PNEUMOLOGIE
MODULE INWENDIGE AANDOENINGEN
INHOUDSOPGAVE
Semeiologie of the respiratory system ............................................................................................................. 4
1. Anamnese .................................................................................................................................................... 4
Cough .............................................................................................................................................................. 4
Haemoptysis .................................................................................................................................................... 6
Dyspnea ........................................................................................................................................................... 7
Thorax pain ..................................................................................................................................................... 8
2. Physical examination................................................................................................................................... 8
3. Complementary exams ................................................................................................................................ 9
Bronchoscopy .................................................................................................................................................. 9
Thoracoscopy .................................................................................................................................................. 9
Pleurocentesis ............................................................................................................................................... 10
Pulmonary function tests ............................................................................................................................... 11
Routine pulmonary function tests ..................................................................................................................... 11
Spirometry & flow-volume loop .................................................................................................................... 11
Pulmonary volumes → TLC, FRC, RV ................................................................................................................. 16
Pulmonary volumes....................................................................................................................................... 16
Pulmonary diffusion capacity → DLCO, KCO ..................................................................................................... 17
Pulmonary diffusion capacity (DLCO) ............................................................................................................ 17
Summary classification of lung defects ............................................................................................................. 18
Pneumologie in practice ................................................................................................................................. 19
Casus 1 .............................................................................................................................................................. 19
COPD: Chronic obstructive pulmonary disease............................................................................................. 19
CASUS 2 ............................................................................................................................................................. 25
Astma ............................................................................................................................................................ 25
Cystic fibrosis (CF) ......................................................................................................................................... 29
Casus 3 .............................................................................................................................................................. 32
Pneumonie .................................................................................................................................................... 32
Micro-organismen ......................................................................................................................................... 35
Necrotiserende pneumonie .......................................................................................................................... 36
Longabces...................................................................................................................................................... 36
Tuberculose ................................................................................................................................................... 36
, COVID-19 ....................................................................................................................................................... 37
Pleurale effusie ............................................................................................................................................. 40
Atelectase...................................................................................................................................................... 42
Hemopteu ..................................................................................................................................................... 42
Neuromusculair lijden ................................................................................................................................... 44
CONCLUSIE ........................................................................................................................................................ 44
Inhalation therapy ......................................................................................................................................... 46
The triangle of good inhalation ......................................................................................................................... 46
Drugs used for inhalation .................................................................................................................................. 46
Correct inhalation.............................................................................................................................................. 47
Incorrect inhalation ........................................................................................................................................... 47
Factors affecting deposition .............................................................................................................................. 48
Available inhalation devices .............................................................................................................................. 48
Improve the coordination problems of a pMDI ................................................................................................. 51
Spacers for pMDI: different types ................................................................................................................. 51
Nebulizers: indications for use are limited ........................................................................................................ 51
Inhalers .............................................................................................................................................................. 52
Choice of inhaler based on the patient in front of you ...................................................................................... 52
Inspiratory capactity – can my patients use DPI? In check dial..................................................................... 53
Instructions on inhalators.................................................................................................................................. 53
Acute and chronic respiratory insufficiency/failure ........................................................................................ 54
Respiratory failure ............................................................................................................................................. 54
Performing an arterial blood gass analysis ................................................................................................... 54
Normal values ............................................................................................................................................... 54
Classification of respiratory failure ................................................................................................................... 55
RIS type 2 – ventilatory (pump) failure – causes ........................................................................................... 56
Multimodaltity therapy in chronic respiratory failure .................................................................................... 57
Effects of multimodality therapy of cris ............................................................................................................ 57
Smoking cessation ............................................................................................................................................. 57
Pulmonary rehabilitation: rationale .................................................................................................................. 58
Pulmonary rehabilitation in COPD ................................................................................................................ 58
Oxygen therapy in chronic respiratory failure ................................................................................................ 59
Oxygen therapy reimbursement criteria ........................................................................................................... 59
In hospital oxygen ............................................................................................................................................. 59
At home oxygen source ..................................................................................................................................... 59
Oxygen sypply systems ...................................................................................................................................... 60
Nasal cannula ................................................................................................................................................ 60
, Nasopharyngeal oxygen catheder ................................................................................................................. 60
Oxygen mask ................................................................................................................................................. 60
Oxygen mask with bag .................................................................................................................................. 61
High flow oxygen mask ................................................................................................................................. 61
High flow nasal oxygen ‘Optiflow’ ................................................................................................................. 61
Cardiopulmonary Excercise testing (CPET) ..................................................................................................... 62
Ergospirometry .................................................................................................................................................. 62
CPET ‘machine’: cycle-ergometer or treadmill ergometer/electrocardiograph ........................................... 62
Cardiopulmonary exercise training ................................................................................................................... 62
Indications for CPET........................................................................................................................................... 63
Bio-energetic basis of work performance.......................................................................................................... 63
Measurements: breath-by-breath gas analyser/pneumotachograph/oximeter............................................... 64
Comprehensive cardiopulminary exercise testing (CPET) .................................................................................. 65
Measurements during CPET .......................................................................................................................... 65
Wich protocol, wich modality? ..................................................................................................................... 66
Physiology of Exercise ....................................................................................................................................... 66
Typical cardiopulmonary responses to exercise ........................................................................................... 67
Ventilatory response ..................................................................................................................................... 68
Cardiac responses ......................................................................................................................................... 74
Patterns of exercise responses ..................................................................................................................... 75
Take home messages ........................................................................................................................................ 80
, SEMEIOLOGIE OF THE RESPIRATORY SYSTEM
1. ANAMNESE
• Cough
o Dry
o Productive: sputum production (or expectoration)
• Haemoptysis
o = ophoesten van bloed
• Dyspnea
o = kortademigheid
• Thorax pain
COUGH
• Classification
o Acute (< 3 weeks)
o Subacute (3-8 weeks)
o Chronic (> 8 weeks)
• Epidemiology
o Up to 40 % of ambulatory consults
o 75-90 % identifiable cause
o 95 % successful treatment possible
• Dry
• Productive
• Aspect/color:
o Aquous
o Mucus of mucopurulent
▪ = etterig
o Purulent
o Blood = hemoptysis
• Smell: putrid: anaerobic: lung abscess
• Bronchorrhea (excessive sputum): bronchiectasis, lung abscess, broncho-alveolar cell carcinoma,
Cystic Fibrosis
o = MUCO
MODULE INWENDIGE AANDOENINGEN
INHOUDSOPGAVE
Semeiologie of the respiratory system ............................................................................................................. 4
1. Anamnese .................................................................................................................................................... 4
Cough .............................................................................................................................................................. 4
Haemoptysis .................................................................................................................................................... 6
Dyspnea ........................................................................................................................................................... 7
Thorax pain ..................................................................................................................................................... 8
2. Physical examination................................................................................................................................... 8
3. Complementary exams ................................................................................................................................ 9
Bronchoscopy .................................................................................................................................................. 9
Thoracoscopy .................................................................................................................................................. 9
Pleurocentesis ............................................................................................................................................... 10
Pulmonary function tests ............................................................................................................................... 11
Routine pulmonary function tests ..................................................................................................................... 11
Spirometry & flow-volume loop .................................................................................................................... 11
Pulmonary volumes → TLC, FRC, RV ................................................................................................................. 16
Pulmonary volumes....................................................................................................................................... 16
Pulmonary diffusion capacity → DLCO, KCO ..................................................................................................... 17
Pulmonary diffusion capacity (DLCO) ............................................................................................................ 17
Summary classification of lung defects ............................................................................................................. 18
Pneumologie in practice ................................................................................................................................. 19
Casus 1 .............................................................................................................................................................. 19
COPD: Chronic obstructive pulmonary disease............................................................................................. 19
CASUS 2 ............................................................................................................................................................. 25
Astma ............................................................................................................................................................ 25
Cystic fibrosis (CF) ......................................................................................................................................... 29
Casus 3 .............................................................................................................................................................. 32
Pneumonie .................................................................................................................................................... 32
Micro-organismen ......................................................................................................................................... 35
Necrotiserende pneumonie .......................................................................................................................... 36
Longabces...................................................................................................................................................... 36
Tuberculose ................................................................................................................................................... 36
, COVID-19 ....................................................................................................................................................... 37
Pleurale effusie ............................................................................................................................................. 40
Atelectase...................................................................................................................................................... 42
Hemopteu ..................................................................................................................................................... 42
Neuromusculair lijden ................................................................................................................................... 44
CONCLUSIE ........................................................................................................................................................ 44
Inhalation therapy ......................................................................................................................................... 46
The triangle of good inhalation ......................................................................................................................... 46
Drugs used for inhalation .................................................................................................................................. 46
Correct inhalation.............................................................................................................................................. 47
Incorrect inhalation ........................................................................................................................................... 47
Factors affecting deposition .............................................................................................................................. 48
Available inhalation devices .............................................................................................................................. 48
Improve the coordination problems of a pMDI ................................................................................................. 51
Spacers for pMDI: different types ................................................................................................................. 51
Nebulizers: indications for use are limited ........................................................................................................ 51
Inhalers .............................................................................................................................................................. 52
Choice of inhaler based on the patient in front of you ...................................................................................... 52
Inspiratory capactity – can my patients use DPI? In check dial..................................................................... 53
Instructions on inhalators.................................................................................................................................. 53
Acute and chronic respiratory insufficiency/failure ........................................................................................ 54
Respiratory failure ............................................................................................................................................. 54
Performing an arterial blood gass analysis ................................................................................................... 54
Normal values ............................................................................................................................................... 54
Classification of respiratory failure ................................................................................................................... 55
RIS type 2 – ventilatory (pump) failure – causes ........................................................................................... 56
Multimodaltity therapy in chronic respiratory failure .................................................................................... 57
Effects of multimodality therapy of cris ............................................................................................................ 57
Smoking cessation ............................................................................................................................................. 57
Pulmonary rehabilitation: rationale .................................................................................................................. 58
Pulmonary rehabilitation in COPD ................................................................................................................ 58
Oxygen therapy in chronic respiratory failure ................................................................................................ 59
Oxygen therapy reimbursement criteria ........................................................................................................... 59
In hospital oxygen ............................................................................................................................................. 59
At home oxygen source ..................................................................................................................................... 59
Oxygen sypply systems ...................................................................................................................................... 60
Nasal cannula ................................................................................................................................................ 60
, Nasopharyngeal oxygen catheder ................................................................................................................. 60
Oxygen mask ................................................................................................................................................. 60
Oxygen mask with bag .................................................................................................................................. 61
High flow oxygen mask ................................................................................................................................. 61
High flow nasal oxygen ‘Optiflow’ ................................................................................................................. 61
Cardiopulmonary Excercise testing (CPET) ..................................................................................................... 62
Ergospirometry .................................................................................................................................................. 62
CPET ‘machine’: cycle-ergometer or treadmill ergometer/electrocardiograph ........................................... 62
Cardiopulmonary exercise training ................................................................................................................... 62
Indications for CPET........................................................................................................................................... 63
Bio-energetic basis of work performance.......................................................................................................... 63
Measurements: breath-by-breath gas analyser/pneumotachograph/oximeter............................................... 64
Comprehensive cardiopulminary exercise testing (CPET) .................................................................................. 65
Measurements during CPET .......................................................................................................................... 65
Wich protocol, wich modality? ..................................................................................................................... 66
Physiology of Exercise ....................................................................................................................................... 66
Typical cardiopulmonary responses to exercise ........................................................................................... 67
Ventilatory response ..................................................................................................................................... 68
Cardiac responses ......................................................................................................................................... 74
Patterns of exercise responses ..................................................................................................................... 75
Take home messages ........................................................................................................................................ 80
, SEMEIOLOGIE OF THE RESPIRATORY SYSTEM
1. ANAMNESE
• Cough
o Dry
o Productive: sputum production (or expectoration)
• Haemoptysis
o = ophoesten van bloed
• Dyspnea
o = kortademigheid
• Thorax pain
COUGH
• Classification
o Acute (< 3 weeks)
o Subacute (3-8 weeks)
o Chronic (> 8 weeks)
• Epidemiology
o Up to 40 % of ambulatory consults
o 75-90 % identifiable cause
o 95 % successful treatment possible
• Dry
• Productive
• Aspect/color:
o Aquous
o Mucus of mucopurulent
▪ = etterig
o Purulent
o Blood = hemoptysis
• Smell: putrid: anaerobic: lung abscess
• Bronchorrhea (excessive sputum): bronchiectasis, lung abscess, broncho-alveolar cell carcinoma,
Cystic Fibrosis
o = MUCO
