Problem Solving in Respiratory Medicine & Allergy PDF
Preview Problem Solving in Respiratory Medicine & Allergy
L Problem Solving in E A C H Respiratory Medicine e t a l . and Allergy SP or o l vb Everydoctor’spoint-of-carecompanionforrespiratorydisorders,in inle gm theconsultationroomorontheward.Aseriesofquestionsleadsthe i n readerlogicallythroughacasepresentation,work-up,diagnosisand R discussionofrecentliterature.Eachcaseisconciselypresented, e includinganalgorithmwhereappropriatetoshowoverall s managementstrategies.Thisisauser-friendlyresourceforquick p i reviewandassessmentofindividualcases,coveringthemostcommon r a yetchallengingcasesseenbyrespiratorydoctors–aninvaluable t referenceandtrainingresourceforthehospital,clinicandGP’s o r surgery. y M Relatedtitles: e Asthma:AtlasofInvestigationandManagement d SL JOHNSTON i Problem Solving in c ISBN9781904392187 i n PaediatricRespiratoryDisease–AirwaysandInfection:Atlasof e Respiratory InvestigationandManagement a A BUSH, J DAVIES n ISBN9781904392972 d Medicine and PaediatricRespiratoryDisease–ParenchymalDiseases:Atlasof A l InvestigationandManagement, l e Allergy A BUSH, J DAVIES r ISBN9781846920868 g y TherapeuticStrategies:AcuteExacerbationsinCOPD M CAZZOLA, S SETHI, F BLASI, A ANZUETO R I C H A R D M L E A C H ISBN9781904392712 C H R I S T O P H E R K O S K Y TherapeuticStrategiesinPulmonaryArterialHypertension E L I Z A B E T H H A D L E Y A PEACOCK, J BARBERÀ ISBN9781846920530 PC B O R I S L A M S UL BIN L CLINICAL PUBLISHING ISHICA www.clinicalpublishing.co.uk INL C L I N I C A L P U B L I S H I N G G Problem Solving in Respiratory Medicine & Allergy Edited by RICHARD LEACH, MD, FRCP Consultant Physician and Clinical Director of Medicine Guy’s and St Thomas’ NHS Foundation Trust London, UK CHRISTOPHER KOSKY, MBBS, FRACP Consultant Physician, Respiratory, General and Sleep Medicine Guy’s and St Thomas’ NHS Foundation Trust Honorary Senior Lecturer King’s College London, UK ELIZABETH HADLEY, MBBS Hons, BSc Hons, MRCP London Consultant Respiratory and General Physician Department of Respiratory Medicine Barking, Havering and Redbridge Hospitals University NHS Trust London, UK BORIS LAMS, MBBS, MD, FRCP Consultant Physician, Respiratory, General and Critical Care Medicine Clinical Lead for Respiratory and Sleep Medicine Guy’s and St Thomas’ NHS Foundation Trust London, UK C L I N I C A L P U B L I S H I N G O X F O R D 00-PS Respiratory Medicine-prelims-cpp.indd 3 25/08/2011 15:28 CLINICAL PUBLISHING an imprint of Atlas Medical Publishing Ltd Oxford Centre for Innovation Mill Street, Oxford OX2 0JX, UK Tel: +44 1865 811116 Fax: +44 1865 251550 E mail: [email protected] Web: www.clinicalpublishing.co.uk Distributed in USA and Canada by: Clinical Publishing 30 Amberwood Parkway Ashland OH 44805 USA tel: 800-247-6553 (toll free within US and Canada) fax: 419-281-6883 email: [email protected] Distributed in UK and Rest of World by: Marston Book Services Ltd PO Box 269 Abingdon Oxon OX14 4YN UK tel: +44 1235 465500 fax: +44 1235 465555 email: [email protected] © Atlas Medical Publishing Ltd 2011 First published 2011 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Clinical Publishing or Atlas Medical Publishing Ltd. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. Clinical Publishing and Atlas Medical Publishing Ltd bear no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and do not guarantee that any content on such websites is, or will remain, accurate or appropriate. A catalogue record for this book is available from the British Library. ISBN 13 978 1 904392 86 6 ISBN e-book 978 1 84692 598 6 The publisher makes no representation, express or implied, that the dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publisher do not accept any liability for any errors in the text or for the misuse or misapplication of material in this work. Project manager: Gavin Smith, GPS Publishing Solutions, Herts, UK Typeset by Phoenix Photosetting, Chatham, UK Printed by Marston Book Services, Abingdon, Oxon, UK 00-PS Respiratory Medicine-prelims-cpp.indd 4 25/08/2011 15:28 Contents Preface ix Contributors xi Abbreviations xiii SECTION 1 Infection 1. Severe Pulmonary Tuberculosis, Oni Choudhury, Heather Milburn 1 2. Non-tuberculous Mycobacterial Disease, Ronan Breen, Richard Leach 8 3. Hospital-acquired Pneumonia, Richard Leach 15 4. Lemierre’s Disease, Boris Lams, Christopher Kosky 21 5. Haemoptysis due to Bronchiectasis, Burhan Khan, Richard Leach 25 SECTION 2 Obstructive Lung Disease/Small Airways Disease 6. Stable Chronic Obstructive Pulmonary Disease (COPD), Burhan Khan, Richard Leach 33 7. Acute Ventilatory Failure in Chronic Obstructive Pulmonary Disease, Richard Leach, Craig Davidson 41 8. Difficult Asthma, Lynette Linkson, Richard Leach 47 9. Asthma and Pregnancy, Lynette Linkson, Richard Leach 53 10. Allergic Bronchopulmonary Aspergillosis, Kate Brignall 55 11. Chronic Cough, Jimstan Periselneris, Richard Leach 62 12. Aspiration Syndrome, Boris Lams, Richard Leach 67 SECTION 3 Interstitial Lung Disease/Sarcoid 13. Classification of the Idiopathic Interstitial Pneumonias, Richard Leach, John Rees 73 14. Treatment of Idiopathic Pulmonary Fibrosis/Usual Interstitial Pneumonias, Lucy Schomberg, Richard Leach 81 00-PS Respiratory Medicine-prelims-cpp.indd 5 25/08/2011 15:28 vi Contents 15. Acute Eosinophilic Pneumonia, Boris Lams, Christopher Kosky 88 16. Cryptogenic Organizing Pneumonia, Boris Lams, Christopher Kosky 93 17. Sarcoidosis (Radiographic Stage I), Anne Collett, Richard Leach 97 18. Sarcoidosis (Radiographic Stages II and III), Richard Leach 104 19. Hypersensitivity Pneumonitis, Elizabeth Hadley, Boris Lams 111 20. Amiodarone Pulmonary Toxicity, Elizabeth Hadley, Boris Lams, Christopher Kosky 117 SECTION 4 Lung Cancer 21. Small Cell Lung Cancer (SCLC), Oni Choudhury, Richard Leach 121 22. Non-Small Cell Lung Cancer (NSCLC), Suma Kumar, Richard Leach 127 23. Pulmonary Nodules, Burhan Khan, Richard Leach 135 24. Mediastinal Mass: Bronchogenic Cyst, Elizabeth Hadley 139 25. Smoking Cessation, Suma Kumar, Richard Leach 142 SECTION 5 Pulmonary Vascular: Including PE and AVM 26. Pulmonary Hypertension, Bethia Bradley, Richard Leach 149 27. Massive Pulmonary Embolism, Elizabeth Hadley, Christopher Kosky 157 28. Sickle Cell Lung Disease, Elizabeth Hadley, Boris Lams, Christopher Kosky 161 29. Pulmonary Arteriovenous Malformation, Elizabeth Hadley 166 SECTION 6 Vasculitis/Rare Diseases 30. Wegener’s Granulomatosis and the Small Vessel Pulmonary Vasculitides, Elizabeth Hadley, Richard Leach 171 31. Diffuse Alveolar Haemorrhage, Christopher Kosky 178 SECTION 7 Ventilatory Failure/Sleep 32. Obesity Hypoventilation Syndrome, Christopher Kosky, Boris Lams 183 33. Guillain-Barré Syndrome, Nicholas Hopkinson, Christopher Kosky 187 SECTION 8 Immunocompromised/HIV 34. Pneumocystis jirovecii Pneumonia, Elizabeth Hadley, Boris Lams 191 35. Lymphocytic Interstitial Pneumonia, Elizabeth Hadley, Boris Lams, Christopher Kosky 195 00-PS Respiratory Medicine-prelims-cpp.indd 6 25/08/2011 15:28 Contents vii SECTION 9 Pleural Disease 36. Parapneumonic Effusion, Liju Ahmed, Richard Leach 199 37. Spontaneous Pneumothorax: Langerhans Cell Histiocytosis, Eleanor Giddings, Boris Lams, Elizabeth Hadley 207 38. Mesothelioma and Asbestos-related Pleural Disease, Amina Aitsi-Selmi, Charles Twort 213 General index 221 00-PS Respiratory Medicine-prelims-cpp.indd 7 25/08/2011 15:28 Contributors Consultant Respiratory Physicians, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Liju Ahmed Christopher Kosky John Rees Ronan Breen Boris Lams Charles Twort Anne Collett Richard Leach Craig Davidson Heather Milburn Consultant Respiratory and General Physician, Barking, Havering and Redbridge Hospitals University NHS Trust, London, UK Elizabeth Hadley Consultant Respiratory Physician, Royal Brompton and Harefield NHS Foundation Trust, London, UK Nicholas Hopkinson Consultant Respiratory Physician, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, Kent, UK Burhan Khan Consultant Respiratory Physician, Medway Maritime Hospital, Medway, Kent, UK Kate Brignall Specialist Registrars in Respiratory Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Bethia Bradley Lynette Linkson Lucy Schomberg Eleanor Giddings Jimstan Periselneris Previous Core Medical Trainees in Respiratory Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Oni Choudhury Suma Kumar Amina Aitsi-Selmi 00-PS Respiratory Medicine-prelims-cpp.indd 9 25/08/2011 15:28 Abbreviations ABG arterial blood gas BHL bihilar lymphadenopathy ABPA allergic bronchopulmonary BM body mass aspergillosis BMI body mass index ACCP American College of Chest BMPR2 bone morphogenetic protein Physicians receptor 2 ACE angiotensin converting enzyme BNP brain natriuretic peptide ACE-I angiotensin converting enzyme BOOP bronchiolitis obliterans organizing inhibitor pneumonia AECOPD acute exacerbation of COPD BP blood pressure AEP acute eosinophilic pneumonia BREATH-1 Bosentan Randomized trial of AF Aspergillus fumigatus Endothelin Antagonist Therapy of AFB acid-fast bacilli pulmonary Hypertension Study AIDS acquired immune deficiency BTS British Thoracic Society syndrome c-ANCA cytoplasmic anti-neutrophil AIP acute interstitial pneumonia cytoplasmic antibody ALK-1 activin receptor-like kinase 1 CAP community-acquired pneumonia ALT alanine transaminase CAVE cyclophosphamide, doxorubicin, ANA anti-nuclear antibody vincristine, etoposide ANCA anti-neutrophil cytoplasmic CCB calcium channel blocker antibody CF cystic fibrosis ANNA-1 type 1 anti-neuronal nuclear antibody cGMP cyclic guanosine monophosphate anti-Ber-EP4 anti-human epithelial antigen CHART continuous hyperfractionated anti-CEA anti-carcino-embryonic antigen accelerated radiotherapy anti-CK5/6 anti-cytokeratin 5/6 CHD congenital heart disease anti-MPO anti-myeloperoxidase antibody CI confidence interval anti-PR3 anti-proteinase 3 antibody CK7 cytokeratin 7 anti–TTF-1 anti-thyroid transcription factor 1 CNS central nervous system anti-WT1 anti-Wilms tumour 1 COP cryptogenic organizing APACHE Acute Physiology and Chronic pneumonia Health Evaluation COPD chronic obstructive pulmonary APAH associated pulmonary arterial disease hypertension CPAP continuous positive airway ARDS acute respiratory distress syndrome pressure ASH Action on Smoking and Health CRP C-reactive protein AST aspartate transaminase CSF cerebrospinal fluid ATS American Thoracic Society CT computed tomography AV arteriovenous CTD connective tissue disease AVM arteriovenous malformation CTEPH chronic thromboembolic BAL bronchoalveolar lavage pulmonary hypertension BCG Bacillus Calmette-Guérin CTPA computed tomography pulmonary BDP beclomethasone angiogram 00-PS Respiratory Medicine-prelims-cpp.indd 11 25/08/2011 15:28 xii Abbreviations CXR chest radiograph HHT hereditary haemorrhagic DAD diffuse alveolar damage telangiectasia DIC disseminated intravascular HIV human immunodeficiency virus coagulation HLA human leukocyte antigen DIP desquamative interstitial HP hypersensitivity pneumonitis pneumonia HPAH heritable pulmonary arterial DLCO carbon monoxide diffusing hypertension capacity HRCT high-resolution computed DOT directly observed therapy tomography DPI dry powder inhalers HTLV-1 human T cell lymphotrophic virus DPLD/ILD diffuse parenchymal (interstitial) type 1 lung disease IASLC International Association for the DPT diffuse pleural thickening Study of Lung Cancer DVT deep vein thrombosis ICS inhaled corticosteroid EBUS endoscopic bronchial ultrasound ICU intensive care unit ECG electrocardiogram IDSA Infectious Diseases Society of ECV epirubicin, cyclophosphamide and America vincristine IgA immunoglobulin A ELISA enzyme-linked immunosorbent IgE immunoglobulin E assay IgG immunoglobulin G EMA epithelial membrane antigen IIP idiopathic interstitial pneumonia EORTC European Organisation for IL-1 interleukin-1 Research and Treatment of Cancer IL-5 interleukin-5 EPAP expiratory positive airway pressure ILD interstitial lung disease EPP extrapleuropneumonectomy IPAH idiopathic pulmonary arterial ERS European Respiratory Society hypertension ESR erythrocyte sedimentation rate IPAP inspiratory positive airway ET-1 endothelin-1 pressure ETS environmental tobacco smoke IPF idiopathic pulmonary fibrosis F female ISOLDE Inhaled Steroids in Obstructive 18FDG 18-fluorodeoxyglucose Lung Disease in Europe FEV forced expiratory volume in 1 IU international unit 1 second Ig-1b interferon gamma-1b FiO2 inspired oxygen concentration KCO transfer coefficient; carbon FRC functional residual capacity monoxide gas transfer corrected FU follow-up for alveolar volume FVC forced vital capacity LABA long-acting b2 agonist GBM glomerular basement membrane LAMA long-acting muscarinic antagonist GBS Guillain-Barré syndrome LC Langerhans cell GGO ground glass opacification LCH Langerhans cell histiocytosis GI gastrointestinal LDH lactate dehydrogenase GORD gastro-oesophageal reflux disease LFT liver function test GP general practitioner LIP lymphocytic interstitial pneumonia GSD glycogen storage disease LOS lower oesophageal sphincter HAART highly active antiretroviral therapy LRT lower respiratory tract HAP hospital-acquired pneumonia LRTI lower respiratory tract infection HbSS homozygous sickle cell disease LTOT long-term oxygen therapy HCAP health-care-associated pneumonia M male HCO partial pressure of arterial MAC M. avium complex 3 bicarbonate MALT mucosal-associated lymphoid HCRF hypercapnic respiratory failure tissue 00-PS Respiratory Medicine-prelims-cpp.indd 12 25/08/2011 15:28 Abbreviations xiii MARS Mesothelioma and Radical Surgery PE pulmonary embolism MDI metered dose inhalers PEC paclitaxel, etoposide, carboplatin MDR multidrug resistant PEEP positive end-expiratory pressure MHC major histocompatibility complex PEFR peak expiratory flow rate MND motor neurone disease PET positron emission tomography MPA microscopic polyangiitis PFT pulmonary function test MPO myeloperoxidase PHT pulmonary hypertension MRSA methicillin-resistant Staphylococcus PiO2 partial pressure of oxygen in aureus airways MS multiple sclerosis PJP Pneumocystis jirovecii pneumonia 99mTc technetium-99m PLCH pulmonary Langerhans cell MV mechanical ventilation histiocytosis 6MW six-minute walks pMDI pressurized metered dose inhaler NAC N-acetylcysteine PN pulmonary nodule nAchR nicotinic acetylcholine receptors PPE parapneumonic effusion Nd-Yag neodymium-yttrium aluminium PPHN persistent PHT in the newborn garnet PPV positive predictive value NHS National Health Service PSP primary spontaneous NICE National Institute for Health and pneumothorax Clinical Excellence QoL quality of life NIPPV non-invasive positive pressure RAP right atrial pressure ventilation RB respiratory bronchiolitis NIV non-invasive ventilation RB-ILD respiratory bronchiolitis-associated NRT nicotine replacement therapy interstitial lung disease NSAID non-steroidal anti-inflammatory RCT randomized controlled trial drugs REM rapid eye movement NSCLC non-small cell lung cancer RHC right heart catheterization NSIP non-specific interstitial pneumonia RR respiratory rate NT nebulizer therapy RV residual volume NTM non-tuberculous mycobacteria RVF right ventricular failure NYHA New York Heart Association RVSP right ventricular systolic pressure OC oral contraceptive Rx treatment OHS obesity hypoventilation syndrome SABA short-acting b2 agonist OP organizing pneumonia SAMA short-acting muscarinic antagonist OR odds ratio SaO oxygen saturation of arterial blood 2 OSA obstructive sleep apnoea SCC squamous cell cancer OT oxygen therapy SCD sickle cell disease PaCO partial pressure of arterial carbon SCLC small cell lung cancer 2 dioxide SIADH syndrome of inappropriate PAH pulmonary arterial hypertension antidiuretic hormone p-ANCA perinuclear anti-neutrophil SIRS systemic inflammatory response cytoplasmic antibody syndrome PaO partial pressure of arterial oxygen SLE systemic lupus erythematosus 2 PAO alveolar oxygen pressure SPP secondary pneumothorax 2 PAP pulmonary artery pressure SVCO superior vena cava obstruction PAS para-aminosalicylic acid TB tuberculosis PASP pulmonary artery systolic pressure TBBx transbronchial biopsy PCI prophylactic cranial irradiation Td deadspace PCWP pulmonary capillary wedge Th1 helper T cell type 1 pressure Th2 helper T cell type 2 PE cisplatin and etoposide TLC total lung capacity 00-PS Respiratory Medicine-prelims-cpp.indd 13 25/08/2011 15:28
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