Problem Solving in Respiratory Medicine & Allergy

240 Pages·2007·10.1 MB·English

by  Richard Leach et al.

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CLINICAL PUBLISHING ISHICA
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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
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CLINICAL PUBLISHING
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First published 2011
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ISBN 13 978 1 904392 86 6
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The publisher makes no representation, express or implied, that the dosages in this
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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
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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
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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
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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
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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
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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
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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
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