Source / episode info
- **Episode:**217
- **Title:**Divine Intervention Episode 217 – Family Medicine Shelf Review Series 6 (Pulm).
- **Published:**2020-03-04
- Source:Episode page
One-liner
This episode reviews pulmonary function testing (spirometry, DLCO) to differentiate obstructive from restrictive lung diseases; details the stepwise management of asthma and COPD exacerbations; and covers the diagnosis, acute care, and complications of cystic fibrosis.
High-yield summary
- Spirometry: Obstructive disease is characterized by a decreased {FEV}_1/{FVC} ratio (typically <0.7). Reversibility suggests asthma. Restrictive disease usually presents with normal or increased {FEV}_1/{FVC}.
- DLCO Interpretation: Decreased DLCO in restrictive lung disease points to interstitial/parenchymal processes (e.g., pulmonary fibrosis). Normal DLCO in restrictive disease suggests a mechanical issue (e.g., neuromuscular weakness, obesity, chest wall deformity).
- Asthma Management: The stepwise approach involves SABA -> Inhaled Glucocorticoid -> LABA -> Oral Corticosteroids. Diagnosis requires positive methacholine challenge testing and consideration of triggers like aspirin/NSAIDs (AERD).
- COPD Management: Treatment escalation is typically SABA -> LAMA -> ICS -> Oral Steroids. Short-acting muscarinic antagonists (SAMA) are preferred over long-acting muscarinic antagonists (LAMA) for initial rescue, but LABAs/LAMAs are key maintenance drugs.
- Cystic Fibrosis (CF): CF is the most common cause of bronchiectasis in this country. Diagnosis requires sweat chloride testing. Acute pneumonia management depends on age: {<20} years suggests Staphylococcus aureus; {>20} years suggests Pseudomonas aeruginosa.
Learning objectives
- Differentiate the physiological findings (spirometry, DLCO) between obstructive and restrictive lung diseases.
- Apply appropriate diagnostic testing for asthma exacerbations (e.g., methacholine challenge).
- Outline the stepwise pharmacological management of both asthma and COPD based on severity/control.
- Identify the key pathogens and appropriate antibiotic coverage required for acute pneumonia in cystic fibrosis, stratified by age.
- Recognize the mechanical causes of restrictive lung disease that maintain normal DLCO.
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