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Respiratory Disorders

Respiratory Disorders. Module 3. Asthma and Pulmonary Thromboembolism. Process. Step 1 . Complete Module #3 with voice overlay Step 2 . Answer the question following Module #3

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Respiratory Disorders

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  1. Respiratory Disorders Module 3. Asthma and Pulmonary Thromboembolism

  2. Process • Step 1. Complete Module #3 with voice overlay • Step 2. Answer the question following Module #3 • Step 3. This completes all the modules in the respiratory unit, you can either move on to another unit or take a break.

  3. Module #3 Learning Objectives • Describe the definition and diagnostic features for asthma and how this disorder differs in later life. • Explain how the stage of severity of asthma directs treatment • Outline the approach to evaluation of suspected pulmonary emboli and treatment of this process when that diagnosis is confirmed

  4. Asthma: Prevalence & Mortality • Second peak in prevalence after age 65 • 5-10% after 65 yrs meet criteria for obstruction & bronchial hyperactivity • 45% of all asthma deaths after 65 yrs

  5. Asthma: Definition • Chronic inflammatory disorder of airways • Triggers: • Air pollutants • Allergies • Chemicals • Emotional distress • Exercise • Tobacco smoke • viruses

  6. Asthma: in later life • Cough is a common presentation • Air flow restriction is less variable and episodic • Presents more fixed obstruction • More difficult to classify • PEF less reliable

  7. Classic Symptoms: Image from :http://www.images.md In older patients DDX of this same set of symptoms includes: Heart Failure COPD Asthma: Symptoms

  8. Asthma: Diagnosis & Staging

  9. Asthma: Nonpharmacologic Therapy • Avoid triggers • Educate on disease management • Use of MDIs/ peak flow meters

  10. Asthma: Geriatric Pharmacotherapy * SR-TH= slow release theophylline ** LK=leukotriene modifiers/inhibitors

  11. Pulmonary Thromboembolism (PE) • Incidence increases with age • 3.5/1000 60-74 years • 9/1000 after age 75 • 30% fatality untreated • Many conditions common in old age mimic

  12. Classic Triad Dyspnea Chest pain Hemoptysis Occurs in < 20% of cases Any of these: Dyspnea Chest pain Hemoptysis Hypotension Hypoxia Syncope Tachycardia PE: Symptoms

  13. PE: Evaluation Suspect PE High Anticoagulate VQ Scan Intermediate Evaluate Further Low No Treatment

  14. PE: Evaluation Suspect PE Angiography Unstable VQ Scan Inter- mediate Or Stable Ultrasound LEs Or D-dimer > 500 < 500 No Treatment

  15. PE: Evaluation Suspect PE VQ Scan Intermediate Stable Ultrasound LEs Negative or Nondiagnostic Positive Comprehensive US of LEs, serial US LEs, or Helical CT Anticoagulate

  16. High-probability VP lung scan Image from :http://www.images.md

  17. Angiogram Showing Main Pulmonary Artery Thromboemboli Image from :http://www.images.md

  18. First line: low molecular weight heparins Unfractionated IV heparin if renal failure If using IV heparin do not bolus When warfarin started do not load Acute Massive PE (filling defects ≥ 2 lobar arteries) hypotension, severe hypoxia or high pulmonary pressures on echo Treat with thrombolytics PE: Therapy

  19. References • Reuben DB, Herr KA, Pacala JT, Pollock BG, Potter JF, Semla TP, eds. Geriatrics at Your Fingertips, 7th Edition, American Geriatrics Society, New York, NY, 2005. Respiratory Diseases pp167-176 • Geriatric Review Syllabus: a core curriculum in geriatric medicine. Fifth Edition 2002-2004. E. L. Cobbs, E.H. Duthie, J.B. Murphy (Eds). • Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). The PIOPED Investigators.JAMA. 1990;263(20):2753-9. • Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, Global Initiative for Chronic Obstructive Lung Disease (GOLD) . NHLBI/WHO Workshop Report, Executive Summary. National Institutes of Health, National Heart, Lung and Blood Institute. March 2001. NIH Publication No. 2701A. http://www.goldcopd.com. • National Asthma Education and Prevention Program, NAEPP Working Group Report: Considerations for Diagnosing and Managing Asthma in the Elderly. Bethesda, MD: National Heart, Lung, and Blood Institute; Feb. 1996. NIH Publication No. 96-3662; • Global Initiative for Asthma, Global Strategy for Asthma Prevention and Management. Bethesda, MD: National Heart, Lung, and Blood Institute, April 2002. NIH Publication No. 02-3659. http://www.ginasthma.com.

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