obstruction
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S/S
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Acute AW obstruction w/ SOB & Wheezing
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Dx
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· Clx → PFT (Gold standard)
· CXR: ⓝ
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Acute Exacerbation
Tx
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· 1˚ O2 / SABA / ipratropium?
· 2˚ IV methylprednisone
· 3˚ (no improvement w/i 1 h) Mg
· non-invasive positive pressure
· If iminent resp failure → ICU + Intubation
· If pt has ⓝ/⤴️ PaCO2
· Muscle fatigue
· ⤵️ Breath sounds
· Hypoxia
· AMS
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Chronic Tx
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Bronchiectasis
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Pathology
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· Recurrent infections + Impaired clearance
· That leads to bacterial overgrowth & Nø infiltration → tissue damage & AW structural changes
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Causes/RF
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· AW obstruction (Cancer)
· Aotuimmune (RA, Sjögren),
· Chronic infection (Aspergillosis, mycobacteria)
· Immunodeficiency (Hypo-Ig)
· Congenital (Cystic Fibrosis, alpha1-antitrypsin deficiency)
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S/S
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· chronic daily cough
· ⊕ a lot of pus produced
· Rx Rhinosinusitis, SOB, hemoptysis
· Crackles, wheezing
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Dx
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· High Resolution CT scan of the chest (needed for initial diagnosis)
· Immunoglobulin quantification
· CF testing, sputum culture (bacteria, fungi & mycobacteria)
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Fast HY Review 