1

Evaluation of the patient with lung diseaseHistoryPhysical examinationPhysiologic evaluationAnatomic evaluationPathologic evaluation

2

History taking in patients with lung disease

Onset, duration, triggers, and severity of symptomsdyspnea (rest, exercise) cough (dry, productive) chest pain (pleuritic, constant)fever

Occupational/environmental exposures Smoking historyFamily history Underlying illnesses (e.g. collagen vascular disease)

Environmental/occupational causes of lung disease: models

Diseaseoccupational asthmapulmonary fibrosisARDSpulmonary edemapulmonary hypertensionbronchogenic carcinomahypersensitivity pneumonitistuberculosis

Exposureisocyanatesasbestoschlorine gashigh altituderapeseed oiluraniumpigeonshomeless shelter

3

• Short intense exposure to inorganic dust, products of combustion, other material among those present at site of World Trade Center after attack on September 11, 2001

• Respiratory complaints common in firefighters who had been at World Trade Center site

4

Clinical course of WTC coughsyndrome

Physical examination in patients with lung diseasePhysical examination

respiratory rate and patternshape of thoracic cage quality of breath sounds and percussion note (normal, dull/absent, hyperresonant)

normal breath soundswheezes crackle

clubbing cyanosis peripheral edema

5

Tools for the diagnosis of lung disease

Anatomic

Chest radiographCT scanBronchoscopy

Physiologic

ABGPFTsV/Q scanExercise

testing

Pathologic

Transbronchiallung biopsy

ThoracentesisPleural biopsyOpen lung biopsy

Tidal volume

Functionalresidualcapacity

Residualvolume

Vitalcapacity

Totallungcapacity

6

Volume

Flow rate(liters•sec-1)

inspiration

expiration

FEV1

Spirogram

7

Effect of smoking on decline of lung function

Scanlon et al. Am J Respir Crit Care Med 2000; 161: 381-390

8

Restrictive lung disease

Normal ObstructiveLung disease

Flow-volume patterns of lung disease

Spirometry in obstructive lung disease

normal mild obstruction severe obstruction

9

Spirometry in restrictive lung disease

normal Severe restriction

10

11

12

13

14

15

16

17

18

Anatomic, physiologic, and pathologic classification of lung disease

Disease

Emphysema

Sarcoidosis

Asthma

Usual interstitialpneumonitis

Anatomy

Hyperinflation

Enlarged LN,parenchymal infiltrates

Normal

Parenchymalinfiltrates

Physiology

Obstruction

Restriction

Obstruction

Restriction

Pathology

Loss of alveolarTissue

GranulomatousInflammationAirwaysinflammation

Interstitialinfiltration, fibrosis