What is the approach to a lung exam and management of lung conditions?

From the Guidelines

A comprehensive lung examination is crucial for diagnosing and managing lung conditions, and it should include inspection, palpation, percussion, and auscultation, as well as diagnostic tools like pulmonary function tests, chest imaging, and sometimes bronchoscopy. The approach to a lung exam involves observing the patient's breathing pattern, chest wall movement, and signs of respiratory distress 1. Palpation of the chest assesses for tactile fremitus, chest expansion, and tenderness, while percussion helps identify areas of consolidation or hyperresonance. Auscultation with a stethoscope detects normal breath sounds, adventitious sounds like crackles, wheezes, or rubs.

Management of lung conditions depends on the specific diagnosis. For example, COPD management includes smoking cessation, bronchodilators such as tiotropium (18 mcg once daily) or salmeterol/fluticasone combination (50/500 mcg twice daily), and pulmonary rehabilitation 1. Pneumonia requires appropriate antibiotics based on likely pathogens—community-acquired pneumonia often responds to amoxicillin-clavulanate (875/125 mg twice daily for 5-7 days) or azithromycin (500 mg on day 1, then 250 mg daily for 4 days). Supplemental oxygen should be provided to maintain oxygen saturation above 88-92%, depending on the condition.

Some key points to consider in lung exam and management include:

• The purpose of the physical examination is to identify respiratory and systemic effects of lung conditions, such as COPD 1
• Chest radiography is generally performed during the initial diagnostic evaluation of patients with suspected lung conditions to exclude other diseases that may cause similar symptoms and signs 1
• Computed tomography (CT) can estimate the degree of emphysema and its distribution, and identify bronchial wall thickening and gas trapping, and is useful in diagnosing lung cancer 1
• A diagnosis of lung cancer should be obtained by whatever method is easiest, and selection of the most appropriate test is best done in a multidisciplinary fashion with input from a pulmonologist, a chest radiologist, a thoracic surgeon, and a pathologist 1.

The most recent and highest quality study 1 emphasizes the importance of a comprehensive lung examination and targeted interventions for managing lung conditions, and this approach should be prioritized in clinical practice.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Approach to a Lung Exam

• The approach to a lung exam involves a systematic sequence of inspection, palpation, percussion, and auscultation 2, 3, 4
• Accurate diagnosis is essential for effective treatment, and the physical examination is second in importance in assessing a pulmonary patient 2
• The use of a stethoscope is still a crucial diagnostic tool, and its appropriate use can improve medical practice and reduce costs 2

Management of Lung Conditions

• The management of lung conditions, such as chronic obstructive pulmonary disease (COPD), involves the prevention of exacerbations and hospitalizations 5
• Bronchodilators and anti-inflammatories are the first line therapy for treatment of COPD, but antibiotic prophylaxis may be necessary in some cases to prevent exacerbations 5
• The use of long-term or intermittent antibiotic treatment has shown to prevent COPD exacerbations and hospitalizations, but the indication of long-term antibiotic therapy must be determined on a case-by-case basis 5

Respiratory Assessment

• A comprehensive respiratory assessment includes an initial assessment, history taking, inspection, palpation, percussion, auscultation, and further investigations 3
• Nurses should have adequate knowledge of the procedures involved in respiratory assessments and practical skills that need to be practised under supervision 4
• A physical examination of the chest should be conducted as part of a comprehensive respiratory assessment, and should follow a systematic approach that includes inspection, palpation, percussion, and auscultation 4

Clinical Decision-Making

• Clinical decision-making tools, such as the evaluation of clinical 'red flags', can be used to support clinical diagnosis and reduce the risk of omitting serious illness 6
• Evidence-based clinical decision-making tools can be used to guide the management of lung conditions and prevent exacerbations 6, 5