Lower Respiratory Disorders Lecture Notes

Achieve mastery of lower respiratory disorders including Bronchitis, Pneumonia, COPD, and TB with focus on etiology, pathophysiology, and management.

Acute Bronchitis

Acute inflammation of the bronchial tree and sometimes the trachea, commonly following a viral upper respiratory infection.

Acute Bronchitis Antibiotic Policy

No antibiotics are traditionally used for this condition; management is primarily supportive care.

Sternal soreness

Common symptom of acute bronchitis resulting from excessive coughing.

CAP (Community-acquired pneumonia)

Pneumonia where signs start BEFORE $48$ hours into hospital admission and the patient was not in a healthcare setting.

Hospital-acquired pneumonia

Pneumonia where signs start more than $48$ hours AFTER admission to the hospital.

Health care-associated pneumonia

Pneumonia in patients with close contact with healthcare providers, long-term care residents, or recent antibiotic/immunosuppressive therapy.

Ventilator-associated pneumonia

Pneumonia where signs appear more than $48$ hours AFTER being placed on a ventilator.

Pneumonia (Basic Definition)

Acute infection of the lung tissues causing them to fill with pus and fluid.

Pneumonia Mortality (U.S.)

Approximately $41,000$ people die from pneumonia and its complications annually in the United States.

Consolidation

A process in pneumonia where alveoli fill with fluid and debris, evidenced by dullness to percussion.

Fever threshold (Pneumonia)

Fever and chills in pneumonia patients can reach up to $105^{\circ}F$ ($40.5^{\circ}C$).

Pleuritic chest pain

Chest pain that occasionally occurs with pneumonia during the respiratory cycle.

Pleural effusion

A pneumonia complication involving fluid accumulation in the intrapleural space.

Lung abscess

A lung tissue cavity filled with pus, often a complication of pneumonia.

Empyema

A complication of pneumonia where the pleural cavity becomes filled with pus.

Pulmonary fibrosis

Decreased lung compliance resulting from pneumonia complications.

Pulmonary hypertension

Increased pulmonary blood pressure that can occur as a complication of pneumonia.

Pericarditis

Infection of the lining of the heart that may complicate pneumonia.

Meningitis

Inflammation of the membrane over the brain, listed as a potential pneumonia complication.

CURB-65

A measurement tool used to predict mortality in the next $30$ days for pneumonia patients.

Confusion (CURB-65)

The 'C' in CURB-65, defined as a status of A&O $x3$.

Urea (CURB-65)

The 'U' in CURB-65, specifically a BUN level higher than $20$.

Respirations (CURB-65)

The 'R' in CURB-65, specifically a respiratory rate higher than $30$.

Blood Pressure (CURB-65)

The 'B' in CURB-65, specifically Systolic $<90$ or Diastolic $<60$.

65 (CURB-65)

The age component of the CURB-65 tool, specifically Age $>65$.

PCV20 or PCV21

Pneumococcal vaccine options recommended for routine vaccination in adults age $50$ years and older.

PCV15 followed by PPSV23

A specific sequence of pneumococcal vaccinations used for routine or high-risk adult regimens.

Good-lung-down positioning

A nursing intervention used to optimize oxygenation by positioning the patient with the healthy lung dependent.

Kilocalorie Increase Rule

Every degree $^{\circ}F$ of body temperature above $98.6$ requires a kilocalorie increase of $7\%$.

COPD (Chronic Obstructive Pulmonary Disease)

A treatable disease characterized by persistent airflow limitation and enhanced chronic inflammatory response to noxious particles or gases.

Emphysema

A subset of COPD characterized by destruction of the walls of the alveoli with resulting enlargement of abnormal air spaces.

Chronic Bronchitis (Medical Definition)

A disorder of excessive bronchial mucous secretion characterized by a productive cough lasting $3$ or more months in $2$ consecutive years.

FEV1/FVC ratio

A value of $<0.7$ on pulmonary function tests indicating persistent airflow limitation.

Pink Puffer

Clinical manifestation of emphysema where the patient is cachectic (thin), has a barrel chest, and uses accessory muscles.

Blue Bloater

Clinical manifestation of chronic bronchitis where the patient is obese, cyanotic, and has peripheral edema.

Secondary polycythemia

A potential complication of COPD involving an increase in red blood cell production.

Cor Pulmonale

Pulmonary heart disease that can develop as a complication of COPD.

SABA

Short-acting beta-agonist used as rescue medication for COPD patients.

LABA

Long-acting beta-agonist used for initial maintenance in COPD groups B and E.

LAMA

Long-acting muscarinic antagonist used for maintenance therapy in COPD groups B and E.

ICS

Inhaled corticosteroids used in triple therapy for COPD exacerbations with history of eosinophils.

Triple Therapy (COPD)

The combination of LABA + LAMA + ICS for managing COPD exacerbations.

Controlled oxygen target (COPD)

Target saturation of $88-92\%$ during acute exacerbations when hypercapnia risk is present.

Bullectomy

Surgical management option for selected giant bullae in advanced COPD.

Huff Cough

A technique involving slow inhalation, holding for $2-3$ seconds, and forceful exhalation to clear mucus.

Pursed-lip breathing (PLB)

A breathing technique where the patient inhales for $3$ counts and exhales slowly through puckered lips for $7$ counts.

Activity to Rest Ratio (COPD)

An intervention strategy where activity is alternated with rest periods in a $1:3$ ratio.

RQ (Respiratory Quotient) - Carbohydrates

Nutrient with the highest RQ, recommended at less than $50\%$ of intake in COPD to decrease $CO_2$ production.

RQ (Respiratory Quotient) - Fat

Nutrient with an RQ of $30-50\%$, favored in COPD for lower $CO_2$ production and high calorie density.

COPD Protein Guideline

Recommended daily intake of $1-2.5\,g/kg/day$ adjusted for malnutrition and stress.

Mycobacterium Tuberculosis

The etiology and causative micro-organism of Tuberculosis (TB).

Acapella / Flutter Devices

Specific airway clearance devices used to assist in mobilizing secretions.

BCG (Bacille-Calmette-Guerin) vaccine

A live attenuated Mycobacterium Bovis vaccine that causes a positive PPD test in the future.

TST (Tuberculin Skin Test)

Also known as Mantoux or PPD test, involving $0.1\,mL$ intradermally into the forearm.

Induration

A palpable, raised, hardened area or swelling that is measured to interpret TST results (not including redness).

5 mm induration

Considered a positive TST in HIV-infected persons, recent TB contact, or immunosupressed patients.

10 mm induration

Considered a positive TST in IV drug abusers, residents of high-risk settings, or immigrants from high-prevalence countries.

15 mm induration

Considered a positive TST in any person, including those with no known risk factors for TB.

Latent TB Infection (LTBI)

A state where the person has a good immune system, no symptoms, cannot spread TB, and has negative sputum but positive PPD.

TB Disease

A symptomatic state where TB can be spread to others, characterized by positive PPD, blood, and sputum tests.

Drug resistant TB Disease

Bacteria resistant to treatment due to ineffective regimens or failure to complete treatment.

Hemoptysis

A later stage clinical manifestation of TB disease involving coughing up blood.

TB Cough Duration

A frequent cough lasting $3$ weeks or more is a characteristic symptom of initial TB disease.

Airborne precautions

Infection control measures for TB including private negative airflow rooms and HEPA filter masks (N-95).

Isoniazid (INH)

A TB medication associated with side effects such as hepatotoxicity and peripheral neuropathy.

Pyridoxine

Vitamin $B_6$ administered to TB patients taking Isoniazid to prevent peripheral neuropathy.

Rifampin / Rifapentine

TB medications that cause orange discoloration of body fluids and reduce hormonal contraception effectiveness.

Pyrazinamide

A TB medication that can lead to hepatotoxicity, hyperuricemia, and arthralgia.

Ethambutol

A TB medication requiring baseline and ongoing vision assessments due to the risk of optic neuritis.

Moxifloxacin

A TB medication associated with QT prolongation, tendinopathy, and glucose effects.

3HP regimen

A short-course latent TB treatment involving weekly INH + rifapentine for $3$ months.

4R regimen

A latent TB treatment involving daily rifampin for $4$ months.

3HR regimen

A latent TB treatment involving daily INH + rifampin for $3$ months.

DOT (Directly Observed Therapy)

A treatment strategy to ensure TB medication adherence by having health personnel observe the patient take doses.

QuantiFeron-TB Gold / T-SPOT TB

Blood tests used to identify TB exposure, often used when a PPD cannot be performed.

Miliary TB

A potential complication of Tuberculosis involving widespread dissemination of the bacteria.

Bronchopleural fistula

A possible complication of Tuberculosis affecting the connection between the bronchus and pleura.

Tripod position

A physical sign in COPD where a patient sits leaning forward with arms on knees or a table to improve breathing.

Cachexia

The state of being very thin, typical of 'Pink Puffers' with emphysema from increased work of breathing.

C-reactive protein (CRP)

A laboratory marker measured to assess inflammation levels in a pneumonia medical plan.