What are the symptoms and diagnosis of lung disease?

From the Guidelines

Lung health is crucial for overall wellbeing, and maintaining it is key to preventing conditions such as chronic obstructive pulmonary disease (COPD), which can be diagnosed through objective measurement of airways obstruction with spirometric tests, as stated in the BTS guidelines for the management of COPD 1. The lungs are vital respiratory organs responsible for gas exchange, allowing oxygen to enter the bloodstream and carbon dioxide to be expelled. Each person has two lungs—right and left—located in the chest cavity protected by the ribcage. The right lung has three lobes while the left has two, making room for the heart. Lungs contain millions of tiny air sacs called alveoli where oxygen and carbon dioxide exchange occurs across thin membranes. When we breathe in, the diaphragm contracts and moves downward, creating negative pressure that draws air into the lungs through the trachea, bronchi, and bronchioles. During exhalation, the diaphragm relaxes, pushing air out. Some key points to consider in lung health and COPD management include:

• The presence of symptoms can be extremely variable in patients with COPD, and a firm diagnosis can only be made by objective measurement of airways obstruction with spirometric tests 1.
• The diagnosis of COPD is first suspected when a patient complains of a cough, sputum production, dyspnoea or recurrent lower respiratory infections, and reports risk factors for the disease, such as exposure to cigarette smoke or environmental or occupational pollutants 1.
• Additional medical history is then obtained to assess for further evidence that COPD is present, evidence that an alternative disease is not the cause of the symptoms, evidence that comorbidities are present, the ability to perform activities of daily living, other effects of the condition, and the availability of social support 1. The most recent and highest quality study, published in 2015, recommends that the diagnosis of COPD should be based on a combination of clinical presentation, medical history, physical examination, and diagnostic tests, including spirometry and chest radiography 1. In terms of management, it is essential to:
• Identify respiratory and systemic effects of COPD through physical examination and diagnostic tests 1.
• Assess the patient's functional capacity through exercise tests, such as timed walking distances or walking speed 1.
• Consider the risk of lung cancer, which is increased among patients with COPD, and perform chest radiography and computed tomography (CT) scans as needed to detect pulmonary comorbidities and nonpulmonary comorbidities 1.

From the Research

Lung Function and Asthma

• Asthma symptoms and lung function can be improved with anti-chlamydial treatment with azithromycin in asthmatic patients positive for C. pneumoniae 2
• Treatment with azithromycin significantly reduced symptom score and improved lung function FEV1, morning and evening PEF values 2

Risk Factors for Pneumonia

• Having asthma is associated with a three times higher risk of being hospitalized for pneumonia 3
• Asthmatics taking continuous treatment with fluticasone propionate were at an increased risk of being hospitalized with pneumonia 3
• Other risk factors for pneumonia include smoking, low or high BMI 3

Bronchodilatory Effects of Medications

• Cetirizine has a significant bronchodilatory effect in patients with mild-to-moderate asthma and can be used to treat concomitant conditions without concern that it will interfere with the bronchodilatory effect of albuterol 4
• Albuterol alone had a significant effect on pulmonary function variables, but cetirizine and albuterol appeared to have an additive bronchodilatory effect 4

Managing Acute Asthma

• Short-acting β2 agonists and short-acting muscarinic antagonists are effective as bronchodilators for asthma in the acute setting 5
• Systemic corticosteroids are the mainstay therapy for asthma exacerbations, and the oral route is favored unless there is a contraindication 5
• Nebulized magnesium should not be routinely used in acute asthma, but intravenous magnesium sulfate may be considered in selected cases 5

Respiratory Assessment

• A physical examination of the chest should be conducted as part of a comprehensive respiratory assessment of the patient, following a systematic approach that includes inspection, palpation, percussion, and auscultation 6
• Nurses undertaking respiratory assessments need to have adequate knowledge of the procedures involved and practical skills that need to be practised under supervision 6