Respiratory Disorders

1. Respiratory Disorders Module 1. Common Respiratory Symptoms and Complaints

2. Process • Step 1. Complete Module #1 with voice overlay • Step 2. Answer the question following Module #1 • Step 3. Complete further modules or take a break.

3. Respiratory Unit Overview • Module 1. Common Respiratory Symptoms and Complaints • Module 2 Chronic Obstructive Pulmonary Disease • Module 3. Asthma and Pulmonary Thromboembolism

4. Module #1 Learning Objectives • Describe the common causes of rhinitis, dyspnea and cough • Describe the evaluation and treatment of these common respiratory symptoms and complaints

5. Common Symptoms and Complaints • Allergic rhinitis (may be perennial) • Cough • Dyspnea

6. Allergic Rhinitis • The most common atopic disorder • Symptoms: rhinorrhea, sneezing • Also often: irritated eyes, nose, mucous membranes. • Post nasal drip is the most common cause of chronic cough

7. Therapy: Nonpharmacologic • Irrigate sinuses with saline or saline/bicarbonate solution once or more per day.

8. Therapy for Allergic Rhinitis

9. Cough Differential diagnosis: • Acute or chronic respiratory disease • Cardiac disease • ACE-inhibitors • Reflux Consider time course: • Acute • Subacute • Chronic

10. Acute Cough: DDX and Rx in Patients Over 65 Years

11. Acute Cough: other causes in older people • Pneumonia • Heart Failure • Asthma

12. Subacute Cough: DDX and Rx in Patients Over 65 Years

13. Chronic Cough: DDX and Rx in Patients Over 65 Years- Part 1

14. Chronic Cough: DDX and Rx in Patients Over 65 Years-Part 2

15. Dyspnea • ATS: “ a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity” • Over age 65 years • 17% at rest at least occasionally • 38% when hurrying on level ground or on a slight hill

16. Approach to the Older Person with Dyspnea • History: appropriate to level of exertion vs. suggest pathology • Consider age, peer performance • Usual activities • Level of fitness • Ask, “What activities have you stopped doing?”

17. History: Onset Describe qualities Frequency Intensity Duration Triggers Provocative activities Associated symptoms Cough Sputum Wheezing Orthopnea PND Chest pain Strategies or actions that provide relief Approach to the Older Person with Dyspnea

18. Approach to the Older Person with Dyspnea • Physical • Heart • Lungs • Neck • Thorax • Extremities

19. Causes of Dyspnea • Cardiac disease • Respiratory disease • Deconditioning/Obesity • Respiratory muscle dysfunction • Psychological disorders

20. Chest X-ray EKG Echocardiogram: LV FUNCTION systolic & diastolic Valves Pulmonary pressure Radionuclide imaging Cardiac Disease Evaluation

21. Spirometry-asthma or COPD Diffusing capacity- emphysema or interstitial lung disease, anemia, pulmonary vascular disease Inspiratory and expiratory mouth pressures-neuromuscular disease Respiratory Disease Evaluation

22. Spirometry and diffusing capacity Chest X-ray EKG O2 saturation Unexplained Chronic Dyspnea

23. Peak inspiration and expiration mouth pressures Cardiopulmonary exercise test Deconditioning and Respiratory Muscle Weakness

24. Physical conditioning Low impact Indoor modality Intensity? Follow heart rate Or base on symptom of dyspnea Duration: 20-30 minutes Frequency: most days Therapy For Deconditioning

25. Strengthen upper extremities Light Weights 8-12 reps, 2-3 sets 2-3 times per week. Ventilatory muscle training Inspire against progressively higher pressures Train 15-30 minutes/day Therapy For Deconditioning

26. REFERENCES AND READINGS • De Martinis M., Timaris PS. The Pulmonary Respiration, Hematopoiesis and Erythrocytes In Physiological Basis of Aging and Geriatrics. Paola Timiras (Ed.), CRC Press, 2003. • Irwin, Richard S., Madison, J. Mark. The Diagnosis and Treatment of Cough N Engl J Med 2000 343: 1715-1721 • Mahler DA, Fierro-Carrion G, Baird JC. Evaluation of dyspnea in the elderly. Clin Geriatr Med 2003 19:19-33. • Canto JG, Shlipak MG et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA June 28 2000, Vol.283, No 24 pp 3223-3229 • Harver A, Mahler DA, Daubenspeck. Targeted inspiratory muscle trainingimproves respiratorymuscle function and reduces dyspnea in COPD.]Ann Intern Med 1989; 111:117-24.