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obstructive & restrictive lung disease

Date post: 12-Feb-2017
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Clinical vignette 3 obstructive and restrictive lung disease Ghaida Al- Rashed
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Page 1: obstructive & restrictive lung disease

Clinical vignette 3obstructive and

restrictive lung disease

Ghaida Al-Rashed

Page 2: obstructive & restrictive lung disease

ObjectivesDescribe the treatment of acute exacerbation of

asthma and COPD ??

How can lung volumes be used to differentiate between obstructive and restrictive lung disease ?

What are the emergent investigations are to be performed on an emergency basis to reach the diagnosis ?

Page 3: obstructive & restrictive lung disease

Objectives:

Describe the treatment of acute exacerbation of asthma and COPD ??

Page 4: obstructive & restrictive lung disease

ACUTE EXACERBATION OF ASTHMA

Treatment

Oxygen 40-60% High doses of inhaled bronchodilators . Systemic corticosteroids. Intravenous fluids. Subsequent management.

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OXYGEN

The patient should supply by High concentrations of oxygen:

Goal: SaO2 > 92% Failure to achieve appropriate oxygenation assisted

ventilation.

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INHALED BRONCHODILATORS o Short-acting β2 agonist agent (SABA) : (Salbutamol 5 mg/hr) or (terbutaline 10mg/hr)via nebulizer driven by oxygen via metered dose inhaler through a spacer device o Inhaled anti-cholinergics (SAMA)(Ipratropium bromide 0.5 mg):

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SYSTEMIC CORTICOSTEROIDS • Hydrocortisone sodium succinate: Dose: 200 mg 4 hourly Rote: intravenous in patients who are unable to swallow or vomiting.

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ARTERIAL BLOOD GASES

We should correct ABG especially If patients ..o Initial PaCO2 measurement was raised ( >7 kPa)o PaO2 was < 8 kPa (60 mmHg) o the patient deteriorates.

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SUBSEQUENT MANAGEMENT If patients fail to improve:

o Intravenous magnesium sulphate (1.2–2 g over 20 min) o Intravenous β2 agonists (e.g. Salbutamol)o Intravenous aminophylline (5mg/kg loading dose over 20

minutes)

Chest x-ray To exclude pneumothorax

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MANAGEMENT OF COPD

The goals of effective COPD management are to:

1. Prevent disease progression2. Relieve symptoms3. Improve exercise tolerance4. Improve health status5. Prevent and treat complication

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OXYGENATION AND VENTILATION• Oxygen therapy:the oxygen saturation level should be at least 90%. • Respiratory support:Non-invasive positive pressure ventilation (NIPPV) BiPAP improves blood gases. indicated if adequate ventilation cannot be achieved using a

high-flow mask.

Nasal oxygen therapy Non- invasive mechanical ventilation invasive mechanical ventilation

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Con..• SHORT-ACTING BRONCHODILATORS (nebulization)

1. Inhaled short-acting β2 agonist agent (SABA).2. Inhaled anti-muscarinic (SAMA).

• CORTICOSTEROIDS:Short courses of systemic corticosteroids.

• ANTIBIOTICSwith bacterial infection

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PREVENTING FUTURE EXACERBATIONS

Appropriate use of

inhaled corticosteroid

+inhaled

bronchodilators

Smoking cessation

vaccination

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Objectives:

How can lung volumes be used to differentiate between obstructive and restrictive lung disease ?

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OBSTRUCTIVE VS. RESTRICTIVE Obstructive disorders

• Characterized by: reduction in airflow.

• So, shortness of breath in exhaling air.

( the air will remain inside the lung after full expiration )

1. COPD2. Asthma3. Bronchiectasis

Restrictive disorders

• Characterized by a reduction in lung volume.

• So, Difficulty in taking air inside the lung.

( DUE TO stiffness inside the lung tissue or chest wall cavity )

1. Interstitial lung disease.2. Scoliosis3. Neuromuscular cause 4. Marked obesity

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SPIROMETRY measures the rate of lung volume changes during forced breathing maneuvers

The diagnosis and distinguished between obstructive and restrictive

lung diseases.

Confirmed by Spirometry

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DIFFERENT BETWEEN OBSTRUCTIVE VS. RESTRICTIVE  

Obstructive disorders• Decrease in both FEV1 and

FEV1/FVC ratio .

Restrictive disorder • Normal FEV1/FVC ratio .

Forced vital capacity (FVC):The maximum volume of air forcibly exhaling from the point of maximal inhalation.

Forced expiratory volume in 1 second (FEV1):Forced expiratory volume in 1 second during FVC maneuver.

Ratio of FEV1 and FVC (FEV1/FVC):Expressed as percentage

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Page 19: obstructive & restrictive lung disease
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Objectives:

What are the emergent investigations are to be performed on an emergency basis to reach the diagnosis ?

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Emergent Investigations1- ECG- ABNORMAL:

In 70% patients with PE:

- Sinus tachycardia- Nonspecific ST-T wave abnormalities

- RBBB

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2- ARTERIAL BLOOD GASES:o hypoxemia, hypocapnia, and respiratory alkalosis due to

hyperventilation.PO2 and A-a gradient most often abnormal Profound hypoxia with normal chest X-ray in the absence of preexisting lung disease is highly suspicious of pulmonary embolism.

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3- D-DIMER • D-dimer: A degradation product of fibrin.• is a substance in the blood that is often increased in people

with PE.D-dimer levels are abnormal in patients with PE; a person with a normal D-dimer level is unlikely to have a PE. Positive D-dimer indicate abnormal high level of fibrin degradation product ( indicate significant blood clut)

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Summary

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Page 27: obstructive & restrictive lung disease

Thank you


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