Lecture 27 Respiratory Disease II 2023 McGriff.pdf

Respiratory Disease II WIL MCGRIFF, OD, MPH CHRISTOPHER PLUMMER, OD, FAAO ASSISTANT PROFESSOR ASSISTANT PROFESSOR [email protected] [email protected] Lecture Objectives u Recall epidemiology of common respiratory disorders u Differentiate between physiologic and pathologic changes associated...

Respiratory Disease II WIL MCGRIFF, OD, MPH CHRISTOPHER PLUMMER, OD, FAAO ASSISTANT PROFESSOR ASSISTANT PROFESSOR [email protected] [email protected] Lecture Objectives u Recall epidemiology of common respiratory disorders u Differentiate between physiologic and pathologic changes associated with common respiratory disorders u Recognize major ocular effects of asthma, emphysema, cystic fibrosis, and lung cancer NBEO Outline u L. Respiratory System u 1. Epidemiology u 2. Symptoms and signs of respiratory disorders u a. Chronic obstructive pulmonary disease (COPD), emphysema, asthma, etc. u b. Infectious diseases of the lung u c. Neoplastic diseases of the lung u d. Interstitial diseases including pneumoconiosis u 3. Significance of common respiratory symptoms (e.g., cough, hemoptysis, wheezing, shortness of breath) u 4. Symptoms and signs of anaphylaxis u 5. Diagnostic testing and imaging u 6. Pathophysiology and diagnosis Obstructive Respiratory Diseases u Airflow obstruction u u Obstructive Sleep Apnea Inability to completely exhale u Cystic fibrosis u Asthma u Emphysema u Chronic bronchitis u COPD Obstructive Sleep Apnea u Recurrent episodes of upper airway collapse during sleep u Leads to: u u Cessation or significant reduction of airflow u Oxygen desaturation ( ≥90% mild, 80-89% moderate, <80% severe) u Arousal from sleep u Excessive daytime sleepiness* Most common type of sleep-disordered breathing u 22% of men, 17% of women Obstructive Sleep Apnea u Nocturnal symptoms u Daytime symptoms u Snoring u Nonrestorative sleep u Witnessed apneas u Morning headache u Gasping and choking sensations u Excessive daytime sleepiness* u Nocturia u Cognitive deficits u Insomnia / restless sleep u Personality and mood changes u Gastroesophageal reflux u Hypertension Obstructive Sleep Apnea u u Risk factors u Age u Obesity u Family history u Neck circumference (>17” in men, >15” in women” u Enlarged tonsils Diagnosis u u Polysomnography (>5 Apnea Hypopnea Index) Treatment u Continuous positive air-pressure (CPAP) u Dental appliances u Surgery Obstructive Sleep Apnea u Systemic effects u Ocular effects u Stroke (2.5x) u Floppy eyelid syndrome u Hypertension (2-3x) u Dry eye u Coronary artery disease (3x) u Type 2 DM (suspected) u Keratoconus u Increased mortality risk (3x if severe OSA) u Glaucoma u Non-arteritic ischemic optic neuropathy u Central serous retinopathy u Ocular associations Cystic Fibrosis u u u Autosomal-recessive disease u Multi-organ effects u 300K cases in US u Lungs* u Whites >> Blacks/Hispanics/Asians u Pancreas u Trait is carried by 1/20 Caucasian persons u Liver u Salivary glands Chloride transport defect u Thick mucus with low water content u Testes u Mucus stasis u Eyes u Kidneys Prognosis u Shortened lifespan (~58 years) u Lung failure Cystic Fibrosis u u Symptoms u Delayed growth u Recurrent pneumonia u Infertility u Pancreatitis u Kidney disease Treatment u Cystic fibrosis transmembrane conductance regulator (CFTR) modulator (effective for ~90% of CF patients) u Mucolytics u Antibiotics u Chest percussion u Lung transplant u Pancreatic enzyme supplements u Hydration Asthma u u Intermittent or persistent airway obstruction u Bronchial hyper-responsiveness u Chronic inflammatory disorder u ~20M in the U.S. Risk factors u Family history of asthma u Personal history of atopy u Maternal tobacco use u Poor air quality u Indoor allergen exposure Asthma u u Type I hypersensitivity u Histamine u Leukotrienes Airflow obstruction u Bronchoconstriction u Mucus production u Inflammatory cell migration Asthma u Symptoms u Triggers u Wheeze* u Exercise u Cough* u Viral infection u Chest tightness u Allergens u SOB u Irritants u Changes in weather u Strong emotional expression u Menstrual cycles u Medications (NSAIDS) Asthma Treatment u Bronchodilators u Beta2-adrenergic agonists u u u Albuterol u Anticholinergics u Methylxanthines Anti-inflammatories u Glucocorticoids u Cromolyn u Leukotriene modifiers Lifestyle modification Leading Causes of Death in US in 2022 u Heart disease u Cancer u COVID – 19 u Accidents/unintentional injuries u Stroke u Chronic lower respiratory diseases u Alzheimer’s disease u Diabetes u Chronic liver disease and cirrhosis u Kidney disease https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm Emphysema u Irreversible enlargement of alveolar spaces u 2M cases in US u Neutrophilic destruction of the alveolar walls u Loss of elastic recoil Emphysema Barrel Chest Emphysema u u Causes u Congenital: deficiency of alpha1-antitrypsin (70K cases), 3%) u IV drug use / Occupational / Infectious u Smoking* (80-90% of cases) Effects u Poor gas exchange u Decreased blood O2 levels u Increased blood CO2 levels u SOB Emphysema Treatment u Bronchodilators u Steroids u Mucolytic agents u Antibiotics u Supplemental oxygen u Lung volume reduction or lung transplant Posterior subcapsular cataract Chronic Bronchitis u 9.3 M new cases annually u Persistent, productive cough u u Excessive mucus production u >3 months or longer u 2 or more consecutive years Causes u Chronic smoking * (75% of cases) u Infection u Exposure to environmental pollutants Chronic Bronchitis u u Effects u Hyperplasia of the bronchial mucous glands and smooth muscles u Destruction of cilia u Squamous cell metaplasia u Bronchial wall thickening and development of fibrosis Treatment u Smoking cessation u Pulmonary rehabilitation u Bronchodilator therapy u Steroids u Mucolytic agents u Supplemental oxygen u Antibiotic therapy and immunizations COPD u u Emphysema and/or Chronic Bronchitis u 15.7M cases in US / 6th leading cause of death in the U.S. u Inflammation of the alveoli and bronchi/bronchioles u Progressive, unremitting, and irreversible Commonly associated with a history of smoking u u 80-90% of cases are former smokers (>20 years) Pathogenesis u Increased mucus production u Loss of elastic recoil – airway collapse u Leads to Right CHF COPD Top Cancer Sites by Deaths Lung Cancer u ~236,740 new cases / 130,180 deaths in 2022 u Etiology u Smoking (80-90%)* u Environmental carcinogens (10-15%) u 2nd-hand smoke u Residential radon u Occupational and environmental exposure u Infection u Men=Women u 5-year survival (all stages, all types): 18% u Variations by race/ethnicity, SES, and geography 15% 38% 20% 3% Lung Cancer u u Most common symptoms Treatment u Persistent, productive cough u Surgery u Weight loss u Chemotherapy u Dyspnea u Radiotherapy Paraneoplastic syndrome u u u Endocrine disorder Diagnosis u X-ray u CT u Prevention is key Lung Cancer u u Pancoast syndrome u Usually non-small cell carcinoma u Pulmonary apex Signs and symptoms u Horner’s syndrome u Shoulder and arm weakness and pain u Hoarse voice u Cough Pancoast Syndrome Respiratory Disease Diagnosis and Treatment u Lab or Diagnostic Test u Treatment u Pulmonary function tests u Anti-inflammatory medications u Arterial blood gases u Humidification u Pulse oximetry u Decongestants u Bronchoscopy u Antitussives u Radiograph, CT, MRI u Bronchodilators u Nuclear lung scan u Chest physiotherapy u Culture and sensitivity tests u Antimicrobials u Thoracentesis u Oxygen therapy u Mechanical ventilation u Surgery Ocular Manifestations u u Pneumonias u Roth’s spots u Septic retinitis Asthma u u Steroid cataract and glaucoma Emphysema u Steroid cataract and glaucoma u Papilledema Ocular Manifestations u u Cystic fibrosis and pancreatic disease u Retinal vascular dilation, edema, hemorrhages u Macular holes u Papilledema u Optic Neuritis Bronchogenic carcinoma u Metastasis to orbit, iris, choroid, and retina Lecture Objectives u Recall epidemiology of common respiratory disorders u Differentiate between physiologic and pathologic changes associated with common respiratory disorders u Recognize major ocular effects of asthma, emphysema, cystic fibrosis, and lung cancer Respiratory Disease II WIL MCGRIFF, OD, MPH CHRISTOPHER PLUMMER, OD, FAAO ASSISTANT PROFESSOR ASSISTANT PROFESSOR [email protected] [email protected]