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Clinical vignette 3
obstructive and
restrictive lung disease
Ghaida Al-Rashed
Objectives
Describe the treatment of acute exacerbation of
asthma and COPD ??
How can lung volumes be used to differenti...
Objectives:
Describe the treatment of acute exacerbation of
asthma and COPD ??
ACUTE EXACERBATION OF ASTHMA
Treatment
 Oxygen 40-60%
 High doses of inhaled bronchodilators .
 Systemic corticosteroid...
OXYGEN
The patient should supply by High concentrations
of oxygen:
Goal: SaO2 > 92%
Failure to achieve appropriate oxyge...
INHALED BRONCHODILATORS
o Short-acting β2 agonist agent (SABA) :
(Salbutamol 5 mg/hr) or (terbutaline 10mg/hr)
via nebuli...
SYSTEMIC CORTICOSTEROIDS
• Hydrocortisone sodium succinate:
 Dose: 200 mg 4 hourly
 Rote: intravenous
 in patients who ...
ARTERIAL BLOOD GASES
We should correct ABG especially If patients ..
o Initial PaCO2 measurement was raised ( >7 kPa)
o Pa...
SUBSEQUENT MANAGEMENT
If patients fail to improve:
o Intravenous magnesium sulphate (1.2–2 g over 20 min)
o Intravenous β2...
MANAGEMENT OF COPD
The goals of effective COPD management are to:
1. Prevent disease progression
2. Relieve symptoms
3. Im...
OXYGENATION AND VENTILATION
• Oxygen therapy:
the oxygen saturation level should be at least 90%.
• Respiratory support:
...
Con..
• SHORT-ACTING BRONCHODILATORS (nebulization)
1. Inhaled short-acting β2 agonist agent (SABA).
2. Inhaled anti-musca...
PREVENTING FUTURE EXACERBATIONS
Appropriate
use of
inhaled
corticosteroid
+
inhaled
bronchodilator
s
Smoking
cessation
vac...
Objectives:
How can lung volumes be used to differentiate
between obstructive and restrictive lung disease ?
OBSTRUCTIVE VS. RESTRICTIVE
Obstructive disorders
• Characterized by: reduction in
airflow.
• So, shortness of breath  in...
SPIROMETRY measures the rate of lung volume changes
during forced breathing maneuvers
The diagnosis and distinguished bet...
DIFFERENT BETWEEN OBSTRUCTIVE
VS. RESTRICTIVE
Obstructive disorders
• Decrease in both FEV1 and
FEV1/FVC ratio .
Restricti...
Objectives:
 What are the emergent investigations
are to be performed on an emergency basis
to reach the diagnosis ?
Emergent Investigations
1- ECG- ABNORMAL:
In 70% patients with PE:
- Sinus tachycardia
- Nonspecific ST-T wave abnormaliti...
2- ARTERIAL BLOOD GASES:
o hypoxemia, hypocapnia, and respiratory alkalosis due to
hyperventilation.
PO2 and A-a gradient...
3- D-DIMER
• D-dimer: A degradation product of fibrin.
• is a substance in the blood that is often increased in people
wit...
Summary
References
• http://www.who.int/respiratory/copd/manag
ement/en/
• http://www.aafp.org/afp/2010/0301/p607.ht
ml
• http://e...
obstructive & restrictive lung disease
obstructive & restrictive lung disease
obstructive & restrictive lung disease
obstructive & restrictive lung disease
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obstructive & restrictive lung disease

  1. 1. Clinical vignette 3 obstructive and restrictive lung disease Ghaida Al-Rashed
  2. 2. Objectives Describe 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 ?
  3. 3. Objectives: Describe the treatment of acute exacerbation of asthma and COPD ??
  4. 4. ACUTE EXACERBATION OF ASTHMA Treatment  Oxygen 40-60%  High doses of inhaled bronchodilators .  Systemic corticosteroids.  Intravenous fluids.  Subsequent management.
  5. 5. OXYGEN The patient should supply by High concentrations of oxygen: Goal: SaO2 > 92% Failure to achieve appropriate oxygenation  assisted ventilation.
  6. 6. 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):
  7. 7. SYSTEMIC CORTICOSTEROIDS • Hydrocortisone sodium succinate:  Dose: 200 mg 4 hourly  Rote: intravenous  in patients who are unable to swallow or vomiting.
  8. 8. 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.
  9. 9. 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
  10. 10. MANAGEMENT OF COPD The goals of effective COPD management are to: 1. Prevent disease progression 2. Relieve symptoms 3. Improve exercise tolerance 4. Improve health status 5. Prevent and treat complication
  11. 11. 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
  12. 12. Con.. • SHORT-ACTING BRONCHODILATORS (nebulization) 1. Inhaled short-acting β2 agonist agent (SABA). 2. Inhaled anti-muscarinic (SAMA). • CORTICOSTEROIDS: Short courses of systemic corticosteroids. • ANTIBIOTICS with bacterial infection
  13. 13. PREVENTING FUTURE EXACERBATIONS Appropriate use of inhaled corticosteroid + inhaled bronchodilator s Smoking cessation vaccination
  14. 14. Objectives: How can lung volumes be used to differentiate between obstructive and restrictive lung disease ?
  15. 15. 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. COPD 2. Asthma 3. 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. Scoliosis 3. Neuromuscular cause 4. Marked obesity
  16. 16. 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
  17. 17. 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
  18. 18. Objectives:  What are the emergent investigations are to be performed on an emergency basis to reach the diagnosis ?
  19. 19. Emergent Investigations 1- ECG- ABNORMAL: In 70% patients with PE: - Sinus tachycardia - Nonspecific ST-T wave abnormalities - RBBB
  20. 20. 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.
  21. 21. 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)
  22. 22. Summary
  23. 23. References • http://www.who.int/respiratory/copd/manag ement/en/ • http://www.aafp.org/afp/2010/0301/p607.ht ml • http://emedicine.medscape.com/article/3009 01-workup#c9

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