An Educational Update on Respiratory Diseases
Many radiologists are working harder than ever before, and radiology is such a rapidly evolving field that many of its practitioners find it challenging just to keep up with developments in imaging, let alone other medical specialties. Yet the rest of medicine is evolving as well, and it is important that radiologists remain abreast of new developments in fields that are likely to impact their practice.
Because the single most commonly performed radiological study is the chest radiograph, and because respiratory signs and symptoms are among the most common reasons for patients to seek medical attention, new developments in pulmonary medicine are likely to be particularly relevant. This article provides a brief refresher on four of the most common and life-threatening pulmonary disorders that radiologists are likely to encounter on a regular basis: asthma, chronic obstructive pulmonary disease (COPD), pneumonia, and acute respiratory distress syndrome (ARDS).
Asthma
The word asthma comes from a Greek root meaning “panting.” It is estimated that about 37 million Americans have been diagnosed with asthma at some point in their life, but only about 23 million currently carry the diagnosis. This amounts to a little over 7% of the US population. Perhaps in part because airways are smaller to begin with, asthma tends to be a more serious problem in younger populations, with a peak prevalence between the ages of 5 and 14 years. In patients younger than 18 years, asthma is more common in males, but in adulthood it is more common in females .
Asthma is a common reason patients seek medical attention, with approximately 14 million primary care visits and nearly 2 million emergency department visits each year . It is the most common reason children are admitted to the hospital from the emergency department. On the other hand, the mortality rate of asthma is relatively low, with fewer than 4000 deaths per year in the United States .
Asthma is an inflammatory disease that affects the larger, conducting airways to a greater extent than COPD, which predominates in smaller airways. It has a strong genetic component and tends to be associated with atopy, a predisposition to allergic rhinitis and eczema. Yet there is also an important environmental component, which may include exposure to a variety of allergens, as well as cold air and exercise.
The principal factors involved in the pathogenesis of asthma include bronchial smooth muscle hyperreactivity, inflammatory bronchial wall thickening, and increased mucus production. In the early phases of an attack, the release of histamine from mast cells and acetylcholine from parasympathetic neurons cause bronchoconstriction and mucus production, followed by leukotriene release from other inflammatory cells such as eosinophils and neutrophils. Long term, asthma can result in permanent airway narrowing .
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
COPD
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Emphysema
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Chronic Bronchitis
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Pneumonia
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
ARDS
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Conclusion
Get Radiology Tree app to read full this article<
References
1. Blackwell D.L., Lucas J.W., Clarke T.C.: Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2012. National Center for Health Statistics. Vital Health Stat 10 2014; 260: pp. 1-161.
2. National Center for Health Statistics : National ambulatory medical care survey: 2010 summary tables. Table 13 [Internet].2010.Centers for Disease Control and PreventionAtlanta Available at http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf Accessed June 23, 2015
3. Centers for Disease Control and Prevention, National Center for Health Statistics : Compressed Mortality File 1999–2013 on CDC WONDER Online Database, released October. Data are from the Compressed Mortality File 1999–2013 Series 20 No. 2S, 2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program; Available at: http://wonder.cdc.gov/cmf-icd10.html Accessed June 23, 2015
4. Kumar V., Abbas A.K., Aster J.C.: The lung.Robbins and Cotran pathologic basis of disease.2014.Elsevier/SaundersPhiladelphia:pp. 674-683.
5. Longo D.L., Kasper D.L., Jameson J.L., et. al.: Harrison’s principles of internal medicine.19th ed.2015.McGraw HillNew York
6. National Asthma Education and Prevention Program : Third expert panel on the diagnosis and management of asthma.2007.National Heart, Lung, and Blood InstituteBethesda
7. Goodacre S., Bradburn M., Cohen J., et. al.: Prediction of unsuccessful treatment in patient with severe acute asthma. Emerg Med J 2014; 31: pp. e40-e45.
8. American Lung Association, Epidemiology and Statistics Unit : Research and Health Education Division. Trends in COPD (chronic bronchitis and emphysema): morbidity and mortality [Internet]. Chicago: American Lung Association. Available at: http://www.lung.org/assets/documents/research/copd-trend-report.pdf Accessed October 12, 2015
9. Kochanek K.D., Murphy S.L., Xu J.: Deaths: Final Data for 2011. National Vital Statistics Reports. vol 63 no 32015.National Center for Health StatisticsHyattsville, MD
10. Volgelmeier C., Agusti A., Anzueto A., et. al.: Global strategy for the diagnosis, management, and prevention of COPD.2015. Available at: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2015_Sept2.pdf Accessed October 12, 2015
11. Vestbo J., Agusti A., Anzueto A., et. al.: Global strategy for the diagnosis, management, and prevention of COPD.2010. Available at: http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf Accessed October 12, 2015
12. Rennard S.I.: COPD: overview of definitions, epidemiology, and factors influencing its development. Chest 1998; 113: pp. 235S-241S.
13. Ho E.D.: Community-acquired pneumonia in adults and children. Prim Care Clin Office Pract 2013; 40: pp. 655-669.
14. Niederman M.S., Craven D.E., Bonten M.J., et. al.: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Crit Care Med 2005; 171: pp. 388-416.
15. CDC : CDC National Vital Statistics Report. Deaths: final data for 2011.2011.
16. Mandell L.A., Wunderink R.G., Anzueto A., et. al.: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community acquired pneumonia in adults. Clin Infect Dis 2007; 44: pp. s27-s72.
17. Rubenfeld G.D., Caldwell E., Peabody E., et. al.: Incidence and outcomes of acute lung injury. N Engl J Med 2005; 353: pp. 1685-1693.
18. Hudson L.D., Milberg J.A., Anardi D., et. al.: Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1995; 151: pp. 293-301.
19. Ranieri V.M., Rubenfeld G.D., Thompson B.T., et. al.: Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307: pp. 2526-2533.