Respiratory

Overview

The respiratory specialty manages diseases of the lower respiratory tract system, largely in adults. 

Diseases

Core 

Chronic - 5

• COPD - chronic & exacerbations

• Asthma - chronic & exacerbations

• Lung Cancer: Small cell, non small cell, mesothelioma; metastatic

• Interstitial lung disease: idiopathic, silicosis, asbestosis

• Pulmonary hypertension

Acute - 5

• Pneumonia: 

  • Community acquired, hospital acquired, aspiration and ventilation

  • Viral pneumonitis: Influenza, covid-19, RSV

• Tuberculosis

• Pulmonary embolus

• Pneumothorax

• Pulmonary Oedema, see congestive heart failure

Everything else

Acute

• Aspergillosis: aspergilloma, ABPA, invasive aspergillosis

• Pneumocystis jirovecii (PJP)

• ARDS

• Loffler's syndrome: Ascaris, Strongyloides stercoralis, or Dirofilaria immitis  

Chronic

• OSA

• Goodpasture's

• Alpha 1 trypsin deficiency

• GPA & eGPA

• Cystic fibrosis

Clinical Summary

Presentations

• Sob

• Cough

• Haemoptysis

• Wheeze

Respiratory examination

Investigations

Body systems

• Bloods: 

  • • • • FBC, CRP, EUC, LFT; serum osmolality

        • Cultures, mycoplasma serology, procalcitonin

• Sputum microscopy

• Urinary: cultures, streph pneumonia/ legionella antigens

Bedside

• Peak flow, spirometry

Imaging

• CXR

• CTPA, CT-Thorax, High resolution CT, PET CT

• VQ mismatch

Interventions

• Bronchoscopy 

Management

Lifestyle

• Smoking cessation

• General air pollution, asbestos & dust

• Pulmonary rehab

Medical

• Inhalers: steroids, beta 2 agonists, anti-muscarinics

• Oral steroids

• Respiratory antibiotics

• Pulmonary HTN medications: endothelial receptor agonists

Procedural

• Chest drain

• Emergency needle compression

Jobs

By Task

1. Admitting under Respiratory

It is useful to be familiar with the core diseases as these make up the majority of patients admitted. Asthma & COPD, pneumothorax and ILD exacerbations are very reasonable. Unfortunately, it is a case of knowing the local preferences for many conditions, this is from my experience

• Pneumonia: gen med > resp

• Covid & influenza: gen med > resp > ID

• Tuberculosis: ID > resp > gen med

• Pulmonary embolus: resp > haem

• Pulmonary oedema Cardio

Admission would usually be the responsibility of the consultant during the day and registrar out of hours. 

Written in 2024.