dr. moshtak wtwt
COPD cont....
()Prognosis: 1-age 2-post-bronchodilator FEV1 3- wt loss: <21 BMI 4- pulmonary hpt 5- degree of airway obstruction: FEV1<35 6- Excersize capacity: poor if < 150 m 7- measurment of dyspnea: if MRC > G4
()Acute exacerbation of COPD: *characterised by an increase in synptoms & deterioation in lung function. *caused by bacteria, viral & change in air quality *many pt can be managed at home with the use of increased dose of bronchodilators, steroid & AB.
So admission to hospital indicated in: 1- presence of cynosis 2- peripheral odema 3 presence of comorbidity 4- altered level of conc 5-Inadequate response of symptoms to outpatient management 6- Marked increase in dyspnea 7- Inability to eat or sleep due to symptoms 8- Worsening hypoxemia Worsening hypercapnia 9- Changes in mental status Inability to care for oneself (ie, lack of home support) 10- Uncertain diagnosis
in hospital do the followings: ()check PaO2, PaCO2, PH, CXR, ECG, CBC, BU, electrolytes, PFT & sputum for culture & sensetivity. ()O2 therapy: ()bronchodilators: ()oral CS: 30 mg for 10 days indicated in: 1- if pt already on oral CS 2- if prevoiuos response of CS 3- failure to response to bronchodilators 4- 1st presentaion of disease ()AB: ()diuretics ()heparin ()NIV
()Complications: *resp failure *core-pulmonale *rupture of bullae lead to pneumothorax *amylodosis
Bronchiectasis:
()definition: abnormal dilatation of the
bronchi. Dilation of the bronchial walls results in airflow obstruction and impaired clearance of secretions because the dilated areas disrupt normal air pressure in the bronchial tubes, causing sputum to pool inside the dilated areas instead of being pushed upward. The pooled sputum provides an environment conducive to the growth of infectious pathogens, and these areas of the lungs are thus very vulnerable to infection.
When this happens, the bronchial tubes become more inelastic and compressed, creating a self-perpetuating cycle of further damage to the lungs.
() types:
There are three types of brochiectasis, varying by level of severity.
1- Fusiform (cylindrical) bronchiectasis (the most common type) refers to mildly inflamed bronchi that fail to taper distally.
2- In varicose bronchiectasis, the bronchial walls appear beaded, because areas of dilation are mixed with areas of constriction.
3- Saccular (cystic) bronchiectasis is characterized by severe and irreversible ballooning of the bronchi peripherally, with or without air-fluid levels.
()ateology:
1- congenital: *cystic fibrosis
*ciliary dysfunction syndroms include primary ciliary dyskinesia & kartagner’s
*primary hypogammaglobulinemia
2- aquired-children: *pneumonia
* primary TB
*inhaled foreign body
3- acquired-adults: *suppurative pn *pul TB *Allergic broncopulmonary aspergillosis *bronchial tumor
Clinical features:
A- symtopms:
*cough:
*pleurisy:
*hemoptysis: (dry bronchiectasis)
*wt loss, anorxia, lassitude & digital clubbing.
B- signs:
*may be asymptomatic, either unilateral or bilateral.
*crackles, wheezing.
*later on bronchial breathing due to pul fibrosis.
()Investigations:
1- sputum:
2- CXR: cystic bronchiactetic changes
3- CT scan:
4- assessement of ciliary dysfunction
()Management:
()physiotherapy:
()AB: Oral ciprofloxacin 250-750 mg 12 h or ceftazidime 1-2 g 8h
()surgery: young pt, unilateral , small area.
() Complications:
*resp failure
*core-pulmonale
*brain abscess
*amylodiosis.