From the Guidelines
The initial workup for a patient with Broad Range of Bronchial and Pulmonary (BRBPR) symptoms should include pulse oximetry and CT chest preferably with contrast if concerned for other etiologies such as pulmonary embolus, as recommended by the American Society of Clinical Oncology guideline update 1.
Initial Evaluation
The workup should start with a thorough history and physical examination to assess the severity of symptoms and identify potential causes.
- Vital signs should be assessed immediately to determine hemodynamic stability.
- Laboratory tests including complete blood count, coagulation studies, and comprehensive metabolic panel are essential.
- Pulse oximetry should be performed to assess oxygen saturation.
Imaging Studies
- CT chest with contrast is recommended to evaluate the lungs and identify potential causes of symptoms such as pulmonary embolus or pneumonia.
- For patients with severe symptoms, additional imaging studies such as bronchoscopy with BAL and transbronchial biopsy may be necessary.
Management
- For patients with mild symptoms (G1), holding immune checkpoint inhibitor therapy and close monitoring with history, physical examination, and pulse oximetry is recommended 1.
- For patients with moderate symptoms (G2), holding immune checkpoint inhibitor therapy, prednisone 1-2 mg/kg/d, and tapering over 4-6 weeks is recommended 1.
- For patients with severe symptoms (G3 or G4), permanently discontinuing immune checkpoint inhibitor therapy and empiric antibiotics may be considered, and methylprednisolone IV 1-2 mg/kg/d may be necessary for life-threatening respiratory compromise 1.
Specialist Consultation
Early specialist consultation with pulmonology or infectious disease is recommended for optimal management of BRBPR symptoms.
- Patients with hemodynamic instability may require ICU admission.
- Management depends on the underlying cause, and medications like oxygen therapy and bronchodilators may be necessary to manage symptoms.
From the Research
Initial Workup for BRBPR Symptoms
The initial workup for a patient with Broad Range of Bronchial and Pulmonary (BRBPR) symptoms is not directly addressed in the provided studies. However, the following general information can be applied to the initial workup and management of patients with respiratory symptoms:
- A complete blood count (CBC) can be useful in evaluating the patient's overall health and identifying potential underlying conditions that may be contributing to the BRBPR symptoms 2, 3, 4
- A basic metabolic panel (BMP) can provide information about the patient's electrolyte levels, renal function, and acid-base balance, which can be helpful in managing patients with respiratory symptoms 5
Management of BRBPR Symptoms
The management of BRBPR symptoms will depend on the underlying cause of the symptoms. Some possible causes of BRBPR symptoms include:
- Infections, such as pneumonia or bronchitis
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Interstitial lung disease
- Pulmonary embolism
- Other conditions that affect the lungs and airways
Diagnostic Tests
The following diagnostic tests may be ordered as part of the initial workup for BRBPR symptoms:
- Chest X-ray
- Computed tomography (CT) scan of the chest
- Pulmonary function tests (PFTs)
- Arterial blood gas (ABG) analysis
- Complete blood count (CBC) with differential 2, 3, 4
- Basic metabolic panel (BMP) 5
Note: There are no research papers that directly address the initial workup and management of patients with BRBPR symptoms. The information provided is general and based on the management of respiratory symptoms.