Asthma, COPD, ACOS, Cystic Fibrosis, and Bronchiectasis: A Comparative Analysis

QUESTION

Please utilize the GINA to answer the following questions:

1. Compare and contrast asthma versus COPD.
2. How is asthma diagnosed and what are the signs and symptoms of an exacerbation (including chest x-ray findings)?
3. Using the GINA guidelines, develop a treatment plan for STEP 5 (provide medication names).

A 28-year-old female that is 5’3″ and 105 lbs. presents to the ED with marked shortness of breath, she has a history of wheezing with exercise and is allergic to shellfish, hay, animal dander, and bee venom. She smokes approximately 1 pack of cigarettes per day and has done so for approximately 10 years; she is malnourished, and she currently lives with a friend who owns two cats and one dog. She states that both she and her roommate smoke in the house. She has an Albuterol MDI prescribed for PRN use as well as Advair 250/50 mcg 2 puffs BID, she states that she only uses them periodically due to their high cost. She has been hospitalized for asthma exacerbations two times in the past 12 months. She stated that she began having trouble breathing after petting her friend’s cat.

Her physical assessment is as follows: RR 29/min with a prolonged expiratory phase, SpO2 87% on 8L oxymask, BP 130/85 mm Hg. Her lungs are diminished with expiratory wheezes in the upper lobes. She had moderate accessory muscle use with intercostal retractions. She was given 5 mg Albuterol via SVN on the Ambulance and had another 5 mg of Albuterol since arrival at the hospital, her post-bronchodilator PEFR is 45% of predicted. An ABG was drawn, and the following was found pH 7.30, PaCO2 55 mm Hg, PaO2 62 mm Hg, HCO3- 23 mEq/L, SaO2 87%.

1. Is this patient suffering from asthma, COPD, or ACOS? Justify your answer.
2. What medication treatment regimen would you suggest for her acute exacerbation?
3. Would she be a candidate for NIV or invasive MV? What V_T would you target for either NIV or invasive MV? Justify your answer.
4. What, if any, lifestyle changes should be suggested for this patient?

Cystic Fibrosis

1. Describe the etiology of cystic fibrosis.
2. What is the incidence of CF in the population in the United States? Worldwide? What group is CF most prevalent in?
3. What does the CF gene regulate?
4. What organ(s) are involved and affected in CF?
5. Describe pulmonary manifestations in CF.
6. What are the lab values and ranges for sweat chloride tests in both infants < 6 months of age and in children > 6 months of age?
7. What are the six screening tests available for CF? What is the gold standard for screening?
8. What clinical manifestations would you expect to see with a CF patient with advanced disease in the following:

• Body build:
• Cough/sputum production:
• Breath sounds:
• Chest X-ray findings:

1. What are the non-respiratory manifestations of CF?
2. What type of treatment plans should be employed in patients with CF? Include bronchial hygiene and medications.
3. What are the odds of inheriting CF based on the following:

• Two-parent carriers:
• One parent carrier, one CF parent:
• One non-carrier parent, one CF parent:
• One non-carrier parent, one carrier parent:

Bronchiectasis

1. Differentiate between the three types of bronchiectasis.
2. Describe the various causes of bronchiectasis (table 16.1 from the textbook).
3. List the diagnostic tools for bronchiectasis.
4. What clinical manifestations would you expect to see with a patient with bronchiectasis:

• Cough/sputum production:
• Breath sounds:
• Chest X-ray findings/CT findings:
• PFTs:

1. Discuss the treatment regimen(s) for bronchiectasis.

ANSWER

Asthma, COPD, ACOS, Cystic Fibrosis, and Bronchiectasis: A Comparative Analysis

Introduction

This essay explores various respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), asthma-COPD overlap syndrome (ACOS), cystic fibrosis (CF), and bronchiectasis. Each section will provide an overview of the condition, including its etiology, diagnostic criteria, clinical manifestations, and treatment options. By comparing and contrasting these respiratory conditions, healthcare professionals can enhance their understanding and improve patient care.

Section 1: Asthma vs. COPD vs. ACOS

Etiology: Different etiological factors contribute to the development of asthma, COPD, and ACOS.
Diagnostic Criteria: Asthma and COPD have specific diagnostic criteria, whereas ACOS combines features of both conditions.
Clinical Manifestations: Asthma is characterized by recurrent wheezing, shortness of breath, and coughing, while COPD is associated with progressive dyspnea and chronic bronchitis or emphysema. ACOS presents with overlapping symptoms of both asthma and COPD.
Treatment Options: Each condition requires a tailored treatment plan, including medication, lifestyle modifications, and patient education.

Section 2: Cystic Fibrosis (CF)

Etiology: CF is an autosomal recessive genetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene.
Incidence: CF is more prevalent among Caucasians, with an incidence of approximately 1 in 3,500 births in the United States and 1 in 2,500 births worldwide.
Organ Involvement: CF primarily affects the lungs, pancreas, liver, and intestines due to impaired chloride and water transport.
Pulmonary Manifestations: CF leads to chronic lung infections, bronchiectasis, and progressive decline in lung function.
Diagnostic Tools: Sweat chloride test is the gold standard for CF diagnosis, with specific values for different age groups.
Treatment: Treatment involves bronchial hygiene techniques, airway clearance devices, medications to improve lung function, and nutritional support.

Section 3: Bronchiectasis

Types: Bronchiectasis can be classified as cylindrical, varicose, or cystic based on the pattern of bronchial dilation.
Causes: Various factors can contribute to bronchiectasis, including infections, immunodeficiencies, congenital abnormalities, and chronic aspiration.
Clinical Manifestations: Patients with bronchiectasis commonly experience chronic cough, excessive sputum production, breath sounds may reveal coarse crackles, and chest X-rays or CT scans often show bronchial dilation.
Treatment: Treatment aims to manage infections, control symptoms, improve airway clearance, and address underlying causes. Medications may include antibiotics, bronchodilators, and mucolytics.

Conclusion

Understanding the similarities and differences between respiratory conditions is crucial for accurate diagnosis and effective management. By recognizing the etiology, clinical manifestations, and treatment options for asthma, COPD, ACOS, CF, and bronchiectasis, healthcare professionals can tailor their approach to meet individual patient needs. With proper assessment and evidence-based interventions, patients can receive the most appropriate care, leading to improved outcomes and enhanced quality of life.