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Sputum cytology
- Can diagnose or monitor disease
- Test early in morning
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FVC
- Forced Vital Capacity
- Low: obstructive
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FEV1
- Forced Expiratory Volume in 1 second
- Low: obstructive
- Both FEV1 and FVC low: restrictive
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FEV1%
- Percentage of air exhaled in first second
- Ration of FEV1 to FVC (FEV1/FVC)
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PEFR
- Peak Expiratory Flow Rate
- Max flow rate during forced vital capacity
- If low --> evaluate for obstructive
- Useful to see if treatment working
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FEF
- Forced Expiratory Flow
- Divided into quartiles
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TLC
- Total Lung Capacity
- Can't measure by spirometry because of Residual Volume
- TLC = FVC + RV
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Staging of lung disease (not cancer)
- Normal: > 85% predicted
- Mild: >65% < 85%
- Moderate: >50% <65%
- Severe: <50%
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Interpret PFTs
- 1) Check FVC
- 2) Check FVC1
- 3) If both normal --> test is normal
- 4) FVC and/or FEV1 low --> likely disease
- 5) If disease, then go to % for FEV1/FVC
- FEV1/FVC > 88-90% --> restrictive
- FEV1/FVC <69% --> obstructive
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Cough DDx
- Post nasal drip
- Asthma
- GERD
- Chronic bronchitis
- Bronchiectasis
- Eosinophilic bronchitis
- ACE inhibitor
- Cancer
- Sarcoidosis
- Aspiration
- Psychogenic
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Ventilation/perfusion ratio (V/Q)
- Normal: 4:5 (0.8)
- Measures effectiveness of exchange of CO2 for O2
- Can be mismatched from
- Shunting (reduces VQ): O2 not getting to part of lung (shunt or obstruction), more CO2 then O2 and it goes back into circulation
- Dead space (increases VQ): blood running around with more oxygen, can't get to a damaged part of lung so doesn't exchange for CO2
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Acute bronchitis
DDx:
Bronchialitis: acute inflammation of small airways
Bronchiectasis: permanent dilation of bronchi
Chronic bronchitis: > 3 mos year, at least 2 yrs
- Viral or bacterial
- Sx: Sputum, fever, malaise, wheezing, dypsnea
Tx: Ipratropium bromide, B2 agonists, Macrolide, Cipro, Amoxicillin, Corticosteroids, chest physiotherapy
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Acute bronchiolitis
DDx: pneumonia, chronic lung disease, aspiration, asthma, reactive airway, heart failure
Sx: constrictive, s/p viral infection, excessive mucus, edema, sloughed epithelial cells in terminal airways causing obstruction and atelectasis, expiratory wheeze, prolonged expiration, accessory muscles, in immunocompromised
Tx: unresponsive to corticosteroids, respiratory support, ventilator if needed, fluid, antivirals if comorbidities, antibiotics (by sputum) empirically (Amoxicillin, Ampicillin, Tetracyclin or Bactrim)
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Acute epiglottitis
Sx: abrupt onset, rapid progression, fever, sore throat, dysphagia, drooling, hot potato voice, severe obstruction
Tx: maintain airway, empirical antibiotics (Oxacillin, Nafcillin, Cefazolin, Clindamycin)
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Croup
DDX: bacterial tracheitis, acute epiglottis, peritonsillar or retropharyngeal abscesses, spasmodic croup, angioneurotic edema, upper airway anomalies
Sx: barking cough, narrowing of trachea in sublottic region, "steeple sign" on x-ray, insiratory stridor, hoarseness
Tx: corticosteroids, nebulized mist treatment, mist treatments not effective but are comforting, watch for emergent situation with pulse ox or cyanosis
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