SOB, DOE, COPD, PFT, WHAT

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SOB, DOE, COPD, PFT, WHAT??

• Underwriting Pulmonary Disorders

Robert Baird, M.D.
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• 52 Year old
• Former smoker 2 ppd
• Mild dyspnea on exertion
• COPD
• Severent, albuterol

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

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• ? Reversible obstructive airways disease
• ? Inflammatory response

• Asthma

COPD
? Emphysema Anatomical/Clinical Pink
Puffer ? Chronic Bronchitis Clinical
Blue Bloater
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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
• PFTs

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• COPD
• Emphysema
• Chronic Bronchitis
• Bronchiectasis
• Asthma clinical assessment

Need to Quantitate Severity
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Evaluation

• History
• Symptoms
• Smoking
• Meds
• Steroid use
• Hospitalizations
• Status asthmaticus
• Ventilator

• ? Exam
• Wheezing

? PFTs ? Oximetry ? Chest X-ray ? CT Scan
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Pulmonary Function Test

• Spirometry
• Lung volumes
• Diffusions capacity
• Oxygen saturation

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Indications Pulmonary Function Test
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PFTS
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Forced Expiratory Volume (FEV)Maneuver
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Obstructive vs. Restrictive Spirograms
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Smoking
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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.

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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.

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Asthma Our Manual
Ages 16 to 75 (Base rating upon average severity
over previous 2 years) Mild
Intermittent or Mild Persistent      0     
WPIC      ADBIC Moderate Persistent    
50      WPRNA      ADBRNA Severe
Persistent         100      WPRNA      ADBRNA
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Hazards
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• 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).

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Caution

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

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

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Case Study 1

• 55 Year Old
• Former smoker
• No dyspnea
• CT - Biapical blebs 2 to emphysema
• FEV 1.88
• FVC 3.15

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Case Study 2

• 53 Year Old
• Smoker
• Intermittent cough, wheezing
• CXR Mild hyperinflation, flattened diaphragrams
  and COPD

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Case Study 3

• 48 Year Old
• SOB, mild on exertion, intermittent
• ½ PPD smoker
• Advair, Spiriva, Albuterol
• FVC 106 104
• FEV1 78 62

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Case Study 4

• 50 Year old
• Smoker, COPD
• Mild DOE
• Azmacort, Albuterol
• Spirometry mild obstruction, low vital capacity
• FEV1 86
• FVC 82

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The End
Robert Baird, M.D.