Pleural Diseases and Bronchial Asthma Treatment

Pleural Diseases Treatment

• Thoracocentesis: Procedure for pleural effusion, extracting fluid via needle inserted above the 10th rib at scapular line.
• Requires strict aseptic technique; complications may include hemothorax, pneumothorax, neurogenic shock, or pulmonary edema.
• Intercostal Chest Tube: Used for treating pneumothorax (open, bilateral, or tension), empyema, and hemothorax.
• Tension Pneumothorax: A medical emergency addressed by immediate needle decompression in the 2nd intercostal space, followed by tube insertion, oxygen, and analgesics.

Bronchial Asthma

• Definition: Condition causing bronchial narrowing.
• Aetiology: Includes bronchospasm, inflammatory infiltrates (eosinophils), edema, and mucus plugs in bronchi.
• Pathophysiology: Types include extrinsic (allergy-related) and intrinsic (hyper-reactivity).
• Clinical Picture: Patients typically symptom-free between attacks; common symptoms include wheezing, non-productive cough, dyspnea, and mucous pellet expectoration.
• Signs During Attack: Limited respiratory movement, palpable rhonchi, hyper-resonance on percussion, harsh expiratory sounds, and generalized rhonchi.

Complications of Asthma

• Respiratory Complications: Status asthmaticus as a severe form, leading to respiratory failure.
• General Complications: Treatment side effects (e.g., steroids leading to diabetes and hypertension).
• Chronic Cough Complications: Include myositis, rib fractures, pneumothorax, hemoptysis, puffy eyelids, and hernias.

Investigations for Asthma

• Sputum Examination: Elevated eosinophils.
• Blood Picture: Presence of eosinophilia.
• Serum IgE Test: Increased levels indicate extrinsic asthma.
• Skin Prick Test: Identifies allergenic causes via intradermal antigens.
• Chest X-ray: Reveals hyperinflation during attacks.
• Pulmonary Function Tests: Spirometry indicates obstructive hypoventilation.

Treatment of Asthma

• Inhaled Short-Acting B2-Agonists (SABA): E.g., Salbutamol for symptomatic relief during attacks.
• Inhaled Corticosteroids (ICS): E.g., Beclomethasone, Budesonide for inflammation control.
• Inhaled Long-Acting B2-Agonists (LABA): E.g., Salmeterol for prolonged control.
• Oral Leukotriene Receptor Antagonists (LTRA): E.g., Montelukast as controller medication.
• Oral/Parenteral Steroids: E.g., Prednisolone for severe cases.
• IgE Monoclonal Antibodies: E.g., Omalizumab for severe or allergic asthma.

Pneumonia

• Clinical Picture: Symptoms include fever, anorexia, headache, malaise, cough, dyspnea, and rusty sputum expectoration.
• Signs: Limited respiratory movements on the affected side, increased tactile vocal fremitus, dullness on percussion, bronchial breathing with crepitations on auscultation.

Special Types of Pneumonia

• Staphylococcal Pneumonia: Caused by Staphylococcus aureus, treated with nafcillin or vancomycin.
• Friedlander's Pneumonia: Associated with Klebsiella, treated with ceftriaxone, mainly affects immunocompromised patients.
• Pneumocystis carinii Pneumonia: Caused by Pneumocystis jirovecii in AIDS patients, treated with Septrin or pentamidine.
• Mycoplasma Pneumonia: Atypical pneumonia in children and young adults, causes various systemic infections, diagnosed by cold agglutination test, treated with macrolides (e.g., erythromycin).
• Legionella Pneumonia: Caused by Legionella pneumophila, associated with contaminated water, diagnosed by urine antigen test, treated with macrolides.

Viral Pneumonia

• Atypical pneumonia caused by viruses such as influenza (H1N1, H5N1), CMV, EBV, RSV, measles, and SARS.