lung fibrosis

LUNG FIBROSIS >> Localized Systemic sclerosis, Sarcoidosis, Tuberculosis, Berylliosis and Asbestosis >>Diffuse Idiopathic lung fibrosis, Rheumatoid lung, Langerhans’ cell histiocytosis ( exclusive in smoker), Tuberous sclerosis, Neurofibromatosis

Idiopathic pulmonary fibrosis (IPF) , >> High-resolution CT scan (HRCT) 90% accurate in diagnosis. Bronchalveolar lavage > increase neutrophil and macrophage, ANA and RF +ve in 30%. Lung biopsy may needed to DD from othe causes

Pneumonia

Pneumonia:

• Hospitalized ‘ill’ patients –Gram negative organisms.
• Alcohol excess ass with aspiration pneumonia (anaerobes>> add metronidazol to antibiotic regimen) and klebsila ( upper lobe + gelatinous sputum).

• Immunosuppression (e.g. AIDS or treatment with cytotoxic agents) – organisms include Pneumocystis jiroveci, Mycobacterium avium-intracellulare,cytomegalovirus.

• Intravenous drug users (may be multiple abcesses in x ray)>> Staph. aureus infection, G+ve cocci. Chlamydia psittaci exposed to infected birds, especially parrots and has chronic course.

• Persistent changes on the chest X-ray after 6 weeks suggest a bronchial abnormality, usually a carcinoma. No improvement with copious sputum >> abscess and empyema.

• Diagnosis of L. pneumophila (shower in hotels) suggested by: a prodromal virus-like illness, a dry cough, confusion or diarrhea, lymphopenia without marked leucocytosis, hyponatraemia., Hypoalbuminaemia and high serum levels of liver aminotransferases. Urinary antigen test and confirmed by direct immunofluorescent staining of the organism. ttt Azithromycin + add rifampicine in sever case.

• CRUB-65 if =2 hospitals and if > 2 ICU

asthma emergency

steps of asthma treatment

COPD

• COPD: smoking, pollution and alph 1 antitrypsin deficiency (under 40ys, basal emphysema). Usually clinical diagnosis, PFT with no or limited <15% reversibility
• In moderate to sever COPD Prednisolone trial should be done: 30 mg daily should be given for 2 weeks, with measurements of lung function before and after the treatment period. If FEV1 increase > 15%, prednisolone should be discontinued and replaced by inhaled corticosteroids.

Long-term continuous domiciliary oxygen therapy will benefit patients who have:

A Pao2 of < 7.3 kPa (55 mmHg) when breathing air. Measurements should be taken on two occasions at least 3 weeks apart after appropriate bronchodilator therapy or

A Pao2 7.3–8 kPa with secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema or evidence of pulmonary hypertension.and

 Carboxyhaemoglobin of less than 3% (i.e. patients who have stopped smoking).

LTOT for 15h/day decrease Pulmonary pressure, 19h/day improve survival

• COPD Surgery, Some patients with large emphysematous bullae can benefit from bullectomy, selected patients with severe COPD (FEV1 < 1 L) may benefit from lung volume reduction surgery.

• Obstructive sleep apnea syndrome: The Epworth Sleepiness Scale then confirmed by oximetry and polysomnographic studies> The diagnosis of sleep apnoea/hypopnoea is confirmed if there are more than 10–15 apnoeas or hypopnoeas in any 1 hour of sleep. Management consists of correction of treatable factors, if necessary, nasal continuous positive airway pressure (CPAP) delivered by a nasal mask during sleep

Chest notes 2

• Restrictive lung disorders are characterised by reduced FEV1 & FVC, FEV1/FVC >70%, reduced TLC & RV and reduced TLCO.

Causes of restrictive lung defect are: - neurogenic or psychogenic causes - abnormalities of the thoracic wall - stiff parenchyma (pulmonary fibrosis) - loss of lung tissue, e.g. pneumonectomy - displacement

• Obstructive lung disorders are characterised by reduced FEV1 & FVC, FEV1/FVC < 70%, raised TLC & RV (gas trapping) and reduced TLCO (emphysema) or normal or raised TLCO (asthmatics).PEFR decrease

• Environmental tobacco smoke (‘passive smoking’) has been shown to cause more frequent and more severe attacks of asthma in children and possibly increases the number of cases of asthma. It is also associated with a small but definite increase in lung cancer

• Drugs for stop smoking: Nicotine replacement therapy (better) and bupropion only for 2 weeks beyond the target stop date. Varenicline is an oral partial agonist on nicotinic acetylcholine receptor, SE is nausea and sever depression

• Influenza Neuraminidase inhibitors 48 hour before the symptoms >> shorten the duration of influenza, But zanamivir and oseltamivir are currently recommended for patients with suspected influenza over the age of 65 and ‘at-risk’ adults. Vaccin CI for patients allergic to egg proteins

• Allergic nasal polyp responds to oral steroid for 2 ws and recurrence can prevented by local steroid

1 Chest Notes

Flow–volume loops : For diagnosis large airway obstruction both intra- and extrathoracic