Other Pulmonary Disease (PEARLS)
The NCCPA™ PANCE Pulmonary Content Blueprint other pulmonary diseases
| Acute respiratory distress syndrome (ARDS) |
Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by fluid collecting in the lungs depriving organs of oxygen
- ⇑ Permeability of alveolar-capillary membranes ⇒ development of protein-rich pulmonary edema (non-cardiogenic pulmonary edema)
- ARDS can occur in those who are critically ill or who have significant injuries ⇒ sepsis (most common), severe trauma, aspiration of gastric contents, near-drowning
People with ARDS have severe shortness of breath and often are unable to breathe on their own without support from a ventilator
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- Rapid onset of profound dyspnea occurring 12-24 hours after the precipitating event
- Tachypnea, pink frothy sputum, crackles
Chest radiograph shows air bronchograms and bilaterally fluffy infiltrate
- Normal BNP, pulmonary wedge pressure, left ventricle function and echocardiogram
Treatment involves identifying and managing underlying conditions
- Tracheal intubation with the lowest level PEEP to maintain PaO2 >60mmHg or SaO2 >90
- ARDS is often fatal, the risk increases with age and severity of illness
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| Asthma (ReelDx) |
Presentation: Most often young patients present with wheezing and dyspnea often associated with illness, exercise and allergic triggers
Diagnosis and monitor with peak flow. PFT's: Greater than 12% increase in FEV1 after bronchodilator therapy
- FEV1 to FVC ratio < 80% (You would expect the amount of air exhaled during the first second (FEV1) to be the greatest amount
- In asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio
Treatment guidelines:
Mild Intermittent: Less than 2 times per week or 3-night symptoms per month
- Step 1: Short-acting beta2 agonist (SABA) PRN
Mild Persistent: More than 2 times per week or 3-4 night symptoms per month
- Step 2: Low-Dose inhaled corticosteroids (ICS) daily
Moderate Persistent: Daily symptoms or more than 1 nightly episode per week
- Step 3: Low-Dose ICS + Long-acting beta2 agonist (LABA) daily
- Step 4: Medium-Dose ICS +LABA daily
Severe Persistent: Symptoms several times per day and nightly
- Step 5: High-Dose ICS +LABA daily
- Step 6: High-Dose ICS +LABA +oral steroids daily
Acute treatment:
Oxygen, nebulized SABA, ipratropium bromide, and oral corticosteroids
Making Sense of Forced Vital Capacity
- Forced expiratory volume (FEV) measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath. Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test
- You would expect the amount of air exhaled during the first second to be the greatest amount. In asthma, since there is an obstruction (inflammation) you will have a decreased FEV1 and therefore a reduced FEV1 to FVC ratio.
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| Cystic fibrosis |
Etiology: Autosomal recessive mutation in the CFTR gene
- Abnormally thick mucus, difficulty clearing mucus
Presentation: Recurrent respiratory infections (especially Pseudomonas), steatorrhea
Diagnosis: Quantitative sweat chloride test
CXR may reveal hyperinflation, mucus plugging, and focal atelectasis
Treatment:
- Maintenance: Chest physiotherapy, high-fat diet, supplement fat-soluble vitamins (A, D, E, K)
- Acute exacerbations: Antibiotics
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| Foreign body aspiration |
Foreign body aspiration occurs when a foreign body enters the airways and causes choking. Objects can enter the esophagus through the mouth, or enter the trachea through the mouth or nose
- Most often food and can be life-threatening. 80% in mainstem or lobar bronchus right > left
- Risk factors include institutionalization, advanced age, poor dentition, alcohol, sedative use
Presentation (depends on the location of obstruction)
- Inspiratory stridor (if high in the airway) or wheezing and decreased breath sounds (if low in the airway)
CXR (expiratory radiograph) may reveal regional hyperinflation of the affected side
- ABG - necessary for appropriately evaluating ventilation, may be useful for following the progression of respiratory failure when it is of concern
Treatment: Remove foreign body with a bronchoscope
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| Hyaline membrane disease |
Etiology: Insufficient surfactant
- Population: Preterm newborn
- Chest radiograph: Ground glass appearance, air bronchograms, bilateral atelectasis
Treatment: Ventilation and steroids |
| Bronchiectasis |
A condition in which the lungs' airways become dilated and damaged, leading to inadequate clearance of mucus in airways
- Mucus builds up and breeds bacteria, causing frequent infections
- A common endpoint of disorders that cause chronic airway inflammation (CF, immune defects, recurrent pneumonia, aspiration, tumor)
- Symptoms include a daily cough that occurs over months or years and production of copious foul-smelling sputum, frequent respiratory infections
DX: CXR = linear “tram track” lung markings, dilated and thickened airways – “plate-like” atelectasis; CT chest = gold standard
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- Crackles, wheezes, purulent sputum
TX: ambulatory oxygen, aggressive antibiotics for acute exacerbations, CPT (chest physiotherapy = bang on the back); eventual lung transplant |
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