Asthma

OLD = Obstructive Lung Disease

SABA = Albuterol
ICS = Inhaled corticosteroid
LABA = Salmeterol/Formeterol

Acute Asthma Exacerbation

 Oxygen
Albuterol/Ipratropium
Steroids

Nebulizers = Albuterol, Ipratropium

PEFR = Peak expiratory flow rate. Done to find how they respond to Tx.
MDI = middle dose inhalers
LS = Lung sounds;
Lung Cancer
Old pt + Smoking Hx

Tap = Thoracentesis
 Biopsy

• After CT Scan: Stage the Ca (PET Scan) and Biopsy (Bronch, CT guided,VATS,
thoracocentesis or Resection if large and spiculated)
Bronch = Bronchoscopy
EBUS = Endobronchial Ultrasound
VATS = Video Assisted thoracoscopic surgery
PFTs done to see if pt can handle a surgery for resection
Lung Cancer Screening
• Primary prevention: Smoking (avoid in self or 2nd hand, Cessation)
• Screening: Low Dose CT Scan once a year
o For who: >55 + 30 pack year + Less than 15 years of quitting
• Finding Nodules are common... what to do then?

o (High risk vs Low Risk)

Lung Cancer Types

Very responsive

Adenocarcionoma = The one assoc with non-smokers and Asbestosis

Serotonin syndrome = Fibrosis, Flushing, Wheezing, Diarrhea
Pleural Effusion

PNA = Pneumonia

Chylo = Chylothorax
 If fails

W + W = Watch and Wait

Thoracostomy = Chest tube

ULN = Upper limit of normal

Pulmonary Embolism
Chest X Ray Normal
 Platelet derived mediators
• Allow fluid to leak out and create barrier b/w alveoli and vessel, causing a larger
diffusion barrier for oxygen – High A-a oxygen gradient (UWorld)
• Tachycardia and Tachypnea cause decreased CO2 leading to Resp Alkalosis
To rule out PE

CTA w/ Contrast*= CT Angiogram = Spiral CT

• Beware kidney dz
NOAC = Apixaban, Dabigatran
tPA reserved for massive UNSTABLE PE = PE + Hypotension
IVC filter only used if pt has bleeding somewhere (i.e GI) – Contraindication for anticoagulation
COPD

DLCO decreased in Emphysema vs Normal DLCO in Chronic Bronchitis (UWorld)

• In emphysema, there is less surface area. Pink Puffer (no cyanosis)
• Bronchitis = Inflammation of airways
• In Bronchitis, less oxygenation causes vasoconstriction, leading to pulmonary hypertension
o Blue Bloater (cyanosis)
 COPD Tx
LAMA = Tiotropium
PDE4 inhibitor

Asthma Tx

• Vaccines: Pneumococcal, Influenza

• Smoking cessation and maintaining oxygenation are the 2 things that decrease mortality.
***In normal people, ↑CO2 causes ↑respiratory drive. In chronic COPD pts, since they
always have ↑CO2, they lose this drive. They depend on being hypoxemic in order to
stimulate the brain stem to breathe.
• Maintain oxygen saturation between 88-92% (too much oxygen sat kills the pt)
COPD Exacerbation

Acute COPD Tx

MDI = Inhalers
NEB = Nebulizer (albuterol/Ipratropium)

Acute Asthma Tx
ARDS
Alveoli and
capillary

O2 is diffusion limited = limited by barrier b/w alveoli and capillary

CO2 is perfusion limited = not limited by diffusion barrier
Fluid permeates out of capillaries and “crush” alveoli. Oxygen is limited, but not CO2

SAS = Sick as Shit, Shortness of breath, tachypnea

**Recognize difference on the test**

Mechanical Ventilation Settings

o With Low Tidal Volume of 6 mL per kg + RR = to blow out CO2
o Positive end expiratory pressure (PEEP) to keep the alveoli open
o Levels of FI02 above 50% are toxic to the lungs.
o Maintain the plateau pressure of less than 30 cm of water

FiO2 (Fraction of inspired oxygen) must be maintained under 60%

If pt has a PaO2 < 60mmHg, after increasing FiO2 to the max (<60%), the next thing is to
increase {{c1::PEEP}}
• Normal PaO2 = >80mmHg

DPLD (Diffused Parenchymal Lung Disease)

Best Initial Test: Chest X Ray shows reticular/nodular
• Better view: CT Scan shows “Ground Glass”
Most Accurate Test: Biopsy (VATS)

DMARDS (methotrexate, sulfasalazine, hydroxychloroquine, TNF inhibitors)

Biologics

Specific Causes of Interstitial Lung Disease

Idiopathic
• (<6wks) Acute Interstitial Pneumonitis vs Idiopathic Pulmonary Fibrosis (>6wks)
Drug Induced
• Bleomycin, Busulfan, Amiodarone; also Radiation
Rheumatologic diseases
• Rheumatoid Arthritis, SLE, Systemic Sclerosis (Scleroderma)
Primary
• Sarcoidosis
Environmental
• Asbestos
• Hypersensitivity Pneumonitis
• Pneumoconiosis
o Silicosis
o Berylliosis
o Coal Miner’s

Sarcoidosis
Mech: Autoimmune
Mostly Black Women
Pt: Asymptomatic Bilateral Hilar Lymphadenopathy^
• Heart Block, Bell’s palsy, Erythema Nodosum^, Uveitis^
Dx: 1. Chest X Ray (bilateral hilar), 2. CT Scan (ground glass), 3. PFT (restrictive)
Most Accurate Test: Biopsy shows Non-Caseating Granulomas
Tx: Steroids
Asbestosis

(ferruginous bodies)

Hypersensitivity Pneumonitis
• Assoc with bird droppings or environmental exposure
• Person that goes to work during workweek and develops Sx of Interstitial lung dz +
Then on vacation/long weekend it goes away
• Mech: Antigen mediated
• Tx: Remove the exposure

Glass workers

Caplan syndrome = RA + pneumoconiosis | R/O with Rheumatoid Factor