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- A 54-kD glycoprotein that inhibits proteolytic enzymes (proteases), trypsin, chymotrypsin, elastases in lysosomes, plasmin, thrombin, collagenase and others; serum A1AT is a so-called acute-phase reactant.
- Increased A1AT:
- Inflammation, liver injury, increased estrogen, pregnancy, malignancy, corticosteroid therapy.
- Decreased A1AT:
- Heterozygous A1AT deficiency, emphysema, prematurity, protein-losing disorders; by immunohistochemistry, A1AT stains atypical fibroxanthoma, granular cell tumor and papillary carcinoma of the thyroid.
- An ABG is a test that measures the arterial oxygen tension (PaO2), carbon dioxide tension (PaCO2), and acidity (pH). In addition, arterial oxyhemoglobin saturation (SaO2) can be determined. Such information is vital when caring for patients with critical illness or respiratory disease. As a result, the ABG is one of the most common tests performed on patients in intensive care units (ICUs).
- The test is used to determine the pH of the blood, the partial pressure of carbon dioxide and oxygen, and the bicarbonate level. Many blood gas analyzers will also report concentrations of lactate, hemoglobin, several electrolytes, oxyhemoglobin, carboxyhemoglobin and methemoglobin. ABG testing is mainly used in pulmonology and critical care medicine to determine gas exchange which reflect gas exchange across the alveolar-capillary membrane.
air-filled bronchi seen as radiolucent, branching bands within pulmonary densities. Indicates involvement of lung parenchyma.
- An antiviral agent that prevents the release of viral nucleic acid into the host cells, which is most effective against influenza virus; in parkinsonism, amantadine increases presynaptic dopamine release, blocks dopamine reuptake into the presynaptic neurons and has anticholinergic effects.
- Adverse effects:
- Nausea, vertigo, confusion, hallucinations, anxiety, restlessness, depression, irritability, peripheral oedema, orthostatic hypotension, psychotic reaction.
Antibiotics may be informally defined as the subgroup of anti-infectives that are derived from bacterial sources and are used to treat bacterial infections. Other classes of drugs, most notably the sulfonamides, may be effective antibacterials. Antibiotics are used for treatment or prevention of bacterial infection.
any agent or group of drugs used to treat tuberculosis. At least two drugs, and usually three, are required in various combinations in pulmonary tuberculosis therapy. These include isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Supplements of pyridoxine (vitamin B6) also may be needed to relieve the symptoms of peripheral neuritis that can occur as a side effect of isoniazid.
Drugs used to suppress coughing
Refers to a drug that can destroy viruses and help treat illnesses caused by them.
Adult respiratory distress syndrome (ARDS), also called acute respiratory distress syndrome, is a type of lung (pulmonary) failure that may result from any disease that causes large amounts of fluid to collect in the lungs. ARDS is not itself a specific disease, but a syndrome, a group of symptoms and signs that make up one of the most important forms of lung or respiratory failure. It can develop quite suddenly in persons whose lungs have been perfectly normal. Very often ARDS is a true medical emergency. The basic fault is a breakdown of the barrier, or membrane, that normally keeps fluid from leaking out of the small blood vessels of the lung into the breathing sacs (the alveoli).
A hereditary disorder marked by the tendency to develop immediate allergic reactions to substances such as pollen, food, dander, and insect venoms and manifested by hay fever, asthma, or similar allergic conditions. Also called atopic allergy.
β2-adrenergic agonists, also known as β2-adrenergic receptor agonists, are a class of drugs that act on the beta2-adrenergic receptor, thereby causing smooth muscle relaxation, resulting in dilation of bronchial passages, vasodilation in muscle and liver, relaxation of uterine muscle, and release of insulin. They are primarily used to treat asthma and other pulmonary disorders.
a disease state defined by localized, irreversible dilation of part of the bronchial tree caused by destruction of the muscle and elastic tissue. It is classified as an obstructive lung disease, along with emphysema, bronchitis, asthma, and cystic fibrosis. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airway obstruction and impaired clearance of secretions. Bronchiectasis may result from a variety of infective and acquired causes, including severe and recurrent pneumonia, tuberculosis, and cystic fibrosis.
a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation. Specimens may be taken from inside the lungs.
air-filled emphysematous space larger than one centimeter, usually located in the lung periphery; can reach large diameter and cause symptoms by compression of normal lung tissue.
hemoglobin combined with carbon monoxide, which occupies the sites on the hemoglobin molecule that normally bind with oxygen and which is not readily displaced from the molecule.
The formation of cavities in a body tissue or an organ, especially those cavities that form in the lung as a result of tuberculosis.
A routine analysis performed on a sample of blood taken from the patient's vein with a needle and vacuum tube. The measurements taken in a CBC include a white blood cell count, a red blood cell count, the red cell distribution width, the hematocrit (ratio of the volume of the red blood cells to the blood volume), and the amount of hemoglobin (the blood protein that carries oxygen). CBCs are a routine blood test used for many medical reasons.
Chest Tube Insertion
a catheter inserted through the rib space of the thorax into the pleural space to remove air and/or fluid, thereby restoring negative pressure in the pleural space. It is attached to a water-seal chest drainage device. It is commonly used after chest surgery and lung collapse.
Relates to neurons or nerve fibers in which acetylcholine (ACh) is the neurotransmitter, or have actions similar to those caused by ACh. Cholinergic receptors are of two types: nicotinic receptors, which are situated in striated muscles (e.g. the extraocular muscles) and muscarinic receptors, which are situated in parasympathetically innervated structures (e.g. the iris and ciliary body).
A condition affecting the fingers and toes in which the extremities are broadened and the nails are shiny and abnormally curved.
Antibodies that cause clumping of red blood cells when the blood temperature falls below normal body temperature (98.6°F/37°C).
Corticosteroids are group of natural and synthetic analogues of the hormones secreted by the hypothalamic-anterior pituitary-adrenocortical (HPA) axis, more commonly referred to as the pituitary gland. These include glucocorticoids, which are anti-inflammatory agents with a large number of other functions; mineralocorticoids, which control salt and water balance primarily through action on the kidneys; and corticotropins, which control secretion of hormones by the pituitary gland.
Computed tomography, a radiologic imaging that uses computer processing to generate an image of tissue density in slices through the patient's body.
chest x-ray; an image of the thoracic cavity, produced by an irradiation scan of the upper torso. Routinely performed to rule out respiratory or heart disease for patients complaining of dyspnea or chest pain.
Cyanosis is a physical sign causing bluish discoloration of the skin and mucous membranes. Cyanosis is caused by a lack of oxygen in the blood. Cyanosis is associated with cold temperatures, heart failure, lung diseases, and smothering. It is seen in infants at birth as a result of heart defects, respiratory distress syndrome, or lung and breathing problems.
- an alkylating agent.
- Indications: It is prescribed in the treatment of neoplasms and as an immunosuppressant in organ transplantation.
- Contraindications: It is teratogenic in animals. It is not used during pregnancy. Adequate methods of contraception should be considered for both males and females who are using it. It is used neither in patients with known hypersensitivity to the drug nor in patients with severely depressed bone marrow function. It is used with caution with impaired renal or hepatic function or with various blood disorders.
- Adverse Effects: Among the more serious adverse reactions are anorexia, vomiting, alopecia, leukopenia, cardiotoxicity, thrombocytopenia, and potentially serious hemorrhagic cystitis.
a fragment of fibrin that is formed as a result of fibrin degradation. A positive test for its presence in the blood is suggestive of conditions such as thrombotic disease, sickle cell crisis, malignancy, disseminated intravascular coagulation, or recent surgery.
medicines used to relieve nasal congestion
doppler duplex ultrasound
- combines traditional ultrasound with Doppler ultrasound. Traditional ultrasound uses sound waves that bounce off blood vessels to create pictures. Doppler ultrasound records sound waves reflecting off moving objects, such as blood, to measure their speed and other aspects of how they flow. There are different types of duplex ultrasound exams. Some include:
- Arterial and venous duplex ultrasound of the abdomen examines blood vessels and blood flow in the abdominal area.
- Carotid duplex ultrasound looks at the carotid artery in the neck.
- Duplex ultrasound of the extremities looks at the arms or legs.
- Renal duplex ultrasound examines the kidneys and their blood vessels.
Difficulty in breathing, often associated with lung or heart disease and resulting in shortness of breath.
A non-invasive ultrasound test that shows an image of the inside of the heart. An echocardiogram can be performed to identify any structural problems which cause a heart murmur.
white blood cells of the granulocyte type that have rough, round granules of cytoplasm that stain with eosin.
a skin disorder characterized by painful red nodules appearing mostly on the shins. Can be caused by many important and treatable diseases. Among them are tuberculosis, several fungal lung infections, leprosy, inflammatory bowel disease, and some potentially dangerous bacterial infections. Drugs can also induce erythema nodosum. The most common are penicillin, sulfonamides, and birth control pills.
a broad-spectrum antibiotic produced by Streptomyces erythreus; used against gram-positive bacteria and certain gram-negative bacteria, spirochetes, some rickettsiae, Entamoeba, and Mycoplasma pneumoniae; used in the form of the gluceptate, lactobionate, stearate, and other salts.
- Erythrocyte sedimentation rate (ESR)
- The rate at which red blood cells settle out in a tube of unclotted blood, expressed in millimeters per hour; elevated sedimentation rates indicate the presence of inflammation.
- formation of fibrous tissue
- pleural fibrosis - fibrosis of the visceral pleura so that part or all of a lung becomes covered with a thick layer of nonexpansible fibrous tissue; fibrothorax is a more extensive form.
a staining procedure in which microorganisms are stained with crystal violet, treated with strong iodine solution, decolorized with ethanol or ethanol-acetone, and counterstained with a contrasting dye; those retaining the stain are gram-positive, and those losing the stain but staining with the counterstain are gram-negative.
Descriptive of an opacity in radiologic imaging that may indicate various disease states. Eg: PCP - Pneumocystis (carinii) jiroveci Pneumonia (interstitial lung diseases)
helical CT scan
computed tomography that combines continuous gantry rotation with continuous table movement to form a helical or spiral path of scan data. Because this method scans a volume of tissue rather than a series of individual slices of tissue, small lesions can be easily detected. Also called spiral computed tomography.
- the coughing up of blood or bloody sputum from the lungs or airway. It may be either self-limiting or recurrent. Massive hemoptysis is defined as 200-600 mL of blood coughed up within a period of 24 hours or less.
- Infections. These include pneumonia; tuberculosis; aspergillosis; and parasitic diseases, including ascariasis, amebiasis, and paragonimiasis.
- Tumors that erode blood vessel walls.
- Drug abuse. Cocaine can cause massive hemoptysis.
- Trauma. Chest injuries can cause bleeding into the lungs.
- Vascular disorders, including aneurysms, pulmonary embolism, and malformations of the blood vessels.
- Bronchitis. Its most common cause is long-term smoking.
- Foreign object(s) in the airway.
- Blood clotting disorders.
- Bleeding following such surgical procedures as bronchial biopsies and heart catheterization.
a sulfated glycosaminoglycan of mixed composition, released by mast cells and by blood basophils in many tissues, especially the liver and lungs, and having potent anticoagulant properties. It also has lipotrophic properties, promoting transfer of fat from blood to the fat depots by activation of lipoprotein lipase. It is used as the calcium or sodium salt in the prophylaxis and treatment of disorders in which there is excessive or undesirable clotting and to prevent clotting during extracorporeal circulation, blood transfusion, and blood sampling.
fibrotic cystic changes (honeycomb changes) seen in the lungs of those with certain end-stage interstitial lung diseases (ILDs). Honeycomb lung is a pathologic finding and not a specific disease entity. The importance of honeycomb lung is that its presence is associated with a poor prognosis.
an abnormal condition in which responses to stimuli are exaggerated. For example, asthma involves hyperreactive airways.
Insufficient oxygenation of arterial blood.
Cells or body fluids that have passed into a tissue or body cavity.
A vaccine recommended for those at high risk for serious complications from influenza: > age 65; Pts with chronic diseases of heart, lung or kidneys, DM, immunosuppression, severe anemia, nursing home and other chronic-care residents, children and teenagers taking aspirin therapy–and who may thus be at risk for developing Reye syndrome after influenza infection, and those in close or frequent contact with anyone at high risk; persons with egg allergy should not receive the vaccine.
lines resembling interstitial infiltrate that appear on chest x-ray images and are associated with certain disease conditions, such as congestive heart failure and pleural lymphatic engorgement. They are several centimeters long and may be oriented in many directions.
any of a group of compounds derived from unsaturated fatty acids, primarily arachidonic acid, that are extremely potent mediators of immediate hypersensitivity reactions and inflammation, producing smooth muscle contraction, especially bronchoconstriction, increased vascular permeability, and migration of leukocytes to areas of inflammation. Certain leukotrienes are collectively known as SRS-A (slow reacting substance of anaphylaxis), the name given to their potent bronchoconstrictor activity 30 years before their structure was elucidated; they also cause leakage of fluid and proteins from the microvasculature.
a medical procedure performed to obtain a small piece of lung tissue for examination under a microscope. Biopsy examinations are usually performed by pathologists, who are doctors with special training in tissue abnormalities and other signs of disease.
A class of antibiotics discovered in streptomycetes, characterized by molecules made up of large-ring lactones; for example, erythromycin; many inhibit protein biosynthesis.
mast cell stabilizer
cromone medications used to prevent or control certain allergic disorders. They block a calcium channel essential for mast cell degranulation, stabilizing the cell and thereby preventing the release of histamine and related mediators. One suspected pharmacodynamic mechanism is the blocking of IgE-regulated calcium channels. Without intracellular calcium, the histamine vesicles cannot fuse to the cell membrane and degranulate. As inhalers they are used to treat asthma, as nasal sprays to treat hay fever (allergic rhinitis) and as eye drops for allergic conjunctivitis. Finally in oral form they are used to treat the rare condition of mastocytosis.
abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, ectopic pregnancy, and for the induction of medical abortions. It acts by inhibiting the metabolism of folic acid.
a group of alkaloids that includes caffeine and related substances. Ingested caffeine is rapidly metabolized in the liver to three dimethylxanthines: paraxanthine, theophylline and theobromine; these are released in the plasma and remain in the circulation while caffeine concentration declines. As caffeine and its metabolites are often present at the same time, it is difficult to resolve which tissues are directly or indirectly affected by which compound.
magnetic resonance imaging uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.
capable of reducing the viscosity of mucus, or an agent that so acts.
A device used to reduce liquid to an extremely fine cloud, especially for delivering medication to the deep part of the respiratory tract.
an incision made into the chest wall to provide an opening for the purpose of drainage.
Any antiviral that inhibits neuraminidase, an enzyme essential for replication of influenza and other viruses.
- an antiviral.
- Indication: It is used to treat type A influenza.
- Contraindication: Known hypersensitivity to this drug prohibits its use.
- Adverse Effects: Adverse effects include fatigue, diarrhea, abdominal pain, and cough. Common side effects include headache, dizziness, insomnia, nausea, and vomiting.
any one of the enzymes secreted by the pancreas in the process of digestion. The most important are trypsin, chymotrypsin, steapsin, and amylopsin.
pulmonary embolism - caused by emboli that travel through the blood stream to the lungs and block a pulmonary artery. When this occurs, circulation and oxygenation of blood is compromised. The emboli are usually formed from blood clots but are occasionally comprised of air, fat, or tumor tissue. Risk factors include: prolonged bed rest, surgery, childbirth, heart attack, stroke, congestive heart failure, cancer, obesity, a broken hip or leg, oral contraceptives, sickle cell anemia, congenital coagulation disorders, chest trauma, certain congenital heart defects, and old age. Symptoms include: labored breathing, sometimes accompanied by chest pain, a rapid pulse, a cough that produces bloody sputum, a low fever, fluid build-up in the lungs.
Peak flow meter - A portable instrument that detects minute decreases in air flow and that is used by people with asthma to monitor small changes in breathing capacity.
a radiologic sign which occurs when excess fluid or mucus buildup in the small airway passages of the lung causes localized patches of atelectasis (lung collapse). This causes the area around the bronchus to appear more prominent on an X-ray. It has also been described as doughnut sign, considering the edge is thicker, and the center contains air.
- pulmonary function test
- Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important tool used for generating pneumotachographs, which are helpful in assessing conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD.
done to differentiate between benign and malignant disease, to diagnose viral, fungal, or parasitic diseases, and to identify a condition called collagen vascular disease of the pleura. It is also ordered when a chest x ray indicates a pleural-based tumor, reaction, or thickening of the lining.
procedure in which the pleural space is obliterated by deliberately fusing the visceral and parietal pleura, either by using chemical sclerosants (e.g., a mixture of mitoxantrone, talc and tetracycline) or mechanically (e.g., by stripping the pleura), to treat recurrent pneumothorax or malignant pleural effusion secondary to cancer.
- an active immunizing agent containing antigens of the 23 types of Pneumococcus associated with more than 98% of the cases of pneumococcal pneumonia in the United States and Europe.
- Indications: It is prescribed for persons over 2 years of age who are at high risk of development of severe pneumococcal pneumonia, all adults over 65 years of age, and immunocompromised adults.
- Contraindications: Pregnancy, early childhood (less than 2 years of age), or known hypersensitivity to the vaccine prohibits its use.
- Adverse Effects: Among the more serious adverse effects are inflammation at the site of injection, fever, and hypersensitivity.
inflammation of the lung. Pneumonitis may be caused by a virus or may be a hypersensitivity reaction to chemicals or organic dusts, such as bacteria, bird droppings, or molds. It is usually an interstitial, granulomatous, fibrosing inflammation of the lung, especially of the bronchioles and alveoli. Dry cough is a common symptom. Treatment depends on the cause but includes removal of any offending agents and administration of corticosteroids to reduce inflammation.
collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse.
- purified protein derivative of tuberculin
- a sterile solution of a purified protein fraction precipitated from a filtrate of tubercle bacillus grown on a special medium; used in tuberculin tests
An x-ray study of the lungs, performed by insertion of a catheter into a vein, through the heart, and into the pulmonary artery. Pulmonary angiography is performed to evaluate blood circulation to the lungs. It is also considered the most accurate diagnostic test for detecting a pulmonary embolism.
pulmonary artery catherization
diagnostic procedure in which a small catheter is inserted through a neck, arm, chest, or thigh vein and maneuvered into the right side of the heart, in order to measure pressures at different spots in the heart
use of a spectrophotoelectric instrument applied to the skin which measures pulse rate and the percentage of oxygenated and reduced hemoglobin.
an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mm Hg. An excessive decline may be a sign of tamponade, adhesive pericarditis, severe lung disease, advanced heart failure, or other conditions.
Quick Vue Influenza Test
The QuickVue Influenza A+B Test detects and differentiates influenza type A and type B antigens directly from nasal swab, nasopharyngeal swab, nasal wash and/or nasal aspirate specimens. A single sample can be used to run both the QuickVue Influenza A+B Test and QuickVue RSV 10 Test.
- radioallergosorbent test
- a radioimmunoassay for the measurement of extremely small amounts of specific IgE antibody to a variety of allergens in the serum of a patient, using an allergen complex fixed in a solid-phase matrix, passing the serum over the matrix so the allergen can catch and bind specific IgE antibodies, and detecting the antibody using radiolabeled anti–human IgE antibody. Uptake of the labeled antibody is proportional to the level of specific serum IgE antibodies to the allergen. RAST is used as an alternative to skin tests to determine sensitivity to suspected allergens.
a genus of viruses of the family Picornaviridae that infect the upper respiratory tract and cause the common cold. Over 100 antigenically distinct varieties infect humans.
an antiviral agent used in prophylaxis and treatment of influenza A.
- most of the CO2 is in the form of a substance called bicarbonate (HCO3-). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level.
- Carbon dioxide is a gas that dissolves in the blood. Dissolved carbon dioxide helps to neutralize acid. Measuring carbon dioxide in a blood test can provide information about the blood’s acid level, or pH.
- A blood carbon dioxide level that’s much higher than normal can be seen with a number of medical conditions. These include:
- Severe breathing problems, such as emphysema
- Vomiting for a long period of time
- Taking high doses of diuretics or antacids
- Certain hormone conditions that cause acids to leak into the urine
- Low blood levels of potassium
(meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is an important tool used for generating pneumotachographs, which are helpful in assessing conditions such as asthma, pulmonary fibrosis, cystic fibrosis, and COPD.
Sputum Culture (AFB)
- done to find and identify the microorganism causing an infection of the lower respiratory tract such as pneumonia (an infection of the lung). If a microorganism is found, more testing is done to determine which antibiotics will be effective in treating the infection.
- acid-fast bacillus - a type of bacillus that resists decolorizing by acid after accepting a stain. Examples include Mycobacterium tuberculosis and M. leprae.
a sputum test to determine the presence of a pulmonary system malignancy. It is used most frequently in patients who have an abnormal chest x-ray, productive cough, and nothing visible on bronchoscopy. A positive test indicates malignancy, but a negative test means only that, if a tumor exists, it is not shedding cells.
a particularly severe asthmatic attack that does not respond adequately to usual therapy and may require hospitalization. an acute, severe, and prolonged asthma attack. It is caused by critically diminished airway diameter resulting from ongoing bronchospasm, edema, and mucous plugging. Hypoxia, cyanosis, and unconsciousness may follow, and the attack may be fatal. Treatment includes supplemental oxygen given to correct hypoxemia, bronchodilators given intravenously or by aerosol inhalation, corticosteroids, mechanical ventilation, sedation, frequent therapy, and emotional support.
any of a large number of hormonal substances with a similar basic chemical structure, produced mainly in the adrenal cortex and gonads. Steroids are chemically related to sterols.
superior vena cava syndrome
a partial occlusion of the superior vena cava. This leads to a lower than normal blood flow through this major vein. SVCS is also called superior mediastinal syndrome and/or superior vena cava obstruction.
a method for evaluating sodium and chloride excretion from the sweat glands, often the first test performed in the diagnosis of cystic fibrosis. The sweat glands are stimulated with a drug such as pilocarpine, and the perspiration produced is analyzed. The eccrine glands of patients with cystic fibrosis produce sodium and chloride concentrations that are three to six times normal. Chloride levels above 60 mEq/L and sodium levels above 90 mEq/L are considered diagnostic for the disease. The test is very reliable, and although it may be useful at any age, it is usually performed on infants from 2 weeks to 1 year of age.
a procedure that removes fluid or air from the chest through a needle or tube
the insertion of an endoscope, a narrow—diameter tube with a viewing mirror or camera attachment, through a very small incision (cut) in the chest wall.
The dilution of a serum containing a specific antibody at which the solution retains the minimum level of activity needed to neutralize or precipitate an antigen.
trimethoprim-sulfamethoxazole - antibiotic used to treat and prevent Pneumocystis Pneumonia (PCP)
Transbronchial Lung Biopsy
a procedure in which a bronchoscope is inserted through the nose or mouth to collect several pieces of lung tissue.
ventilation/perfusion lung scan is a type of medical imaging using scintigraphy and medical isotopes to evaluate the circulation of air and blood within a patient's lungs, in order to determine the ventilation/perfusion ratio. The ventilation part of the test looks at the ability of air to reach all parts of the lungs, while the perfusion part evaluates how well blood circulates within the lungs.
venous compression ultrasonography
combines real-time imaging of the deep veins with venous compression to diagnose deep vein thrombosis
inflammation of the tracheobronchial tree, commonly following a URI, that occurs in patients without chronic lung disorders. The cause is almost always a viral infection. The pathogen is rarely identified. The most common symptom is cough, with or without fever, and possibly sputum production. Diagnosis is based on clinical findings. Treatment is supportive; antibiotics are usually unnecessary. Prognosis is excellent.
Approach to Resp Patient
Respiratory distress is a very common presenting complaint in emergency practice. It is essential that the clinician rapidly determine the underlying cause of the clinical signs using physical examination findings and nonstressful diagnostic tests. Oxygen therapy will often stabilize a patient, allowing for a more complete physical examination and diagnostics, including thoracocentesis, thoracic radiographs, and blood collection for laboratory analysis. The disease processes that cause respiratory distress can be grouped according to anatomic location: the airways, pulmonary parenchyma, pleural space, or thoracic wall. The choice of diagnostic and therapeutic techniques will be dependent on the suspected anatomic origin of disease. Techniques useful in diagnosing airway disorders include oral examination, cervical and thoracic radiographs, fluoroscopy, and bronchoscopy. Therapeutic techniques include intubation and tracheostomy. For parenchymal disease, thoracic radiographs, echocardiography, ultrasound of the thorax, and transtracheal or endotracheal wash can be useful. When the disease process is in the pleural space, thoracocentesis can be both diagnostic and therapeutic. Chest tube placement may be necessary for continuous removal of air or fluid from the pleural space. Monitoring of the respiratory patient can involve serial physical examination, pulse oximetry, and arterial blood gas analysis. It is essential to minimize stress on patients with respiratory distress because decompensation can occur easily, leading to respiratory arrest.
Acute hypoxemic respiratory failure (AHRF) is severe arterial hypoxemia that is refractory to supplemental O2. It is caused by intrapulmonary shunting of blood resulting from airspace filling or collapse. Findings include dyspnea and tachypnea. Diagnosis is by ABGs and chest x-ray. Treatment usually requires mechanical ventilation.
a disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction. Symptoms and signs include dyspnea, chest tightness, cough, and wheezing. The diagnosis is based on history, physical examination, and pulmonary function tests. Treatment involves controlling triggering factors and drug therapy, most commonly with inhaled β2-agonists and inhaled corticosteroids. Prognosis is good with treatment.
partially reversible airflow limitation caused by an inflammatory response to inhaled toxins, often cigarette smoke. α1-Antitrypsin deficiency and various occupational exposures are less common causes in nonsmokers. Symptoms are productive cough and dyspnea that develop over years; common signs include decreased breath sounds, prolonged expiratory phase of respiration, and wheezing. Severe cases may be complicated by weight loss, pneumothorax, frequent acute decompensation episodes, right heart failure, and acute or chronic respiratory failure. Diagnosis is based on history, physical examination, chest x-ray, and pulmonary function tests. Treatment is with bronchodilators, corticosteroids, and, when necessary, O2 and antibiotics. About 50% of patients with severe COPD die within 10 yr of diagnosis.
right ventricular enlargement secondary to a lung disorder that causes pulmonary artery hypertension. Right ventricular failure follows. Findings include peripheral edema, neck vein distention, hepatomegaly, and a parasternal lift. Diagnosis is clinical and by echocardiography. Treatment is directed at the cause.
an inherited disease of the exocrine glands affecting primarily the GI and respiratory systems. It leads to chronic lung disease, exocrine pancreatic insufficiency, hepatobiliary disease, and abnormally high sweat electrolytes. Diagnosis is by sweat test or identification of 2 cystic fibrosis-causing mutations in patients with characteristic symptoms or a positive newborn screening test result. Treatment is supportive through aggressive multidisciplinary care.
a viral respiratory infection causing fever, coryza, cough, headache, and malaise. Mortality is possible during seasonal epidemics, particularly among high-risk patients (eg, those who are institutionalized, at the extremes of age, have cardiopulmonary insufficiency, or are in late pregnancy); during pandemics, even healthy, young patients may die. Diagnosis is usually clinical and depends on local epidemiologic patterns. Everyone aged ≥ 6 mo should receive annual influenza vaccination. Antiviral treatment reduces the duration of illness by about 1 day and should be specifically considered for high-risk patients.
Interstitial Lung Disease
- Interstitial lung diseases are a heterogeneous group of disorders characterized by alveolar septal thickening, fibroblast proliferation, collagen deposition, and, if the process remains unchecked, pulmonary fibrosis. Interstitial lung diseases can be classified using various criteria (eg, acute vs chronic, granulomatous vs nongranulomatous, known cause vs unknown cause, primary lung disease vs secondary to systemic disease).
- Among the numerous possible causes are most connective tissue disorders and occupational lung exposures and many drugs. A number of interstitial lung diseases of unknown etiology have characteristic histology, clinical features, or presentation and thus are considered unique diseases, including eosinophilic pulmonary diseases, pulmonary Langerhans cell histiocytosis (granulocytosis), lymphangioleiomyomatosis, pulmonary alveolar proteinosis, and sarcoidosis. In up to 30% of patients who have interstitial lung diseases with no clear cause, the disorders are distinguished primarily by characteristic histopathologic features; these disorders are termed the idiopathic interstitial pneumonias.
Lung carcinoma is the leading cause of cancer-related death worldwide. About 85% of cases are related to cigarette smoking. Symptoms can include cough, chest discomfort or pain, weight loss, and, less commonly, hemoptysis; however, many patients present with metastatic disease without any clinical symptoms. The diagnosis is typically made by chest x-ray or CT and confirmed by biopsy. Depending on the stage of the disease, treatment includes surgery, chemotherapy, radiation therapy, or a combination. For the past several decades, the prognosis for a lung cancer patient was poor, with only 15% of patients surviving > 5 yr from the time of diagnosis. For patients with stage IV (metastatic) disease, the 5-yr overall survival rate was < 1%. However, outcomes have improved because of the identification of certain mutations that can be targeted for therapy.
The role of dietary factors relating to asthma is controversial. Observational studies have shown that diets low in antioxidants such as vitamin C and vitamin A, magnesium, selenium, and omega-3 polyunsaturated fats (fish oil) or high in sodium and omega-6 polyunsaturates are associated with an increased risk of asthma. Vitamin D deficiency may also predispose to the development of asthma. However, interventional studies with supplementary diets have not supported an important role for these dietary factors. Obesity is also an independent risk factor for asthma, particularly in women, but the mechanisms are thus far unknown.
PE & infarction
Pulmonary embolism (PE) is the occlusion of ≥ 1 pulmonary arteries by thrombi that originate elsewhere, typically in the large veins of the lower extremities or pelvis. Risk factors are conditions that impair venous return, conditions that cause endothelial injury or dysfunction, and underlying hypercoagulable states. Symptoms are nonspecific and include dyspnea, pleuritic chest pain, cough, and, in severe cases, syncope or cardiorespiratory arrest. Signs are also nonspecific and may include tachypnea, tachycardia, hypotension, and a loud pulmonic component of the 2nd heart sound. Diagnosis is based on a CT angiogram, ventilation/perfusion scan, or a pulmonary arteriogram. Treatment is with anticoagulants and, sometimes, clot dissolution with thrombolytics or surgical removal. Preventive measures include anticoagulants and sometimes insertion of an inferior vena caval filter.
Pleural disease, a hallmark of asbestos exposure, includes formation of pleural plaques, calcification, thickening, rounded atelectasis, adhesions, effusion, and mesothelioma.Diagnosis is based on history and chest x-ray or CT findings. Treatment is supportive.
Pneumonia is an infection of the lung that can be caused by nearly any class of organism known to cause human infections. These include bacteria, amoebae, viruses, fungi, and parasites. In the United States, pneumonia is the sixth most common disease leading to death; 2 million Americans develop pneumonia each year, and 40,000-70,000 die from it. Pneumonia is also the most common fatal infection acquired by already hospitalized patients. In developing countries, pneumonia ties with diarrhea as the most common cause of death. Even in nonfatal cases, pneumonia is a significant economic burden on the health care system. One study estimates that people in the American workforce who develop pneumonia cost employers five times as much in health care as the average worker.
- A rare lung disorder characterized by increased pressure in the pulmonary artery.
- blood pressure in the circulation of the lungs is measured at greater than 25 mm of mercury (Hg) at rest or 30 mm Hg during exercise. Pulmonary hypertension can be either primary or secondary:
- Primary pulmonary hypertension. The cause of pulmonary hypertension is unknown. It is rare, affecting one people per-million. The illness most often occurs in young adults, especially women.
- Secondary pulmonary hypertension. Secondary pulmonary hypertension is increased pressure of the blood vessels of the lungs as a result of other medical conditions.
- Regardless of whether pulmonary hypertension is primary or secondary, the disorder results in thickening of the pulmonary arteries and narrowing of these blood vessels. In response, the right side of the heart works harder to move the blood through these arteries and it becomes enlarged. Eventually overworking the right side of the heart may lead to right-sided heart failure, resulting in death.
Pulmonary Tests and Resp function
Pulmonary function tests provide measures of airflow, lung volumes, gas exchange, response to bronchodilators, and respiratory muscle function. Basic pulmonary function tests available in the ambulatory setting include spirometry and pulse oximetry; these tests provide physiologic measures of pulmonary function and can be used to quickly narrow a differential diagnosis and suggest a subsequent strategy of additional testing or therapy. More complicated testing includes measurement of lung volumes; lung, chest wall, and respiratory system compliance (which requires measurement of esophageal pressure); and complete cardiopulmonary exercise testing. These tests provide a more detailed description of physiologic abnormalities and the likely underlying pathology. The choice and sequence of testing are guided by information taken from the history and physical examination.
a program of exercise, education, and support to help the patient learn to breathe—and function—at the highest level possible
Sarcoidosis is a disorder resulting in noncaseating granulomas in one or more organs and tissues; etiology is unknown. The lungs and lymphatic system are most often affected, but sarcoidosis may affect any organ. Pulmonary symptoms range from none to exertional dyspnea and, rarely, lung or other organ failure. Diagnosis usually is first suspected because of pulmonary involvement and is confirmed by chest x-ray, biopsy, and exclusion of other causes of granulomatous inflammation. First-line treatment is corticosteroids. Prognosis is excellent for limited disease but poor for more advanced disease.
Tuberculosis (TB) is a chronic, progressive infection, often with a period of latency following initial infection. TB most commonly affects the lungs. Symptoms include productive cough, fever, weight loss, and malaise. Diagnosis is most often by sputum smear and culture and, increasingly, by rapid molecular-based diagnostic tests. Treatment is with multiple antimicrobial (antituberculars) drugs given for at least 6 mo.
upper respiratory infection - includes the common cold, laryngitis, pharyngitis, rhinitis, sinusitis, and tonsillitis