Obstructive Lung disease Lung Cancer Rob Nicholson Finals
Obstructive Lung disease + Lung Cancer Rob Nicholson
Finals simplified Every Condition: What is it? What causes it? What do patients present with? How do we investigate it? How do we treat it acutely? How do we treat it chronically?
COPD What is it? Chronic bronchitis: Cough for 3 months for 2 consecutive years. Emphysema: Enlarged air spaces distal to the terminal bronchiole
COPD
COPD Lung function tests: FEV 1: FVC ratio = <70%
COPD What causes it? Smoking Pollution Alpha 1 antitrypsin deficiency
COPD What to patients present with? History: Increased SOB Cough (productive white normally) Weight loss Depression Chest pain?
COPD
COPD How do we investigate it? History and examination Bloods Radiology Special tests
COPD Routine bloods: Increased Hb: Polycythemia Increased inflammatory markers in an exacerbation
COPD ABG: Type I respiratory failure • P 02 low • PCO 2 normal/low • p. H: normal Type II respiratory failure • PO 2 low • PCO 2 high • p. H: low
COPD Absence of other cause of breathlessness Greater than 7 anterior ribs Flattened Diaphragm
COPD P-Pulmonale
COPD Lung function tests: Decreased FEV 1 Dramatically decreased FEV 1/FVC ratio
COPD Treating an acute exacerbation of COPD: Steroids Nebulisers +/- antibiotics Oxygen? NIV?
COPD Chronic: Stop smoking!
COPD Long term treatment (pharmaceutical): Short acting B agonist/ Short acting ant muscarinic FEV > 50 Long acting beta 2 agonist Long acting muscarinic antagonist FEV < 50 Long acting beta 2 agonist + steroid One combined with steroid All three Long acting muscarinic antagonist
COPD Long term oxygen therapy. Differs if have cardiac disease or not Essentially low O 2 on two separate occasions on ABG (<7. 3 if no cardiac Hx) Non-smokers Clinically stable
Asthma What is it? Reversible airway obstruction Bronchial hyperactivity
Asthma What do they present with? Increased cough (particularly bad at night) Diurnal variation of all symptoms Wheeze Dyspnea (Atopic symptoms) Triggers
Asthma Clinical examination: Use of accessory muscles Tachycardia and tachypnea Widespread polyphonic wheeze (Signs of steroid usage)
Asthma How do we investigate it? Bloods: Eosinophilia Raised Ig. E
Asthma Radiology: Chest X-ray: Chronically shows the same signs as COPD. Acutely very little
Asthma Special tests: Spirometry: Obstructive pattern that displays >15% reversibility. PEFR: diurnal variation / morning dipping Atopy: RAST testing and skin prick testing
Asthma Treatment: Bio, psycho social……. . Technique Avoidance Monitor Educate
Asthma
Asthma
Asthma
Asthma Essentially: Under 5: Beta 2 agonist----steroid----LTA----REFER 5 -12’S: Beta 2 agonist----steroid----LOBA----increase steroid-----oral steroids --- REFER Adults: Same but try everything else before referral
Asthma Acute asthma: Severity Symptoms Mild asthma exacerbation Deterioration in normal resp function Moderate asthma exacerbation 50 -75% PEFR Severe asthma exacerbation 33 -50% PEFR, incomplete sentences, RR>25, HR >110 Life threatening asthma exacerbation O 2 < 92%, p. O 2 < 8, silent chest, decreased conscious level
Asthma Treatment: Nebs Steroids Theophylline Magnesium sulphate OXYGEN Leukotriene ITU
Lung Cancer What is it? Squamous cell carcinoma Adenocarcinoma Large cell carcinoma Small cell carcinoma
Lung Cancer What do they present with? Weight loss Cough +/- haemoptysis Chest pain Recurrent pneumonia’s Hoarse voice Beware Horners syndrome….
Lung Cancer Squamous: Smokers Centrally located Metastasise late Parathyroid hormone
Lung Cancer Adenocarcinoma Non smokers Peripheral Metastasise early
Lung Cancer Small cell lung cancer Starts centrally Rapidly progressive Ectopic hormone production (Cushings, SIADH, Carcinoid)
Lung cancer Investigations: Bloods: FBC, Ca 2+, LFT’s, Alk phos Radiology: CT, MRI, bronchoscopy Special tests: Biopsy, cytology
Lung Cancer Treatment: BIOPSYCHOSOCIAL MDT Chemo Radiotherapy Surgery Palliation
Example Case Measurement Normal values p. H 7. 35 -7. 45 p. CO 2 4. 5 -6. 1 p. O 2 12 -14 HCO 3 22 -28
Example case
Any questions?
Thanks to: Radiology masterclass British lung foundation Google images BLS guidelines NICE guidance SIGN guidelines
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