20 types respiratory system disease treatment investigation finding differential diagnosis contraindication ICO management OPD prescription
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Based on extensive medical textbook sources (Goldman-Cecil Medicine, Harrison's, Murray & Nadel's Respiratory Medicine, Fishman's Pulmonary Diseases), here is a comprehensive clinical reference for 20 Respiratory System Diseases covering Treatment, Investigation, Findings, Differential Diagnosis, Contraindications, ICU Management, and OPD Prescription.
🫁 20 Respiratory System Diseases — Complete Clinical Reference
1. BRONCHIAL ASTHMA
| Domain | Details |
|---|---|
| Investigations | Spirometry (FEV₁/FVC <0.70, reversibility >12%), Peak Flow, FeNO, IgE, skin prick test, CXR, ABG (acute) |
| Findings | Wheeze, dyspnea, cough (nocturnal), chest tightness; prolonged expiration, air trapping |
| Differential Dx | COPD, vocal cord dysfunction, cardiac asthma, bronchiectasis, GERD, foreign body |
| Treatment | Stepwise: SABA (salbutamol) PRN → ICS (budesonide/fluticasone) → ICS+LABA → add LAMA/LTRA/biologics (dupilumab, mepolizumab) |
| OPD Rx | Salbutamol MDI 100 mcg PRN; Budesonide 200 mcg BD; Montelukast 10 mg OD; Prednisolone 40 mg/day (exacerbation ×5d) |
| Contraindications | Non-selective beta-blockers (propranolol), aspirin/NSAIDs (AERD), nebulized cold air |
| ICU Management | IV Magnesium sulfate 2g over 20 min; IV salbutamol infusion; heliox; NIV or intubation if deteriorating; ketamine induction |
2. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
| Domain | Details |
|---|---|
| Investigations | Spirometry (post-bronchodilator FEV₁/FVC <0.70) — GOLD staging; CXR (hyperinflation, flat diaphragm); HRCT; ABG; CBC; 6MWT; Echo |
| Findings | Barrel chest, pursed-lip breathing, reduced air entry, wheeze, prolonged expiration; hypoxemia, hypercapnia late |
| Differential Dx | Asthma, bronchiectasis, CHF, TB, obliterative bronchiolitis, lung cancer |
| Treatment | Smoking cessation; SABA/SAMA → LABA+LAMA → add ICS (eosinophilia); roflumilast; long-term O₂ (LTOT); pulmonary rehab; vaccines |
| OPD Rx | Tiotropium 18 mcg OD; Formoterol+Budesonide 6/200 BD; Roflumilast 500 mcg OD (chronic bronchitis, FEV₁<50%); Azithromycin 250 mg 3×/week |
| Contraindications | High-flow O₂ (hypercapnia risk); sedatives (suppress respiratory drive); beta-blockers (relative CI) |
| ICU Management | Controlled O₂ (SpO₂ 88–92%); NIV (BiPAP) — first line; IV hydrocortisone 100 mg TDS; IV salbutamol; invasive ventilation (low RR, long expiratory time) |
3. COMMUNITY-ACQUIRED PNEUMONIA (CAP)
| Domain | Details |
|---|---|
| Investigations | CXR (consolidation), CBC, CRP, procalcitonin, sputum C&S, blood culture, urine Legionella/pneumococcal antigen, ABG, LFT/RFT (severity) |
| Findings | Fever, productive cough, pleuritic chest pain, tachypnea; dullness to percussion, bronchial breathing, crepitations |
| Differential Dx | TB, lung abscess, pulmonary infarction, pulmonary edema, malignancy, eosinophilic pneumonia |
| Severity Score | CURB-65 (Confusion, Urea >7, RR ≥30, BP <90/60, Age ≥65); PSI/PORT score |
| Treatment | Mild (outpatient): Amoxicillin 500 mg TDS; Moderate: Amoxiclav + Clarithromycin; Severe/ICU: Co-amoxiclav + Azithromycin or Fluoroquinolone (Levofloxacin) |
| OPD Rx | Amoxicillin 500 mg TDS ×5–7d; Clarithromycin 500 mg BD ×5d (atypical); Levofloxacin 500 mg OD ×7d (penicillin allergy) |
| Contraindications | Fluoroquinolones in children/pregnancy; Tetracycline in <12 yr; delay antibiotics >4h (worsens outcome) |
| ICU Management | IV Piperacillin-tazobactam + Azithromycin or Levofloxacin; vasopressors (septic shock); prone positioning (if ARDS); mechanical ventilation |
4. PULMONARY TUBERCULOSIS (TB)
| Domain | Details |
|---|---|
| Investigations | Sputum AFB smear ×3, GeneXpert MTB/RIF, culture (Löwenstein-Jensen), CXR (upper lobe cavities, infiltrates), TST/Mantoux, IGRA (Quantiferon Gold), CBC, LFT, RFT, HIV |
| Findings | Chronic cough >2 weeks, hemoptysis, evening fever, night sweats, weight loss; upper lobe consolidation/cavitation on CXR |
| Differential Dx | Lung cancer, lung abscess, sarcoidosis, fungal infection (histoplasmosis), atypical pneumonia, bronchiectasis |
| Treatment | HRZE ×2 months (Intensive) → HR ×4 months (Continuation) [standard DOTS regimen]; MDR-TB: Bedaquiline + Pretomanid + Linezolid (BPaL) |
| OPD Rx | Isoniazid 5 mg/kg + Rifampicin 10 mg/kg + Pyrazinamide 25 mg/kg + Ethambutol 15 mg/kg OD ×2m; then INH+RIF ×4m; Pyridoxine 25 mg OD (prevent INH neuropathy) |
| Contraindications | Rifampicin in liver disease (relative); Ethambutol in optic neuritis; Streptomycin in pregnancy; Pyrazinamide in gout |
| ICU Management | Respiratory isolation (negative pressure); nutritional support; manage hemoptysis (bronchial artery embolization); ARDS protocol if needed |
5. PLEURAL EFFUSION
| Domain | Details |
|---|---|
| Investigations | CXR (meniscus sign, >200 mL), USS chest (bedside), CT chest, diagnostic thoracentesis (Light's criteria: protein, LDH, glucose, pH, cytology, culture, adenosine deaminase) |
| Findings | Dullness to percussion, reduced breath sounds, reduced vocal fremitus; tracheal deviation away (large effusion) |
| Differential Dx | Transudate (CHF, cirrhosis, nephrotic syndrome) vs. Exudate (pneumonia, TB, malignancy, PE) |
| Light's Criteria (Exudate) | Pleural protein/serum protein >0.5; Pleural LDH/serum LDH >0.6; Pleural LDH >2/3 upper limit normal |
| Treatment | Treat cause; therapeutic thoracentesis; chest drain (empyema, hemothorax); pleurodesis (recurrent malignant); VATS |
| OPD Rx | Furosemide 40 mg OD (transudates/CHF); specific antibiotics for parapneumonic; drainage referral for exudates |
| Contraindications | Blind thoracentesis without USS (risk of pneumothorax); anticoagulants without reversal; fibrinolytics contraindicated in hemorrhagic effusion |
| ICU Management | Large bore chest drain for tension hemothorax; monitor drainage rate; manage underlying cause (sepsis, cardiac failure) |
6. PNEUMOTHORAX
| Domain | Details |
|---|---|
| Investigations | CXR (absent lung markings, pleural line), CT chest (small/occult PTX), SpO₂, ABG |
| Findings | Sudden pleuritic chest pain, dyspnea, reduced breath sounds, hyper-resonance; tracheal deviation (tension) |
| Differential Dx | Pulmonary embolism, MI, aortic dissection, acute asthma, large bullae |
| Treatment | Observation (small <2cm, primary, stable); needle aspiration; chest drain (large/secondary/tension); VATS (recurrent) |
| OPD Rx | Analgesia (paracetamol/ibuprofen); avoid air travel for 6 weeks; smoking cessation; follow-up CXR |
| Contraindications | Positive pressure ventilation without chest drain in tension PTX; high-flow O₂ in COPD patient with PTX |
| ICU Management | Tension PTX: immediate needle decompression 2nd ICS MCL → large bore chest drain; O₂ 100%; fluid resuscitation |
7. PULMONARY EMBOLISM (PE)
| Domain | Details |
|---|---|
| Investigations | D-dimer (negative rules out if low probability), CTPA (gold standard), V/Q scan, BNP/Troponin, Echo (RV strain), lower limb Doppler USS |
| Findings | Sudden dyspnea, pleuritic chest pain, hemoptysis; tachycardia, pleural rub; Hampton's hump, Westermark sign (CXR); S1Q3T3 (ECG) |
| Differential Dx | Pneumothorax, MI, pericarditis, pneumonia, aortic dissection, anxiety |
| Risk Scores | Wells score, Geneva score; PESI for severity |
| Treatment | Anticoagulation: LMWH → DOAC (rivaroxaban/apixaban) or warfarin; Thrombolysis (massive PE + haemodynamic compromise); catheter-directed therapy; IVC filter |
| OPD Rx | Rivaroxaban 15 mg BD ×21d then 20 mg OD; or Apixaban 10 mg BD ×7d then 5 mg BD; minimum 3–6 months duration |
| Contraindications | Thrombolysis in recent surgery/stroke/active bleeding; DOAC in pregnancy (use LMWH); warfarin without bridging |
| ICU Management | Systemic thrombolysis (Alteplase 100 mg over 2h); vasopressors for shock; avoid excessive fluids (worsen RV); VA-ECMO in refractory cases |
8. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)
| Domain | Details |
|---|---|
| Investigations | ABG (P/F ratio <300 moderate, <200 severe), CXR/CT (bilateral infiltrates), Echo (exclude cardiac), BAL (if infection), Berlin criteria |
| Findings | Bilateral pulmonary infiltrates, severe hypoxemia (PaO₂/FiO₂ <300), non-cardiogenic pulmonary edema, tachypnea, cyanosis |
| Differential Dx | Cardiogenic pulmonary edema, diffuse alveolar hemorrhage, bilateral pneumonia, eosinophilic pneumonia |
| Treatment | Lung-protective ventilation (tidal volume 6 mL/kg IBW, plateau pressure <30 cmH₂O); prone positioning ≥16h/day (PF<150); PEEP optimization; fluid conservative strategy; steroids (methylprednisolone) |
| OPD Rx | N/A (ICU condition); post-ICU: pulmonary rehab, psychological support |
| Contraindications | High tidal volume ventilation (barotrauma); excessive fluid resuscitation; high FiO₂ prolonged (O₂ toxicity) |
| ICU Management | Lung-protective ventilation; prone positioning; neuromuscular blockade (cisatracurium); dexamethasone 6 mg OD ×10d; ECMO (salvage) |
9. LUNG ABSCESS
| Domain | Details |
|---|---|
| Investigations | CXR (cavity with air-fluid level), CT chest, sputum C&S (anaerobes), bronchoscopy, CBC (leukocytosis), blood cultures |
| Findings | Fever, productive cough (copious foul-smelling sputum), weight loss, hemoptysis; dullness/bronchial breathing over cavity |
| Differential Dx | TB cavitation, empyema, cavitating carcinoma, Wegener's granulomatosis, cystic echinococcus |
| Treatment | Prolonged antibiotics 4–6 weeks: Amoxiclav or Clindamycin (anaerobes); postural drainage; percutaneous/surgical drainage (refractory) |
| OPD Rx | Co-amoxiclav 625 mg TDS ×4–6 weeks; or Clindamycin 450 mg QDS + Metronidazole 400 mg TDS; chest physiotherapy |
| Contraindications | Early surgery (allow medical treatment first); vigorous chest percussion if massive hemoptysis |
| ICU Management | Broad-spectrum IV antibiotics; percutaneous drainage under CT/USS; bronchoscopic aspiration; manage hemoptysis |
10. BRONCHIECTASIS
| Domain | Details |
|---|---|
| Investigations | HRCT chest (gold standard — tram-track lines, signet ring sign), sputum C&S, spirometry, immunoglobulins, ABPA serology, sweat chloride test, ciliary biopsy |
| Findings | Chronic productive cough (mucopurulent sputum), recurrent chest infections, hemoptysis; coarse crackles; HRCT: dilated bronchi > adjacent artery |
| Differential Dx | COPD, TB sequelae, cystic fibrosis, endobronchial tumor |
| Treatment | Airway clearance (physiotherapy, oscillating PEP devices); antibiotics (exacerbation and long-term); mucolytics; surgery (localized disease); lung transplant |
| OPD Rx | Amoxicillin 500 mg TDS (exacerbation ×14d); Azithromycin 250 mg 3×/week (prophylaxis); Carbocisteine 750 mg TDS; nebulized hypertonic saline |
| Contraindications | Antitussives (suppress productive cough); routine mucolytic inhalation without physiotherapy; fluoroquinolones as first-line without C&S |
| ICU Management | Massive hemoptysis: bronchial artery embolization; ICU ventilation (avoid high PEEP); broad-spectrum IV antibiotics |
11. INTERSTITIAL LUNG DISEASE (ILD) / IDIOPATHIC PULMONARY FIBROSIS (IPF)
| Domain | Details |
|---|---|
| Investigations | HRCT (honeycombing, basal/subpleural, UIP pattern), PFT (restrictive: reduced FVC, DLCO), ANA/ANCA/anti-dsDNA (connective tissue ILD), BAL, surgical lung biopsy |
| Findings | Progressive exertional dyspnea, dry cough, bibasal fine (Velcro) crackles, clubbing; CXR reticulonodular infiltrates |
| Differential Dx | Hypersensitivity pneumonitis, sarcoidosis, drug-induced ILD, connective tissue ILD (RA, SLE, SSc), asbestosis |
| Treatment | IPF: Pirfenidone 801 mg TDS or Nintedanib 150 mg BD (anti-fibrotics); supplemental O₂; pulmonary rehab; lung transplant |
| OPD Rx | Pirfenidone 267 mg TDS ×7d → 534 mg TDS ×7d → 801 mg TDS maintenance; Omeprazole 20 mg OD (GERD common); N-acetylcysteine |
| Contraindications | Steroids alone in IPF (worsens outcomes — PANTHER trial); amiodarone, methotrexate, nitrofurantoin (drug-induced ILD) |
| ICU Management | Oxygen therapy (avoid high FiO₂); NIV/intubation (poor outcomes); palliative care; transplant listing |
12. SARCOIDOSIS
| Domain | Details |
|---|---|
| Investigations | CXR (BHL — bilateral hilar lymphadenopathy), HRCT, serum ACE (elevated), serum calcium (elevated), 24h urinary calcium, BAL (lymphocytosis, CD4:CD8 >3.5), bronchoscopic biopsy (non-caseating granulomas), PET scan, ECG |
| Findings | Dry cough, dyspnea, fatigue, erythema nodosum, uveitis, facial palsy; BHL on CXR (Stage 1); non-caseating granulomas |
| Differential Dx | TB (caseating granulomas), lymphoma, berylliosis, hypersensitivity pneumonitis, histoplasmosis |
| CXR Stages | 0-Normal; 1-BHL; 2-BHL+infiltrates; 3-Infiltrates only; 4-Fibrosis |
| Treatment | Observation (Stage 1, asymptomatic); Prednisolone 20–40 mg OD (symptomatic, progressive); Methotrexate/Azathioprine (steroid-sparing); Hydroxychloroquine (skin/hypercalcemia) |
| OPD Rx | Prednisolone 30 mg OD ×8–12 weeks then taper; Calcium/Vitamin D supplementation; SPF sunscreen (hypercalcemia risk); eye drops (uveitis) |
| Contraindications | Calcium/Vitamin D supplements only if hypocalcemic (risk worsening hypercalcemia); NSAIDs long-term |
| ICU Management | Cardiac sarcoidosis: pacemaker/ICD; respiratory failure: steroids, ventilation; hypercalcemic crisis: IV fluids, loop diuretics |
13. PULMONARY HYPERTENSION (PAH)
| Domain | Details |
|---|---|
| Investigations | Echo (RVSP >35 mmHg), Right heart catheterization (mPAP ≥25 mmHg — gold standard), PFT, V/Q scan (CTEPH), 6MWT, BNP/NT-proBNP, CT chest, autoimmune screen |
| Findings | Progressive dyspnea, syncope, chest pain, RV failure (JVP elevation, edema, hepatomegaly); loud P2, right ventricular heave |
| Differential Dx | COPD, ILD, CHF, PE/CTEPH, sickle cell disease, HIV, portopulmonary hypertension |
| WHO Groups | 1-PAH; 2-Left heart disease; 3-Lung disease/hypoxia; 4-CTEPH; 5-Unclear/multifactorial |
| Treatment | Group 1: Endothelin receptor antagonists (Ambrisentan, Bosentan); PDE-5 inhibitors (Sildenafil, Tadalafil); Prostacyclins (Epoprostenol IV); Riociguat; combination therapy |
| OPD Rx | Sildenafil 20 mg TDS; Ambrisentan 5 mg OD; Macitentan 10 mg OD; Diuretics (Furosemide 40 mg OD); Warfarin (CTEPH, Group 1) |
| Contraindications | Pregnancy (teratogenic drugs — bosentan); PDE-5 inhibitors + nitrates (severe hypotension); Riociguat + PDE-5 inhibitors; high-altitude travel |
| ICU Management | IV Epoprostenol or inhaled Iloprost; IV Sildenafil; avoid intubation if possible; vasopressors (norepinephrine); ECMO as bridge |
14. LUNG CANCER
| Domain | Details |
|---|---|
| Investigations | CXR, CT chest/abdomen/pelvis, PET-CT, bronchoscopy + biopsy, endobronchial USS (EBUS), CT-guided biopsy, LFT/RFT/CBC, LDH, Ca²⁺; molecular testing (EGFR, ALK, PD-L1, KRAS) |
| Findings | Cough, hemoptysis, weight loss, finger clubbing, Horner syndrome (apical), SVC syndrome; new CXR lesion/shadow |
| Differential Dx | TB, lung abscess, carcinoid tumor, pulmonary metastasis, lymphoma, pulmonary hamartoma |
| Types | NSCLC (adenocarcinoma 40%, squamous 25%, large cell); SCLC (central, early metastasis) |
| Treatment | NSCLC early (I–II): surgical resection; NSCLC III: chemoradiation; NSCLC IV: targeted therapy (EGFR → erlotinib/osimertinib; ALK → crizotinib/alectinib); immunotherapy (pembrolizumab PD-L1 ≥50%); SCLC: cisplatin+etoposide |
| OPD Rx | Osimertinib 80 mg OD (EGFR+); Pembrolizumab 200 mg IV q3w; palliative care; analgesia; dexamethasone 4 mg BD (brain mets) |
| Contraindications | Immunotherapy in active autoimmune disease; EGFR inhibitors in KRAS-mutated; surgery if FEV₁ predicted <40% post-resection |
| ICU Management | Hemoptysis: bronchial artery embolization; SVC syndrome: IV dexamethasone + radiotherapy; spinal cord compression: IV dexamethasone + urgent radiation |
15. HYPERSENSITIVITY PNEUMONITIS (HP) / EXTRINSIC ALLERGIC ALVEOLITIS
| Domain | Details |
|---|---|
| Investigations | HRCT (ground-glass, mosaic attenuation, upper/mid-lobe), PFT (restrictive), BAL (lymphocytosis, CD4:CD8 <1), precipitating antibodies (farmer's lung - Micropolyspora), bronchoscopic biopsy |
| Findings | Fever, cough, dyspnea 4–8h after antigen exposure (acute); progressive dyspnea, weight loss (chronic); fine crackles, no clubbing (early) |
| Differential Dx | Sarcoidosis, IPF, organising pneumonia, drug-induced ILD, infections |
| Treatment | Antigen avoidance (most important); Prednisolone 40–60 mg OD ×2 weeks then taper; azathioprine/mycophenolate (chronic HP) |
| OPD Rx | Prednisolone 40 mg OD taper over 8–12 weeks; antigen avoidance counseling; Omeprazole; respiratory mask at work |
| Contraindications | Continued antigen exposure; amiodarone (causative drug); smoking cessation recommended |
| ICU Management | Acute HP with hypoxemia: high-dose IV steroids; NIV/mechanical ventilation; removal from exposure environment |
16. CYSTIC FIBROSIS (CF)
| Domain | Details |
|---|---|
| Investigations | Sweat chloride >60 mmol/L (gold standard), CFTR genotyping, sputum C&S (Pseudomonas, MRSA, Burkholderia), PFT, HRCT, fecal elastase, HbA1c (CFRD), DEXA scan |
| Findings | Recurrent respiratory infections, bronchiectasis, malabsorption, steatorrhea, meconium ileus (newborn), nasal polyps, male infertility |
| Differential Dx | Bronchiectasis (other causes), primary ciliary dyskinesia, immune deficiency, Shwachman-Diamond syndrome |
| Treatment | Airway clearance (physiotherapy, DNase — dornase alfa); CFTR modulators (Ivacaftor for G551D; Elexacaftor/Tezacaftor/Ivacaftor — Trikafta for F508del); antibiotics; enzyme replacement; insulin (CFRD) |
| OPD Rx | Ivacaftor 150 mg BD (G551D) or Elexacaftor/Tezacaftor/Ivacaftor (2+1 tablets OD/AM, 1 tablet PM); Dornase alfa 2.5 mg nebulized OD; Azithromycin 250 mg 3×/wk; Creon (pancreatic enzyme) with meals |
| Contraindications | Avoid cross-infection between CF patients (Burkholderia cepacia); caution with aminoglycosides (nephrotoxicity/ototoxicity) |
| ICU Management | IV antibiotics (Piperacillin-tazobactam + Tobramycin); aggressive airway clearance; NIV; hemoptysis — BAE; transplant evaluation |
17. OBSTRUCTIVE SLEEP APNEA (OSA)
| Domain | Details |
|---|---|
| Investigations | Overnight polysomnography (PSG — gold standard): AHI ≥5/h; home sleep apnea test (portable); Epworth Sleepiness Scale; thyroid function; ECG/Echo (if PAH suspected) |
| Findings | Snoring, witnessed apneas, excessive daytime sleepiness, morning headache, nocturia, cognitive impairment; obesity, retrognathia, enlarged tonsils |
| Differential Dx | Central sleep apnea, obesity hypoventilation syndrome, narcolepsy, restless legs syndrome, insomnia |
| Severity (AHI) | Mild 5–14; Moderate 15–29; Severe ≥30 events/hour |
| Treatment | CPAP (first-line for moderate-severe); mandibular advancement device (mild-moderate); positional therapy; weight loss; ENT surgery (tonsillectomy, UPPP); bariatric surgery |
| OPD Rx | CPAP prescription (fixed or auto-CPAP 4–20 cmH₂O); modafinil 200 mg OD (residual sleepiness); antihypertensives; weight management |
| Contraindications | Sedatives/benzodiazepines, alcohol (worsen apnea); opioids; CPAP in CSA without bilevel settings; high-flow O₂ alone without CPAP |
| ICU Management | CPAP/BiPAP; avoid sedation; manage related complications (atrial fibrillation, nocturnal hypertension); obesity management |
18. ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA)
| Domain | Details |
|---|---|
| Investigations | Total IgE (>1000 IU/mL), specific IgE/IgG to Aspergillus fumigatus, skin prick test (immediate wheal), eosinophilia, CXR/HRCT (central bronchiectasis, mucus plugs), Aspergillus precipitins |
| Findings | Wheezing, productive cough (brown mucus plugs), recurrent consolidations, central bronchiectasis; underlying asthma or CF |
| Diagnostic Criteria | Rosenberg-Patterson: asthma + immediate skin reactivity + elevated IgE + specific IgE + CXR changes |
| Differential Dx | Asthma, eosinophilic pneumonia, invasive aspergillosis, bronchiectasis, vasculitis |
| Treatment | Oral prednisolone 0.5 mg/kg/day ×2 weeks then taper; Itraconazole 200 mg BD ×16 weeks (steroid-sparing); Omalizumab (refractory) |
| OPD Rx | Prednisolone 30 mg OD reducing dose; Itraconazole 200 mg BD (with food, check levels); Nebulized salbutamol; Cetirizine 10 mg OD |
| Contraindications | Voriconazole first-line without allergy testing; fluconazole (inadequate for Aspergillus); steroids alone without antifungal in refractory cases |
| ICU Management | IV methylprednisolone; IV voriconazole if invasive aspergillosis suspected; bronchoscopic mucus plug removal; antifungal monitoring |
19. ACUTE EXACERBATION OF BRONCHIECTASIS / NON-CF BRONCHIECTASIS
| Domain | Details |
|---|---|
| Investigations | Sputum C&S, CXR, HRCT, CBC, CRP, spirometry, immunoglobulins, autoimmune screen, bronchoscopy |
| Findings | Increased cough frequency, increased sputum volume/purulence, increased breathlessness; coarse crepitations on auscultation |
| Differential Dx | COPD exacerbation, CAP, TB reactivation, endobronchial lesion |
| Treatment | Antibiotic guided by previous C&S; Pseudomonas: Ciprofloxacin or IV Piperacillin-tazobactam; airway clearance; mucolytics |
| OPD Rx | Ciprofloxacin 500 mg BD ×14d (Pseudomonas); Co-amoxiclav 625 mg TDS ×14d (H. influenzae); Long-term Azithromycin 250 mg 3×/wk; Carbocisteine 750 mg TDS |
| Contraindications | Antitussives; fluoroquinolones without culture guidance (resistance risk); macrolides in QT-prolongation |
| ICU Management | IV antibiotics; bronchoscopic clearance; aggressive physiotherapy; hemoptysis management (embolization) |
20. OCCUPATIONAL LUNG DISEASE (Pneumoconiosis)
| Domain | Details |
|---|---|
| Conditions | Silicosis (quartz), Coal worker's pneumoconiosis (coal), Asbestosis (asbestos → mesothelioma risk), Berylliosis, Byssinosis (cotton) |
| Investigations | CXR (nodules, progressive massive fibrosis), HRCT, PFT (restrictive), sputum, bronchoscopy biopsy, ILO classification (for CXR), occupational history |
| Findings | Progressive dyspnea, dry cough; upper zone nodules (silicosis/coal); lower zone (asbestosis); pleural plaques (asbestos); bibasal crackles |
| Differential Dx | Sarcoidosis, TB (silicosis + TB = silicotuberculosis), IPF, malignant mesothelioma, COPD |
| Treatment | Remove from exposure; no specific treatment; supportive care; LTOT; pulmonary rehab; lung transplant (advanced); surveillance for malignancy |
| OPD Rx | Bronchodilators (Tiotropium 18 mcg OD); Prednisolone (berylliosis); Carbocisteine; LTOT if PaO₂ <55 mmHg; annual CXR surveillance |
| Contraindications | Continued occupational exposure; talc pleurodesis in mesothelioma candidates for surgery; avoid respiratory depressants |
| ICU Management | Manage respiratory failure (NIV/mechanical ventilation); treat comorbid TB; pleural drainage (malignant effusion); palliative management |
Quick Reference Summary Table
| # | Disease | Key Investigation | First-line Treatment | ICU Priority |
|---|---|---|---|---|
| 1 | Asthma | Spirometry, FeNO | ICS + SABA | IV Mg²⁺, NIV |
| 2 | COPD | Post-BD spirometry | LABA+LAMA | BiPAP, controlled O₂ |
| 3 | CAP | CXR, CURB-65 | Amoxicillin/Macrolide | IV pip-tazo + azithromycin |
| 4 | TB | GeneXpert, AFB | HRZE ×2m → HR ×4m | Isolation, DOTS |
| 5 | Pleural effusion | USS, thoracentesis | Treat cause, drain | Chest drain |
| 6 | Pneumothorax | CXR | Needle aspiration/drain | Needle decompression |
| 7 | PE | CTPA, D-dimer | DOAC/LMWH | Thrombolysis (Alteplase) |
| 8 | ARDS | ABG, P/F ratio | Lung-protective ventilation | Prone + PEEP |
| 9 | Lung abscess | CT chest | Co-amoxiclav ×6wks | IV antibiotics + drainage |
| 10 | Bronchiectasis | HRCT | Airway clearance + antibiotics | BAE (hemoptysis) |
| 11 | IPF/ILD | HRCT (UIP pattern) | Pirfenidone/Nintedanib | O₂, transplant |
| 12 | Sarcoidosis | ACE, HRCT, biopsy | Prednisolone | IV steroids |
| 13 | PAH | RHC, Echo | Sildenafil + Ambrisentan | Epoprostenol IV |
| 14 | Lung cancer | CT-PET, biopsy | Surgery/Targeted/Immunotherapy | Dexamethasone |
| 15 | HP | HRCT, BAL | Antigen avoidance + steroids | IV steroids |
| 16 | Cystic fibrosis | Sweat Cl⁻, CFTR | CFTR modulators | IV pip-tazo + tobramycin |
| 17 | OSA | Polysomnography | CPAP | Avoid sedation |
| 18 | ABPA | IgE, Aspergillus IgE | Prednisolone + Itraconazole | IV voriconazole |
| 19 | Bronchiectasis exacerbation | Sputum C&S | Ciprofloxacin/Co-amoxiclav | IV antibiotics |
| 20 | Pneumoconiosis | HRCT, ILO staging | Remove from exposure + supportive | NIV, palliative |
Key Abbreviations: SABA = short-acting beta agonist; LABA = long-acting beta agonist; LAMA = long-acting muscarinic antagonist; ICS = inhaled corticosteroid; LTOT = long-term oxygen therapy; NIV = non-invasive ventilation; CTPA = CT pulmonary angiography; BAE = bronchial artery embolization; HRCT = high-resolution CT; PFT = pulmonary function tests; ABG = arterial blood gas; DOTS = directly observed treatment short-course; DOAC = direct oral anticoagulant; AHI = apnea-hypopnea index; RHC = right heart catheterization.
Sources: Murray & Nadel's Textbook of Respiratory Medicine, Fishman's Pulmonary Diseases and Disorders, Goldman-Cecil Medicine, Harrison's Principles of Internal Medicine (22nd Ed.), Goodman & Gilman's Pharmacological Basis of Therapeutics.
20 types respiratory system disease treatment investigation finding differential diagnosis contraindication ICO management OPD prescription detail
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