Chunxue Bai MD

Institute of Respiratory Diseases

Fudan University

Introduction

Respiratory System

• In 2001, respiratory diseases was No 1 reason for

mortality in China

Urban Area No.4（13.36%）

Rural Area No.1（22.46%）

• The morbidity of COPD，ALI，lung cancer, tuberculosis

keeps increasing

• The burden of chronic respiratory diseases remains in

high level

• New contagious respiratory diseases (SARS, bird flu)

Epidemiology

Risk Factors

• Air Pollution：

Is the risk factor for

– chronic bronchitis

– COPD

– lung cancer

Risk Factors

• Smoking： the main pollution in small area

the main risk factor for chronic respiratory diseases and lung cancer in China

China has big three for smoking

Risk Factors

• Inhaled Antigens：

the morbidity of asthma is increasing

Risk Factors

• New Pathogens and antimicrobial resistance – ESBL, MRSA, antimicrobial resistant bacterial

– Virus

– non-specific pathogens

ESBL

• Double Circulation：

– pulmonary circulation: interposed between the right

and left ventricles

blood gas exchange

production and release humoral mediators

a barrier to maintain lung fluid balance

– bronchial circulation: from systemic circulation

mostly perfuse the upper airways

provide nutritive flow

Physiology & Defense

• Defense Mechanisms and Immunology

– physical barrier: against airbone pathogens

and irritants (cough clearance, mucus-

cytoplasmic cilia)

Physiology & Defense

• Defense Mechanisms and Immunology

– alveolar clearance (alveolar macrophages,

PMN, T cell)

– Immunology (IgA、IgM、IgG)

Too strong stimuli and weak defense results in

lesion and injury of the lung

– Asthma

– COPD

– ALI

– infection

Physiology & Defense

History

Symptoms

Signs

Additional Diagnostic Evaluation

Diagnosis &

Differential Diagnosis

Historic Information

• Smoking:

– year

– intensity (number of packs per day)

Historic Information

• Exposure:

– occupational and personal histories

– inorganic dusts (asbestos, silica dusts)

– organic antigens (dust mites, pet dander, pollen)

Historic Information

• Food and Other treatment:

– crab

– chemo or radiation therapy

– amiodarone

– ß-blocking agents

– ACEi

Historic Information

• Family History:

– cystic fibrosis

– α1-antitrypsin deficiency

– asthma

Clinical Presentation

• Cough

– the duration of the cough:

Acute cough (<3 weeks)

Subacute cough (between 3 and 8 weeks)

Chronic cough (>8 weeks)

– be associated with: season, wheezing, fever,

sputum…

Clinical Presentation

• Sputum:

– Colour

– Quantity

• Suggest airway disease：

– COPD

– Bronchiectasis

– Lung cancer

– TB

• Hemoptysis

– Quantity and color

– Related diseases：

• Lung cancer

• Bronchiectasis

• TB

Clinical Presentation

• Dyspnea

– Time course：

acute, intermittent, chronic

– differential diagnosis:

respiratory system dyspnea or cardiovascular

system dyspnea

Clinical Presentation

• Chest Pain

– caused by respiratory diseases and PE

– usually originates from involvement of the

parietal pleura

Clinical Presentation

Physical Examination

• Meticulous Physical Examination:

inspection, palpation, percussion, auscultation

– clubbing , cyanosis

Additional Diagnostic Evaluation

1. Collection of Sputum spontaneous

expectoration or sputum induction

staining

pathogens culture

cytologic staining

Additional Diagnostic Evaluation

2.Arterial Blood Gases

• Invasive sample collection

• Gas pressures are diluted by heparin solution

• lagged report

Containing

50 uL heparin

with PO2

150 mmHg

N2 O2

5

mi

n

Flu

or

esce

nce

inte

n

sity

5

0

%

Additional Diagnostic Evaluation

3. Skin Test for Antigens：

• PPD

• Antigens

Additional Diagnostic Evaluation

4. Thoracentesis

• Purposes：diagnosis; palliation of dyspnea

• Classification: exudative or transudative

• LDH、ADA、CEA、chromosome analysis:

tuberculosis or malignant effusion

• Cytologic study and pleural biopsy: benign or

malignant

Additional Diagnostic Evaluation

5. Radiography

• Routine chest radiography

• Computed tomography (CT): HRCT

• MRI

• Pulmonary Angiography

Routine Chest Radiography

X-ray & CT

CTPA

Normal pulmonary artery

Pulmonary Angiography

Pulmonary embolism

MRI

Additional Diagnostic Evaluation

6. Bronchoscopy

• rigid bronchoscopy

• foreign body retrieval

•massive hemorrhage suction

Additional Diagnostic Evaluation

6. Bronchoscopy

flexible fiberoptic bronchoscopy

to visualize virtually to subsegmental bronchi; samples from

airway lesions: washing, brushing, biopsy; bronchoalveolar

lavage; transbronchial biopsy; fluorescence bronchoscopy

Dysplasia

Bronchitis Bleeding

Cancer

气管原发鳞癌 激光治疗后

Lung Cancer

Biopsy & TBNB

Additional Diagnostic Evaluation

6. Thoracoscope

• newer interventional techniques:

laser therapy, cryotherapy, electrocautery, stent placement

• Thoracoscope: pleural and lung biopsy

Additional Diagnostic Evaluation

7. Radionuclide Scanning

• 133Xenon、99mTe：PTE、lung tumor；

• 67Ga：sarcoidosis,lung cancer,alveolitis

• Positron Emission Tomographic

Scanning (PET)：

to identify malignant lesions

• Perfusion：multiple sections and subsections deletion;

Ventilation：abnormal distribution, normal clearance.

• Diagnosis：PTE

Evaluation of

solitary pulmonary

nodules and as an

aid to staging lung

cancer, through

identification of

mediastinal lymph

node involvement

by malignancy

18F-fluoro-2-deoxyglucose (FDG)

PET

How to improve the accuracy？

-image fusion

PET/CT：In one round of scanning, corresponding

fusion between function and structure images is

implemented

+

PET CT PET/CT

PET/CT

Additional Diagnostic Evaluation

8. Lung Tissue Biopsy • transbronchial biopsy

• percutaneous needle aspiration

localized by X-ray, ultrasound and CT

• open lung biopsy

Additional Diagnostic Evaluation

9.Pulmonary Function Test

• disturbances in ventilatory function;

• diffusing capacity

Additional Diagnostic Evaluation

10. Ultrasound

• be helpful in the detection and localization

of pleural abnormalities

• guide to thoracentesis

• endobronchial ultrosound

Lymph node

Additional Diagnostic Evaluation

11. Mediastinoscopy

• for the diagnosis of mediastinal masses or

enlarged mediastinal lymph nodes

• under general anesthesia

• rigid mediastinoscope

Future

Prevention

• Smoking cessation, less air pollution

• To manage pulmonary contagious disease

• Possible early diagnosis：

regular X-ray examination

regular lung function test

PCR, molecular genetics

Future

Treatment

• Development of respiratory physiology and

intensive care

• New antibiotics

• Non-invasive ventilation

• Lung transplantation

• Molecular Biology Technics (gene targeted

therapy)

易医

提供安全数据的网络和

具备互操作性的平台

生命真可贵，

健康价更高，

若想均得到，

易医有诀窍！

www,emed1.org

本学科国际杂志兼职 Name International Journals Position 王向东 Journal of Clinical Bioinformatics 主编

王向东 Journal of Epithelial Biology & Pharmacology 主编

白春学 Journal of Epithelial Biology & Pharmacology 副主编

白春学 Journal of Organ Dysfunction 副主编

白春学 Journal of Clinical Bioinformatics 副主编

王向东 Therapeutic Advances of Respiratory Disease 副主编

王向东 Journal of Cellular & Molecular Medicine (IF=4.608) 亚太主编

白春学 CHEST (IF 6.519) 编委

白春学 American Journal of Respiratory Cell and Molecular Biology （IF 4.426） 编委

王向东 American Journal of Respiratory Cell and Molecular Biology （IF 4.426） 编委

王向东 Respiratory Research （IF=3.7） 副主编

宋元林 Respirology （IF=1.865） 编委

王向东 Clinical Medicine: Therapeutics 编委

王向东 Expert Review of Clinical Pharmacology 编委

王向东 Expert Review of Respiratory Medicine 编委

王向东 Journal of Biophysics 编委

王向东 Journal of World Gastroenterology 编委

王向东 Proteomics Insights 编委

宋元林 ISRN Pulmonology 编委

宋元林 Journal of Pulmonary and Respiratory Medicine 编委

Only part of our work has been implemented

in 2011. We hope more and more young

doctors and students could have chances to

be awarded in 2012.

Thank you!