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Range of lung diseases
The Big 4 Lung Diseases
- Chronic оbstructive pulmonary disease (COPD) — the most common cause of acute medical admissions
- Asthma — the most common chronic respiratory disease
- Lung cancer — the most common fatal cancer in the Western world for both men and women
- Pneumonia — the most common serious infectious disease
Other common respiratory diseases
- Infectious: tuberculosis, empyema
- Pulmonary emboli
- Bronchiectasis
- Interstitial lung disease and sarcoidosis
- Pleural effusions and pneumothorax
- Obstructive sleep apnea
Range of Lung Diseases
Diseases of the airways
| Upper airway obstruction | |
| Lower airway obstruction | |
| Airway infection |
|
| Airway tumors |
|
Image: Classification of lung diseases. By Lecturio
Lung parenchyma (alveoli and interstitium)
| Infections | |
| Interstitial Lung Diseases |
|
| Adult respiratory distress syndrome | |
| Parenchymal tumors |
|
Circulation
| Pulmonary emboli (PE) | |
| Pulmonary hypertension |
|
| Hemoptysis | |
| Vasculitis |
Image: Range of lung diseases By Lecturio
Pleural diseases
| Pneumothorax | |
| Pleural infection |
|
| Pleural malignancy |
|
Other
| Diseases of physiology |
|
| Iatrogenic lung disease |
|
Investigation of Lung Disease
Image: Pulmonary artery diseases. By Lecturio
Different Causes of Large Airway Obstruction
Acute upper airway obstruction
| Speed of onset | Cause | Clinical presentation |
| Sudden | Aspiration of a foreign body; mucous plug | Very acute dyspnea and stridor |
| Acute | Epiglottis/ tonsillar abscess
Diphtheria Smoke inhalation Deteriorations of subacute/chronic causes |
Acute dyspnea and stridor
Saliva drooling Fever (infective cause) |
Chronic upper airway obstruction
| Speed of onset | Cause | Clinical symptoms and signs |
| Subacute/progressive | Cancer: lung/larynx/thyroid
Benign tracheal tumors Massive mediastinal nodes Vocal cord paralysis |
Progressive/positional dyspnea
Cough Hemoptysis Stridor (can be intermittent) Post-obstructive bronchiectasis Dysphagia (esophageal invasion) Pain (malignant causes) |
| Chronic/non-progressive | Post-intubation tracheal stenosis
Post-infective, e.g., tuberculosis Goiter Previous upper airway surgery Vasculitis Tracheomalacia |
Large Airway Obstructions: Clues
-
Image: ‘Squared off’ flow volume loop of tracheal obstruction. By Lecturio
Minimal variability in peak flow/spirometry
- Positional symptoms rather than diurnal
- Inspiratory wheeze (stridor)
- History of intubation/tracheal disease
- Characteristic flow-volume loop
- Fall in peak expiratory flow rate (PEFR) relatively greater than fall in forced expiratory volume in the 1st second (FEV1)
Bronchoscopy
- Visual confirmation
- Biopsies to confirm the cause (but can bleed…)
- Treatment
Treatment of acute presentation
- Sit the patient up
- High flow oxygen or heliox (a mixture of oxygen and helium) via a mask
- Intravenous high-dose corticosteroids (reduce edema around obstruction)
- Nebulized salbutamol and adrenaline
- Intravenous fluid replacement
- Potentially urgent intubation or tracheostomy or bronchoscopy intervention
Treatment of chronic obstruction
Chronic—relieve the obstruction by
- Treating the underlying cause if possible
- Bronchoscopic interventions e.g.,
- Stents
- Laser ablation
- Surgical interventions
- Remove cause
- Tracheostomy
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