Preface

This course delves deeply into the subject of pulmonary medicine, which is something all medical practitioners will encounter on some level. There will be a discussion of the anatomy and physiology of the airways and an in depth understanding of the different disorders faced by the practitioner of pulmonary medicine. It includes the common disorders, such as asthma, pneumonia, and COPD, as well as complex lung diseases like the different pneumoconioses, pulmonary hypertension, and cystic fibrosis. The complicated issues of respiratory failure, ventilator management, and ECMO are also covered so as to understand the phenomena of the various lung diseases and how they are managed by the pulmonary specialist.

Chapter one in the course introduces the topic of pulmonary medicine with a discussion of the anatomy and physiology of the respiratory system. This system includes the conducting zone and the respiratory zone, which will be discussed. The different mechanism of breathing and gas exchange are also covered. Lastly, the anatomy of the pulmonary circulation will be discussed as a review of normal pulmonary anatomy and physiology.

Chapter two covers the basics of different types of pulmonary testing. There are multiple types of lung tests that can be done to evaluate a patient with lung symptoms. These include spirometry, pulse oximetry, and arterial blood gases, which are basic tests of lung function. The chest radiograph is an important radiographic tool that can detect multiple types of lung diseases. Finally, ventilation-perfusion lung scanning is covered as a tool for detecting pulmonary emboli in the lungs.

The focus of chapter three in the course is the approach to the patient with different respiratory symptoms. The underlying pathophysiology of dyspnea is discussed as well as the approach in the diagnosis of the patient who has dyspnea as an outpatient. The approach and management of the individual who has subacute or chronic cough is covered as well as the diagnostic approach to the patient who has chest pain for pulmonary and non-pulmonary diseases.

The topic of chapter four is lung infections. The most common lung infection seen is community-acquired pneumonia. These are infections that happen to individuals in the community setting. Ventilator-associated pneumonia is also covered because there are many more organisms that can cause these infections that just aren’t seen in community-acquired pneumonia. Lung abscesses are uncommon infections of the lung from a variety of pathogens; these are more difficult to treat than pneumonia. Opportunistic lung infections are seen in immunosuppressed patients and represent a wide variety of bacterial and non-bacterial pathogens. Tuberculosis manifestations and treatment are also a part of this chapter.

Chapter five in the course is a discussion of the different obstructive lung diseases. The two most common obstructive lung diseases are asthma or reactive airway disease and COPD or chronic obstructive pulmonary disease. Asthma can be seen at any age but normally begins in childhood. COPD is almost always a disease of older adults and is usually seen in individuals with a long cigarette smoking history. The chapter also covers alpha-1 antitrypsin disease, which is a genetic disease that leads to obstructive lung disease.

The focus of chapter six is the autosomal recessive disease known as cystic fibrosis. This affects various aspects of the body, including the lungs, digestive tract, reproductive system, and sweat glands. A main feature of the disease is related to the lungs, with difficulty clearing pathogens and the frequent occurrence of severe lung infections. While CF traditionally involved a markedly shortened lifespan, current treatment has lengthened this so that individuals can live longer and healthier lives.

Chapter seven in the course involves a discussion of two different bronchial diseases. Bronchiectasis is disease of distortion and dilation of the bronchial tree that can affect either children or adults. The manifestations and treatment of the disease as it exists in children and as it is seen in adults are covered separately. Bronchiolitis is an infectious disease of the bronchioles that mainly affects infants and children. The characteristics of the disease and the treatment are discussed as part of this chapter.

Chapter eight in the course introduces lung cancer and its manifestations. There are two main types of primary lung cancer that are most commonly seen: non-small cell

lung cancer, which is the most common, and small cell lung cancer. Most of these cancers are tobacco-related. Less commonly, patients can have a malignancy of the pleura, seen in individuals who’ve been exposed to asbestos, usually in the workplace. A rarer type of lung cancer is carcinoid cancer of the lungs, which is also covered as part of this chapter.

The main focus of chapter nine is the acute pulmonary embolism. The most common cause of this is a deep venous thrombosis of the lower extremity that travels from the leg to the lungs, leading to a significant ventilation-perfusion mismatch. Some patients will have milder disease and will present with symptoms that are survivable. Others will have a massive embolus and will have a cardiac arrest from which they do not recover. The presentation, diagnosis, and management of pulmonary emboli are covered in this chapter.

Chapter ten in the course is about pulmonary hypertension. It involves any condition that leads to a mean pulmonary artery pressure of greater than or equal to 20 millimeters of mercury. There are several different groups that are represented by having pulmonary hypertension as part of the features. The different groups of pulmonary hypertension are based on the underlying cause of the disease process. Special emphasis is given of group 3, which is pulmonary hypertension due to chronic lung disease and/or hypoxemia. The treatment of pulmonary hypertension is discussed as well.

Chapter eleven talks about the different causes and manifestations of pulmonary edema. Pulmonary edema can be cardiogenic in nature or related to various types of lung disease. One cause of pulmonary edema is high altitude, which can cause this problem in the absence of any type of heart problem or pulmonary condition. The various treatments for pulmonary edema are covered as a part of this course; the treatment depends on the underlying etiology.

There are many different infiltrative and interstitial lung diseases discussed in chapter twelve in the course. This includes idiopathic interstitial pneumonia, which is actually a wide range of diseases involving abnormalities of the interstitium of the lungs. Other related disorders include sarcoidosis, which is infiltrative, and hypersensitivity

pneumonitis. The relatively uncommon diseases of the lungs called eosinophilic lung disease and pulmonary alveolar proteinosis are also covered in the chapter.

The focus of chapter thirteen is workplace lung injuries. A common workplace lung injury that can be seen in a variety of workplace situations is occupational-induced asthma. This is not much different from normal asthma but tends to be triggered by workplace situations. There are specific lung diseases that are also related to workplace exposure. These include silicosis, asbestosis, and berylliosis, which are collectively called pneumoconioses. These are specific lung disease brought on by the inhalation of a foreign substance—usually on a chronic basis in the workplace.

Chapter fourteen in the course talks about several different types of pleural diseases. Pleural effusions can be transudative or exudative, depending on the cause of the effusion. They can also be unilateral or bilateral. Pleural infections may be primary or may be secondary to extension of other lung infections. This chapter also covers the causes and manifestations of pneumothoraces, which can be secondary to trauma or to spontaneous disease of these membranes.

The main topics of chapter fifteen include those involving the mediastinal space. This is typically a small centrally-located space that is rarely involved in disease processes. The chapter discusses benign and malignant tumors of the mediastinum as well as pneumomediastinum, which involves air in the mediastinum. Fibrosing mediastinitis is a complication of certain fungal infections of the lungs that can present in the patient with underlying lung disease.

Chapter sixteen in the course involves a discussion of the different disorders that affect breathing itself. Perhaps the most common of these is obstructive sleep apnea, seen in patients of all ages and presentations. Less commonly seen is central sleep apnea, in which the problem is caused by a defect in the respiratory centers of the brain. Lastly, respiratory patterns can be greatly affected by neuromuscular diseases. There is a variety of neuromuscular diseases that can adversely affect the ability to breathe spontaneously.

The focus of chapter seventeen in the course is severe lung diseases that can lead to ventilatory failure. Acute respiratory distress syndrome is a severe response to different

lung insults that often leads to ventilatory failure. The management of ventilatory failure and hypercapnia is also covered in this course as is the basics of mechanical ventilation. ECMO is used primarily for cardiorespiratory surgery, which is discussed as part of this chapter.