COPD

Respiratory Disease characterized By progressive irreversible airways

Obstruction as a Result Of chronic obstruction bronchitits &
emphysema.

Cause
▪ Alpha-1- antitrypsin deficiency
▪ Smoking
▪ Dust
▪ Chemical
▪ Pollution

Clinical Feature

▪ Chronic Cough More Than 3 months

▪ Diffuses cynosis
▪ Tachycard
▪ Tachypenia
▪ Expiratory Dyspanea

▪ Precaution:- Band Box Sound

▪ Ascultion :- Weezing & Redlles
▪ Palpation:- Chest Tightness

Lab Test
CBC- leuco, esiono, neutron
CRP Test ESR TEST
Alpha Antitrypsin
Albumin
Blood Cluture
Sputum Test
Electrolyte test(Ca k Na)
Plural Effusion
Skin sensitivity

Instrumental
▪ Chest X-ray
▪ Lung function
▪ O2 saturation
▪ ECO-ECG
▪ Bronchoscopy
▪ CT
▪ MRI

Treatment
Etiological
Antibiotics
Amoxicillin 500mg
Ampicilline 500mg
AntiViral
Acyclovir 1000 mg
 Tenofovir 300 mg

Pathogenic
Bronchodilator -→ Albuterol (90-100 mg)
(Beta-agonist)
Salbutanol (200 mg)
Salmeterol (50 mg)

Corticosteroids (inflammation)
Prednisone (1 mg/kg)
Dexamethasone (1 mg/kg)

Symptomatic
Mucolytic----→
Ambroxial 10ml N-acetylcysteine
Methyl xanthine
Tneophyline (20 mg)
Anticolinergic
Iprotropiume Bromide (160-220 mg)

Beta Blockers
 Meteprolol (50 mg)
Atenolol (20 mg)

Lung Absess

A necrotic area in the lung that develops into a cavity filled with pus due
to infection
Abscess <2 cm diameter cavity

Causes
▪ Infection (Bacterial , fungal,)
▪ Immunosuppression
▪ Tumor
▪ Foreign Body obstruction

Clinical Features
Respiratory Symptoms
- Cough with foul-smelling sputum (indicates anaerobic infection).
- Hemoptysis (coughing blood).
- Shortness of breath (dyspnea Mixed ).
Chest Pain
Sepsis
Asucultion – crackle Sound
Treatment
Etiological
Antibiotics
Amoxicillin 500mg
Ampicilline 500mg
AntiViral
Acyclovir 1000 mg
Tenofovir 300 mg

Pathogenic
Gluco-cortico- steroid
Preduesolon (1mg/kg)
Saline-Natrial chloride 0.9% 200ml Glucose
Anti-protozoal
Metenozole

Symptomatic
Mucolytic----→
Ambroxial 10ml N-acetylcysteine
Methyl xanthine
 Tneophyline (20 mg)
Anticolinergic
Iprotropiume Bromide (160-220 mg)

Beta Blockers
Meteprolol (50 mg)
Atenolol (20 mg)

Analgesics
Morphine

Pulmonary Artery Hypertension

• Pulmonary hypertension (PH) is a complex and progressive
condition characterized by high blood pressure in the arteries that
supply blood to the lungs (pulmonary arteries). This leads to strain
on the right side of the heart, which can cause a range of
symptoms and complications if untreated.

Classification
 • Group-1 :-Pulmonary Arterial Hypertension(PAH)
• Group-2 :-Pulmonary Hypertension due to Left Heart Disease
• Group-3 :-Pulmonary Hypertension due to lung Disease
• Group-4 :-Chronic Thromboembolio Pulmonary
Hypertension(CTEPH)
• Group-5 :-Pulmonary Hypertension due to unclear or
Multifactorial Mechanism

Cause
• Genetic mutations or family history of PH.
• Underlying diseases like scleroderma, lupus, or liver disease.
• Exposure to drugs (e.g.. Appetite suppressants or certain
chemotherapy drugs).
• Chronic conditions like sleep apnea or chronic thromboembolic
events.

Specific symptoms
• Tachycardia
• Tachypnea
• Cyanosis
• Edema
• Ascites
 • Hepatomegaly
• Syncope
• Polyuria
• Pressure vein jugulary vein
• Systemic murmur at 2nd intercostal space
• Hypertension
• olyuria
• Anuria
• Epigastric pulsation

Lab Test
1. Complete Blood Count (CBC):
• Expected findings: Polycythemia (increased red blood cell count),
anemia, or thrombocytosis.
2. Electrolyte Panel:
• Expected findings: Hypokalemia, hyponatremia, or metabolic
alkalosis.
3. Liver Function Tests (LFTs):
• Expected findings: Elevated liver enzymes (AST, ALT) or bilirubin levels.
4. Renal Function Tests:
▪ Expected findings: Elevated creatinine or urea levels.
5. Coagulation Studies:
 • Expected findings: Prolonged prothrombin time (PT) or
activated partial thromboplastin time (aPTT).
6. Brain Natriuretio Peptide (BNP):
▪ Expected findings: Elevated BNP levels (>100 pg/mL).
7. N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP):
▪ Expected findings: Elevated NT-proBND levels (>300 pg/mL).

Instrumental Test
• Chest x-ray
• Echo-ECG
• Pulmonary function test
• O2 saturation
• CT scan
• Ultrasound
• Heart catheterization
• Peak flowmatry
• Bronchoscopy

Etiological treatment
1) Antibiotics :-
 o Ceftriaxone (1-2 gm IV –12hrs),cefotaxine,vacomycin
2) Antiviral:-
o Acyclovir,tenofovir (20mg/kg IV-8 Hrs)
3) Antiprotozoal
4) Antifungal
o Fucanarole (400-800 mg IV-24hrs)

Pathological tāreatment
• Vasodilators
o Nitrites (0.023% 100ml IV)
o Digoxin (0.0025 mg) - 0.3 ml
o Glucocortico steroids
o Prednison (1-2 mg/kg 4-6 hrs)
o Bronchodila
o Albuterol (2.5-5 mg INH 4-6 Hrs)
o ipratroprium

Symptomatic treatment
• For Edema Diuretics furosymide (40 mg TD)
• For Tachypnea
o Methylxanthine ----> Theophyline (2.4 IV)
• Anticogulants ----> warfarin
 • Hepato protector
• Anti-arrthmic -----> Lidocaine (50-100 mg/Day)
• HTN
o Beta-Blockers ----> Metoprolol (25-50 mg 6-8 hrs)
Atenolol

Respiratory Failure
Respiratory failure is a condition where the respiratory system fails
to maintain adequate gas exchange, resulting in:
1. Hypoxemia: Low oxygen levels in arterial blood
(PaO₂ < 60 mmHg).
2. Hypercapnia: High carbon dioxide levels in arterial blood
(PaCO₂ > 50 mmHg).

Classification

1. Type I (Hypoxemic Respiratory Failure) :

- PaO₂ < 60 mmHg with normal or low PaCO₂.
 - Common in diseases affecting oxygen exchange
(e.g., pneumonia, ARDS).

2. Type II (Hypercapnic Respiratory Failure) :

- PaCO₂ > 50 mmHg with or without hypoxemia.
- Common in conditions causing ventilatory failure
(e.g., COPD, neuromuscular disorders).
3. Type III (Perioperative Respiratory Failure) :
- Associated with atelectasis during or after surgery.
4. Type IV (Shock-Related Respiratory Failure) :
- Occurs in patients with shock requiring mechanical ventilation
for oxygenation and ventilation.
1. By development rate
Acute PF
Development of tit takes several minutes, days.
Associated with hypoxemia and respiratory acidosis or alkalosis
Is a life-threatening condition
Chronic PF
Development of tit takes several months, years.
Associated with hypoxemia and/or hypercapnia
Potentially is a life-threatening condition
2. based on type of gas exchange impairment :
• hypoxemic – parenchymatous, or PF type I
 • hypercapnic – ventilation, or PF type II

Etiology
1. Central Nervous System (CNS):
- Drug overdose (e.g., opioids, sedatives).
- Traumatic brain injury or stroke.
2. Neuromuscular System:
- Guillain-Barré syndrome, myasthenia gravis.
- Spinal cord injury.
3. Cardiovascular System:
- Pulmonary edema (cardiogenic or non-cardiogenic).
- Pulmonary embolism.
4. Airways and Lungs:
- Obstructive diseases: COPD, asthma.
- Restrictive diseases: Interstitial lung disease, ARDS.
- Infections: Pneumonia, tuberculosis.
5. Chest Wall:
- Trauma (e.g., rib fractures, flail chest).
- Kyphoscoliosis.
6. Others:
- Severe obesity (obesity hypoventilation syndrome).
 - Metabolic acidosis or alkalosis.

Specific Symptoms

1. Hypoxemia: - Dyspnea, cyanosis, restlessness.

- Tachycardia, tachypnea.
- Confusion, altered mental status.
2. Hypercapnia: - Dyspnea, headache, confusion, drowsiness.
- Flapping tremor (asterixis),
papilledema.
- Progression to coma in severe cases.

Lab test
1. Arterial Blood Gas (ABG): - Key diagnostic test.
- Hypoxemia
(PaO₂ < 60 mmHg),
- hypercapnia (PaCO₂ > 50 mmHg).
- Assess pH for acidosis or alkalosis.

2. Complete Blood Count (CBC): - Detect infections or anemia.

 3. Electrolytes and Renal Function Tests: - To rule out metabolic

causes or complications.
4. Lactate Levels: - Assesses tissue hypoxia.
5. Brain Natriuretic Peptide (BNP): - To evaluate cardiac-related
causes like pulmonary edema.

1. Chest X-Ray: - To identify pneumonia, ARDS, atelectasis, or

pulmonary edema.
2. Computed Tomography (CT) Chest: - For detailed imaging of
lung
parenchyma, embolism.
3. Echocardiography: - Evaluate heart function and
pulmonary pressures.
4. Pulmonary Function Tests (PFTs): - Determine obstructive or

restrictive lung disease.

5. Ultrasound (Thoracic): - Assess pleural effusion or
diaphragmatic movement.

Etiological Treatment
1. Antibiotics for Infection: (Community-acquired pneumonia)
 - Ceftriaxone 1–2 g IV daily + Azithromycin 500 mg IV daily.
2. Bronchodilators for COPD/Asthma:
- Salbutamol nebulization: 2.5 mg every 4–6 hours.
- Ipratropium nebulization: 0.5 mg every 6–8 hours.
3. Anticoagulation for Pulmonary Embolism:
- Enoxaparin 1 mg/kg SC every 12 hours.
Pathogenetic Treatment
1. Oxygen Therapy:
- Nasal cannula, mask / high-flow oxygen to maintain SpO₂ >
90%.
2. Non-Invasive Ventilation (NIV):
- BiPAP for hypercapnic respiratory failure.
3. Mechanical Ventilation:
- For severe hypoxemia or respiratory fatigue.
4. Steroids for ARDS or COPD Exacerbation:
- Prednisolone 40–60 mg/day orally for 5–7 days.
Symptomatic Treatment
1. Analgesics:
- Paracetamol 500 mg orally every 6–8 hours for
1. Sedatives in Agitated Patients:
- Midazolam 0.5–1 mg IV as needed.
 Bronchitis
Bronchiectasis is a disease in which there is permanent enlargement of
parts of the airways of the lung.
(A chronic condition that causes the airways of the lungs to
permanently widen and thicken )

Cause

Congenital alpha 1 anti trips in deficiency.

Past infection TB pneumonia.
Obstruction foreign body.
Hypersensitivity:- allergic bronchopulmonary aspergillosis and bronchiol
tumours
Cystic Fibrosis

Classification
By shape:
• cylindrical,
• saccular,
• fusiform
• mixed bronchoectasis.
Phase of the process: remission, exacerbation.
Pathogenesis:- Primary and secondary.
By amount single and multi.
Clinical Features
typical productive cough syndrome with expectoration of purulent
sputum in large amount (up to 200-300 and more ml), with “full
mouth” in mornings, with streaks of blood and putrid smell;
dyspnea, (mixed)
Chest pain, clubbing finger
Intoxication signs (weakness, fatigability, headaches, fever).
auscultation:
Coarse and medium moist rales heard over affected area,
Rough breathing or bronchial resonance.
In case of diffuse bronchitis – dry rales of different pitches.
In severe course – emaciation, ashy color of face, clubbed fingers,
turtle-back nails.

Lab Test
• Alpha-1 Antitrypsin Levels: To rule out alpha-1 antitrypsin
deficiency.
• General blood test.(leuco+eosino increase)(Normal leuco:- 4,500
to 11,000 cells per microliter (μL) of blood:)( between 30 and 350
cells per microliter of blood)
 • Immunoglobin test- IgA & IgE(To check for primary
immunodeficiencies, such as common variable immunodeficiency
(CVID).)
• Allergy Testing: For ABPA or other hypersensitivity reactions.
• C-reactive Protein (CRP) & Erythrocyte Sedimentation Rate (ESR):
To check for systemic inflammation or infection.
• Sputum Culture and Sensitivity: To identify infectious agents (e.g.,
Pseudomonas aeruginosa, Haemophilus influenzae,
Mycobacterium tuberculosis) and guide antibiotic therapy.
• Chest X-ray:- - Peribronchial sclerosis, rough, intensive cellular
lung pattern, decrease of volume of affected lung areas.
•
• Pulmonary Function Tests (PFTs): To assess airflow limitation or
obstruction.
• Bronchoscopy: To collect lower airway samples or rule out
mechanical obstruction.

Treatment
----Etiological
Antibiotics:-
Amoxiciline:- 500mg/d
Amphicilin 500mg
Erythromycin 500mg
Cefrioxon 1000 /d

Pathogenic
 Anticolinergic:- tiotropium bromide 18mg

Bita 2 agonist
salbutamol 200mg
Semiterol 50mg

Corticosteroid prednisone 1mg

Symptomatic
Mucolytic----→
Ambroxial 10ml N-acetylcysteine
Methyl xanthine
Tneophyline (20 mg)
Drug Intoxication
Saline-Natrium Chloride – 0.9% 200 ml Glucose

Pleurisy
Pleurisy is an infectious or aseptic inflammation of pleural leafs with
formation of fibrin matters and/or accumulation of fluid effusion
(serous, purulent) in pleural cavity.

Classification
Transexudat Exudate Course By By Location
e Infection Consitency
Congestine Inflammator Acute Fibrous Diffuse
effusion y Effusion
Hypopntoniu Inflammator Sub- Serofibrous Enlysted
c y Non- acute
infectious
Tumor Chroni Plurelent Apical
c
Hemorrhag Diaphragmati
e c
Eosinophili Mediastinal
c
Chylous Parietal
Cholesteric

Causes
Infection
Autoimmune
Trauma
Pulmonary condition (Pneumothorx)
Clinical Features
Mixed Dysapnea
Sharp Chest pain
Tachypnea
Tachycardie
Diffuse Cynosis
Deformetive of chest

Lab Test
Relative density <1,015 > 1,018
Protein <20 g/l > 30g/l
Effusion protein/ Serum pro-tein <0,5 >0,5
Ri valt’s test negative positive
РН >7,3 <7,3
Cytology
4. Bacteriological study
5. Immunologicalstudy
6.Thoracoscopywithbiopsyofpleura

Diagnostic thoracocentesis
CT
MRI
X-ray

Treatment
Etiological
Antibiotics
Amoxicillin 500mg
Ampicilline 500mg
AntiViral
Acyclovir 1000 mg
Tenofovir 300 mg

Symptometic

Mucolytic----→
Ambroxial 10ml N-acetylcysteine
Methyl xanthine
Tneophyline (20 mg)
Anticolinergic
Iprotropiume Bromide (160-220 mg)
Beta Blockers
Meteprolol (50 mg)
Atenolol (20 mg)
Analgesics
Morphine
Diuretics
Furasenemide

Asthma
Bronchial asthma is a chronic inflammatory disease of the airways
characterized by bronchial hyperreactivity and a variable degree of
airway obstruction

Causes
Bacterial & Viral infection
Respi. Infection
Genetic
Environmental Factors

Clinical
Cough
Dyspnea mixed
Tachypanea
Tachycardia
Cynosis mixed
Allergic skin

Treatment
Etiological
Antibiotics
Amoxicillin 500mg
Ampicilline 500mg
AntiViral
Acyclovir 1000 mg
Tenofovir 300 mg

Pathogenic
Antiinflammatory
 Gluco-corticosteroid
Prednisone (1 mg/kg)

* Anticolinergic:- tiotropium bromide 18mg

Bita 2 agonist
salbutamol 200mg
Semiterol 50mg
Symptomatic
Mucolytic----→
Ambroxial 10ml N-acetylcysteine
Methyl xanthine
Tneophyline (20 mg)
Beta Blockers
Meteprolol (50 mg)
Atenolol (20 mg)
Analgesics
Morphine

Pneumonia
is an acute infectious inflammatory process of lower airways (alveoli,
alveolar ducts and respiratory bronchioles), manifested by fever,
infiltration with inflammation cells and exudation of lung parenchyma
(approved by radiological study).

Etiology
Bacterial
(Streptococcus pneumoniae
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
Haemophilus Influenzae
Enterobacteriaceae family
Viral
Staphylococcus aureus
Other causative agents

Clinical
Inspiratory Dyspnea
Tachycardia
Tachypanea
Hemoptosis
Chest Pain with breath
Dry cough

Treatment
Etiological
Antibiotics
Amoxicillin 500mg
Ampicilline 500mg
AntiViral
Acyclovir 1000 mg
Tenofovir 300 mg
Pathogenic
Corticosteroid
Predisolon (1mg/kg)

Symptomatic
Mucolytic----→
Ambroxial 10ml N-acetylcysteine
Methyl xanthine
Tneophyline (20 mg)
Beta Blockers
Meteprolol (50 mg)
Atenolol (20 mg)
Nacrotic analgesics (pain)
Marphine

Detoxification
Natrian chlonide- 0.9% of 200 ml 20 % glucose