SIU School of Medicine

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Department of Internal Medicine

COPD & Asthma

Rationale

The chronic obstructive pulmonary diseases (chronic bronchitis/emphysema/asthma) are important causes of morbidity and mortality and are a major cause of total disability, second only to coronary artery disease. Cigarette smoking plays a major role in the progression of the disease, with survival rates lower among patients who continue to smoke cigarettes. The severity and debilitation of these particular disorders make them an important training problem for all third year medical students.

Prerequisites

Prior knowledge should include:

  • normal structure and function of the heart and lungs and how these are altered in respiratory system diseases
  • pathogenesis and pathophysiology of pulmonary diseases
  • pharmacology of drugs used for pulmonary diseases
  • epidemiology and risk factors of lung disease

Knowledge

Students should be able to define, describe, and discuss:

  • disease entities and pathophysiologic processes of common, serious, or prototypical respiratory diseases that can result in COPD:
    • asthma
    • chronic bronchitis
    • emphysema
    • genetic predisposition such as alpha 1 antitrypsin deficiency
  • other disease entities that may cause symptoms or signs similar to those caused by COPD
  • allergic and non-allergic factors that may precipitate bronchospasm and asthma
  • the risks for developing COPD in various patients and correlate risk factors associated with each respiratory tract diseases with occupational and environmental hazards
  • basic principles of oxygen, antibiotic, bronchodilator and corticosteroid therapy
  • the scientific evidence supporting use of influenza vaccine/pneumovax in COPD patients
  • the effects of oxygen use and smoking cessation on mortality

Skills

Students should demonstrate specific skills, including:

  • History-Taking Skills: Students should be able to obtain, document, and present a medical history that differentiates among etiologies of disease including:
    • existence, duration, and severity of:
      • shortness of breath
      • sputum production
      • cough
      • wheezing
      • hemoptysis
      • fever
      • abnormal nocturnal/diurnal sleep patterns
    • patient’s occupational history, including:
      • current and past exposures
      • environmental
      • smoking
    • active and passive
    • current and past, include total amount pack-year smoking
      • travel
    • family respiratory tract history, including:
      • a history of allergies
      • previous respiratory tract diseases
      • previous PPD, TB and BCG status
      • risk for alpha 1 antitrypsin deficiency
  • Physical Exam Skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease including:
    • assessing the use of accessory muscles for breathing
    • inspection, palpation, percussion and auscultation of the chest discriminating the following:
      • recognizing and differentiating abnormal lung sounds, such as wheezes, rhonchi, and crackles from normal breath sounds
      • differentiating between a normal, dull and hyperresonant chest by percussion
      • differentiating between areas of consolidation and pleural fluid by assessing the quality of the breath sounds and ancillary findings such as egophony and whispered pectoriloquoy
      • assessing the presence of pleural friction rub
  • Differential Diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that confirm or refute a diagnosis of:
    • asthma
    • chronic bronchitis
    • emphysema
  • Laboratory Interpretation: Students should be able to understand the rationale for and correctly identify abnormalities detected by the following tests.
    • chest x-ray to recognize x-ray patterns that suggest asthma, bronchitis and emphysema
    • basic pulmonary function tests used to evaluate respiratory tract diseases:
      • ABG
      • pulmonary function tests
      • spirometry
    • interpretation of a gram stain of sputum
    • pulse oximetry
  • Basic Procedure Skills: Students should become familiar with how to perform:
    • a gram stain of sputum

  • Management Skills: Students should be able to develop an appropriate evaluation and treatment plan for patients that includes knowledge of:
    • the basic principles of oxygen therapy
    • when antibiotics are appropriate
    • the indications for bronchodialator and corticosteroid therapy
    • key components in managing patients hospitalized with COPD exacerbations including indications for non-invasive positive pressure ventilation and endotracheal intubation
    • smoking cessation strategies
    • how to access and utilize appropriate information systems and resources to help delineate issues related to COPD.

Attitudes and Professional Behaviors

Students should be able to:

  • appreciate the impact of working, living, and environmental conditions on the development and progression of respiratory tract disease

Resources

  • “The Diagnosis and Treatment of Cough”, Irwin, Richard S, MD, Madison, Mark, MD, The New England Journal of Medicine, December 7, 2000, Vol. 343, No. 23, 1715-1721
  • “Chronic Obstructive Pulmonary Disease”, Barnes, Peter J, DSc, The New England Journal of Medicine, July 27, 2000, Vol. 343, No. 4, 269-280
  • “Management of Chronic Obstructive Pulmonary Disease”, Sutherland, ER and Cherniack, RM. The New England Journal of Medicine, June 2004, Vol. 350, No.26, 2689-2697
  • Clerkship Seminar, “COPD and Asthma”, Haitham Bakir, MD (slides available on Pulmonary web site)
  • Clerkship Seminar, “Chest Radiograph Interpretation,” K. Kraudel, MD
  • Radiology Web Sites:

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