RESPIRATORY DISEASES

OBSTRUCTIVE (ABCT)

• Asthma

• Brochiectasis

• COPD/Cystic Fibrosis

• Tracheal Obstruction

RESTRICTIVE (AINT)

• Alveolar (Edema, Bood and Pus)

• Inflammatory, Idiopathic, Interstitial Lung Disease

• Neuromuscular Diseases

• Thoracic Wall deformities

DEFINITION

• An abnormal bronchoconstriction of

the airways.

• It is REVERSIBLE obstructive pulmonary

disease.

CAUSES

PRESENTATION

WHEEZING

SHORTNESS OF BREATH

CHEST TIGHTNESS

COUGH

↑ BREATHING RATE

↑ HEART RATE

PRESENTATION

ACCESSORY MUSCLE USE

↓BREATH SOUNDS

↓ OXYGEN SATURATION

ACCESSORY MUSCLE USE

INITIAL DIAGNOSTIC TESTS

PEAK EXPIRATORY FLOW

ARTERIAL BLOOD GAS (ABG)

CHEST X-RAY

PEAK EXPIRATORY FLOW

PEAK EXPIRATORY FLOW

ABG

ABG

NORMAL VALUES

• pH 7.35-7.45

• PaO2 >80mmHg

• PaCO2 35-45mmHg

ACUTE ASTHMA

• pH ↑

• PaO2 ↓

• PaCO2 ↓

CHEST X-RAY

NORMAL ASTHMA

(HYPERINFLATION)

ACCURATE DIAGNOSTIC TEST

PULMONARY FUNCTION TESTING

PULMONARY FUNCTION TESTING (PFTs)

PULMONARY FUNCTION TESTING (PFTs)

• ↓ FEV1/FVC

• ↑ RV

• ↑ TLC

• RV (Residual Volume) The volume of air remaining in

the lungs.

• TLC (Total Lung Capacity) The volume of air in the lungs at maximal inhalation, the sum of

VC (Vital Capacity) and RV.

VC (Vital Capacity)• The volume of air breathed out

after the deepest inhalation.

PULMONARY FUNCTION TESTING

• ↓ FEV1/FVC

• ↑ RV

• ↑ TLC

PFTs are normal in between exacerbations.

• FEV1 (Forced Expiratory Volume in 1 sec)

Volume that has been exhaled at the end of the 1st second of forced

expiration.

• FVC (Forced Vital Capacity) The determination of the vital

capacity from a maximally forced expiratory effort

OTHER DIAGNOSTIC TESTS

↑ Eosinophils (Normal = 1 - 3% Relative Value) .

Complete Blood Count

Skin Testing

Serum IgE Levels

METHACHOLINE TESTING

• Methacholine is an artificial acetylcholine. Used when PFTs are normal but asthma is still suspected.

MEDICATIONS

SABA (Short-Acting β-

Agonists)

ICS (Inhaled

Corticosteroids)

LABA (Long-Acting β-

Agonists)

SABA e.g. Albuterol

Common Side-Effect: Oral Thrush

ICS e.g. Beclomethasone

LABA e.g. Salmeterol

ASTHMA - TYPES

INTERMITTENT (TREATMENT)

SABA

PERSISTANT (TREATMENT)

MILD

SABA + ICS

MODERATE

SABA + ICS + LABA

SEVERE

SABA + ICS + LABA (AND POSSIBLE ORAL STEROIDS)

OTHER MEDICATIONS

Theophylline

Effective only for Prophylaxis of Asthma

Cromolyn

Montelukast, Zafirlukast

OTHER MEDICATIONS

When SABA+ICS+LABA has all failed. E.g. Prednisolone

Corticosteroids (Oral)

Magnesium

OTHER MEDICATIONS

Given to those with ↑IgE levels.

Omalizumab

E.g. Ipratropium

Anti-Cholinergics

SALBUTAMOL

Salbutamol metered dose inhaler is commonly used to treat asthma attacks.

SALBUTAMOL

• The Spacer makes it easier to use the inhaler and

helps ensure that more of the medication gets into the lungs instead of just

into the mouth or the air. • With proper use, a spacer

can make an inhaler somewhat more effective

in delivering medicine.

FLUTICASONE

• Steroid inhalers (Used for long-term control) - having a good inhaler technique and using a spacer device may

reduce the risk of oral thrush.

• Also, wash your mouth every time after using the

inhaler to help remove any medicine particles left in

your mouth.

ORAL THRUSH

Oral Thrush: Common side-effect of chronic ICS (Inhaled Corticosteroids)

use.

A-S-T-H-M-A

A – Agonists (β2)

S – Steroids

T – Theophylline

H – Humidified Oxygen

M – Magnesium

A – Anti-Cholinergics

MECHANICAL VENTILATION

PaCO2: >50mmHg

PaO2: <50mmHg

PREVENTION

AVOIDANCE OF ALLERGENCE

SMOKING BANS

INFLUENZA AND PNEUMOCOCCAL VACCINATIONS