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Outline
- What is dyspnea?
- What tests do we use for it?
- Questions
done about it? Dan Culver DO Outline What is dyspnea? What tests - - PowerPoint PPT Presentation
done about it? Dan Culver DO Outline What is dyspnea? What tests - - PowerPoint PPT Presentation
What is dyspnea and what can be done about it? Dan Culver DO Outline What is dyspnea? What tests do we use for it? Questions What is dyspnea? What is dyspnea? Central Airways narrowing Acid build-up Difficulty in breathing or
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What is dyspnea?
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What is dyspnea?
“Difficulty in breathing or in catching the breath” Low oxygen delivery Acid build-up Muscle weakness Lung blood vessels Restriction of lung motion Central Airways narrowing
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The main role of the lungs is gas exchange
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Subpleura Interlobular septa Bronchovascular area
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Sarcoidosis likes to involve the airways too
“Pebbly mural” appearance
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Bronchoscopy results
LUL LLL RUL Upper division lingula
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Pulmonary hypertension in sarcoidosis
10 20 30 40 50 60 70 80 Percent with Pulmonary Hypertension
Kyoto Detroit Milan New York Cincinnati Transplant
All patients Only Dyspneic Patients
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Muscle weakness in sarcoidosis
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Marcellis RG. ERJ 2011
Muscle weakness relates to other variables affecting QOL
6MWD Hand grip Extensor Quadrice ps PT HPT Pimax Men
- 0.25
- 0.25
- 0.29
- 0.17
- 0.36
0.24 Women
- 0.12
- 0.21
- 0.30
- 0.04
- 0.043
0.051
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Outline
- What is dyspnea?
- What tests do we use for it?
- Questions
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Spirometry
Flow-volume loop showing obstruction
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Data at the time of evaluation
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The main role of the lungs is gas exchange
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Stage I: 85-90% Stage II: 50-65% Stage III: 20-30% Stage IV: 0%
Scadding X-ray stages
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Which patient has worse pulmonary function tests?
69 year-old male 46 year-old male
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Some potential causes of shortness of breath in sarcoidosis
- Involvement of the lung tissue
- Airways involvement (usually asthma-like)
- Deconditioning (out of shape)
- Anemia (low blood counts)
- Airways involvement with stenosis
- Poor heart function
- Muscle inflammation
- High blood pressures in the lungs
(pulmonary hypertension)
RARE
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Chest x-ray is not a very good marker of disease activity
5 10 15 20 25
- 7 -6 -5 -4 -3 -2 -1
1 2 3 4 5 6 7
1 1 15 6 7 23 3 3 4 9
Judson MA. Respirology 2008
51%
n=36 ĸ=0.54
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What about chest CT scan?
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Does ACE help?
Rothkrantz-Kos S. Clin Chem 2003 Correlation with respiratory functional impairment in 144 non-smoking patients
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Correlation of biomarkers with
- utcome
Acute sarcoidosis Chronic sarcoidosis
AUC 0.89 (0.79-1) sIL2R AUC 0.72 (0.52-0.92) for ACE Rothkrantz-Kos S. Clin Chem 2003
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Sarcoidosis penumbra
Lazar CA. SRCCM 2010
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Pulmonary sarcoid with bulky adenopathy
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Overdosing steroids?
- 36 acute exacerbations
- Mean steroid dose
19 mg
- FVC improved from
68% to 82%
- Median assessment at
21 days
Goldstein DS. Thorax 1986 McKinzie BP. AM J Med Sci 2010
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Predictors of requirement for therapy at 2 years in ACCESS
20 40 60 80 100 120 No early treatment Early treatment
Independent predictors Initial treatment O.R. 3.6 (1.8-7.2) Dyspnea O.R. 2-4 Baughman RP. QJM 2006
n=205
- No. of subjects
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Data at the time of evaluation
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Making the diagnosis: Bronchoscopy
Overall diagnostic yield 70-97% Yield in non-chest diseases
Sensitivity TBBx: 43-96% EBBx: 40-75% TBNA: 46-66% Combination: 91%
“Pebbly mural” appearance
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Treatment
- Treat the disease
– Immunosuppressives – TNF antagonists variably successful
- Cognitive behavioral therapy
- Aerobic and strength training
- Stimulants
Hoving JL. Scand J Rheumatol 2009 Chauffier K. Rheumatology 2011 Lower EE. Chest 2008 White PD Lancet 2011
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