SOB, DOE, COPD, PFT, WHAT

1. SOB, DOE, COPD, PFT, WHAT?? Underwriting Pulmonary Disorders

2. 52 Year old Former smoker 2 ppd Mild dyspnea on exertion “COPD” Severent, albuterol

3. Physicians think they do a lot for a patient when they give his disease a name. Immanuel Kant

4. Asthma ? Reversible obstructive airways disease ? Inflammatory response

5. Bronchiectasis ? A disease of the lungs characterized by dilation of the bronchi, principally the peripheral branches, with obstruction, infection, and destruction of the involved bronchial walls ? Consider: • Hospitalization • CT Scan • PFT’s

6. COPD Emphysema Chronic Bronchitis Bronchiectasis Asthma clinical assessment

7. Evaluation History Symptoms Smoking Meds Steroid use Hospitalizations Status asthmaticus Ventilator

8. Pulmonary Function Test Spirometry Lung volumes Diffusions capacity Oxygen saturation

9. Indications Pulmonary Function Test

10. PFT’S

11. Forced Expiratory Volume (FEV)Maneuver

12. Obstructive vs. Restrictive Spirograms

15. Smoking

16. Diffusing capacity Measurement of the single-breath diffusing capacity for carbon monoxide (DLCO) is quick, safe, and useful in the evaluation of both restrictive and obstructive disease. It requires use of a piece of equipment that costs $20,000. In the setting of restrictive disease, the diffusing capacity helps distinguish between intrinsic lung disease, in which DLCO is usually reduced, from other causes of restriction, in which DLCO is usually normal. In the setting of obstructive disease, the DLCO helps distinguish between emphysema and other causes of chronic airway obstruction.

17. Oxygen desaturation during exercise The six-minute walk test (6MWT) is a good index of physical function and therapeutic response in patients with chronic lung disease such as COPD or idiopathic pulmonary fibrosis. A fall in Sp02 of more than 4 percent (ending below 93 percent) suggests significant desaturation.

19. Asthma Our Manual

21. Hazards

22. Continued smoking in a patient with airways obstruction often results in an abnormally rapid decline in FEV1 (90 to 150 mL/yr). On the other hand, smoking cessation often results in an increase in FEV1 during the first year, followed by a nearly normal rate of FEV1 decline (30mL/yr).

23. Caution Flat diaphragms by X-ray Reduced oximetry Status asthmaticus Chronic Steroids Frequent hospitalizations Poor compliance Low diffusion capacity

24. All who drink of this remedy will recover… except those in whom it does not help, who will die. Galen

27. Case Study # 1 55 Year Old Former smoker No dyspnea CT - Biapical blebs 2° to emphysema FEV = 1.88 FVC = 3.15

28. 53 Year Old Smoker Intermittent cough, wheezing CXR – Mild hyperinflation, flattened diaphragrams and COPD Case Study # 2

29. 48 Year Old SOB, mild on exertion, intermittent ½ PPD smoker Advair, Spiriva, Albuterol FVC = 106 % 104% FEV1 = 78 % 62% Case Study # 3

30. 50 Year old Smoker, COPD Mild DOE Azmacort, Albuterol Spirometry – mild obstruction, low vital capacity FEV1 = 86% FVC = 82% Case Study # 4

31. The End