Common Lung Diseases — Overview and Investigations
In Lecturio . This article should provide an overview of the main type of diseases that affect the lung. You will find a description of the important diagnostic tests used for investigating respiratory diseases, like general principles, emphasis on lung function testing role and interpretation and examples of diagnostic testing approach for some common presentations.
Table of Contents
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Range of lung diseases
The Big 4 Lung Diseases
- COPD — most common cause of acute medical admissions
- Asthma — most common chronic respiratory disease
- Lung cancer — most common fatal cancer in the Western world for both men and women
- Pneumonia — most common serious infectious disease
Other common respiratory diseases
- Infectious: tuberculosis, empyema
- Pulmonary emboli
- Bronchiectasis
- Interstitial lung disease and sarcoidosis
- Pleural effusions and pneumothorax
- Obstructive sleep apnea
Range of Lung Diseases
Diseases of the airways
| Upper airway obstruction | |
| Lower airway obstruction | |
| Airway infection |
|
| Airway tumors |
|
Range of lung diseases
Lung parenchyma (alveoli and interstitium)
| Infections | |
| Interstitial Lung Diseases |
|
| Adult respiratory distress syndrome | |
| Parenchymal tumors |
|
Circulation
| Pulmonary emboli (PE) | |
| Pulmonary hypertension |
|
| Hemoptysis | |
| Vasculititis |
Range of lung diseases
Pleural diseases
| Pneumothorax | |
| Pleural infection |
|
| Pleural malignancy |
|
Other
| Diseases of physiology |
|
| Iatrogenic lung disease |
|
Investigation of Lung Disease
Different Causes of Large Airway Obstruction
Acute upper airway obstruction
| Speed of onset | Cause | Clinical presentation |
| Sudden | Aspiration of foreign body Mucous plug | Very acute dyspnea and stridor |
| Acute | Epiglottis/ tonsilar abscess Diphtheria Smoke inhalation Deteriorations of subacute/ chronic causes | Acute dyspnea and stridor Saliva drooling Fever (infective cause) |
Chronic upper airway obstruction
| Speed of onset | Cause | Clinical symptoms and signs |
| Subacute/ progressive | Cancer: lung/ larynx/ thyroid Benign tracheal tumors Massive mediastinal nodes Vocal cord paralysis | Progressive/ positional dyspnea Cough Hemoptysis Stridor (can be intermittent) Post obstructive bronchiectasis Dysphagia (esophageal invasion) Pain (malignant causes) |
| Chronic/ non-progressive | Post-intubation tracheal stenosis Post-infective, e.g., tuberculosis Goiter Previous upper airway surgery Vasculitis Tracheomalacia |
Large Airway Obstructions: Clues
- Minimal variability in peak flow/ spirometry
‘Squared off’ flow volume loop of tracheal obstruction - Positional symptoms rather than diurnal
- Inspiratory wheeze (Stridor)
- Past history of intubation/ tracheal disease
- Characteristic flow volume loop
- Fall in PEFR relatively greater than fall in FEV1
Bronchoscopy
- Visual confirmation
- Biopsies to confirm the cause (but can bleed…)
- Treatment as well
Treatment of acute presentation
- Sit the patient up
- High flow oxygen or heliox (mixture of oxygen and helium) via mask
- Intravenous high-dose corticosteroids (reduce edema around obstruction)
- Nebulized salbutamol and adrenaline
- Intravenous fluid replacement
- Potentially urgent intubation or tracheostomy or bronchoscopy intervention
Treatment of chronic obstruction
Chronic—relieve the obstruction by- Treat underlying cause if possible
- Bronchoscopic interventions e.g.
- Stents
- Laser ablation
- Surgical interventions
- Remove cause
- Tracheostomy
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