Download presentation
Presentation is loading. Please wait.
Published bySophia Boyd Modified over 9 years ago
1
Respiratory examination, basic investigations and therapeutics Dr Felix Woodhead Consultant Respiratory Physician
2
Examination General appearance –Smoker –BMI –Tattoos etc –Other diseases (RA etc) Clubbing and Lymph nodes Trachea, apex etc (mediastinal shift) Scars Unilateral vs bilateral
3
Examination –Unilateral changes crackles: –Pneumonia –localised bronchiectasis –‘LRTI’ Bronchial breathing –consolidation, –severe fibrosis, –anterior chest Wheeze: localised stricture (never heard!) Reduced air entry –Collapse –effusion
4
Examination –Bilateral changes Wheeze (obstructive disease) –Asthma –COPD –Bronchiectasis Crackles –Pulmonary oedema:moist –Bronhiectasis:moist, pt coughing –Interstitial disease:Velcro, ‘hair-on-end’
5
Investigations Physiology –Peak flow meter –Spirometry –‘Full lung function’ Spirometry Lung Volumes Gas transfer Radiology –PA CXR –CT (spiral vs HRCT)
6
Spirometry and PFTs
7
Spirometry Measure Volume (bellows) or Flow (turbine), derive one from the other FEV 1 and FVC FEV 1 /FVC ratio cutoff 70% Calculate it yourself! <70% = obstructive –quantify by FEV 1 % predicted ≥70% = NORMAL or restrictive –quantify by FVC % predicted Graph allows assessment of blow technique Better assessed by Flow/volume loop
8
Typical graphs
9
Other components of PFTs Static lung volumes –He dilution –Body plethysmography –TLC & RV –↑ in obstructive lung disease (esp emphysema) –↓ in restrictive disease Gas transfer –TLco ≡ DLco –Kco = TLco/V A –↓ in alveolar/interstitial damage (emphysema & ILD)
10
Restrictive Defect “Small lungs” vs “Wheezy lungs” (obstructive) Intrinsic lung disease –abnormal radiology –↓TLco Extrathoracic restriction –normal radiology –normal TLco –? ↑Kco (↓V A → TLco/V A ↑)
11
Extrathoracic Restriction Soft tissues –Obesity –BMI not weight Muscles –Diaphragm > intercostals –Orthopnoea –Sitting/lying FVC Thoracic cage –Scoliosis > kyphosis Pleural thickening
12
Respiratory Therapeutics Dr Felix Woodhead Consultant Respiratory Physician
13
Airways
14
Delivery methods Nebulisers Inhalers –Aerosol –Dry powder –Proprietary types
15
Drugs Bronchodilators
16
β 2 agonists Short-acting –Salbutamol –Terbutaline Long-acting –Salmeterol –Formoterol
17
Antimuscarinics Short-acting –ipratropium Long-acting –tiotropium
18
Steroids Beclomethasone Budesonide Fluticasone Small- particle BCZ
19
Combined agents Seretide (Purple) –=serevent (salmeterol) + flixotide (fluticasone) –Evohaler (MDI) or accuhaler (DPI) Symbicort –Oxis (formoterol) + pulmicort (budesonide) –Turbohaler (DPI) –SMART regime
20
Systemic agents
21
Asthma β 2 agonists –Paediatrics –Occ IV Theophyllines –IV –Oral sustained release leukotriene-receptor antagonists –Monteleukast/zafirleukast Omalizumab
22
Antibiotics
23
Gram positive infections Penicillins –Amoxicillin –Co-amoxiclav –Piperacillin/tazobactam Macrolides –Erythromycin –Clarithromycin –Azithromycin
24
Gram negative infections Quinolones –Ciprofloxacin –Moxifloxacin Aminoglycosides –Gentamicin –Tobramycin –Amikacin
25
Prophylactic antibiotics Oral –Azithromycin –Others Nebulised –Aminoglycosides –Colistin
26
Immunosuppressants
27
Steroid Prednisolone –Dose –weaning Hydrocortisone (Dexamethasone) Methylprednisolone
28
Azathioprine Dosing –1 mg/kg/day first 1/12 with weekly FBC/LFTs –2 mg/kg/day thereafter. Bloods every 6/52 TPMG –Thiopurine methyltransferase –Reduce dose if low expression –Avoid Aza if absent levels
29
Methotrexate Widely used outside respiratory Generally avoided because of potential pulmonary toxicity ?useful in eg sarcoid
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.