The kCO is reduced most in emphysema when alveoli have been destroyed The kCO is also reduc ed in interstitial lung diseases where the alveolar capillary membrane may be thick enough to reduce CO passage The kCO may also be raised when lungs are poorly expanded by, say, wea k respiratory muscles, because the lung is \200\230more concentrated \200\231 and transfer s CO better when quoted per unit volume The kCO may also be raised for a few days when ther e has been profuse lung hemorrhage, as can occur in, SLE, Wegener \200\231s, and Goodpastur e \200\231s. This is because the free red cells lining the alveoli take up CO directly and \200\230falsely \200\231 elevate the \201 gure. As the hemoglobin is broken down, the kC O returns to normal, unless there is another bleed. This helps to distinguish re-bleeding f rom other causes of lung in \201 ltrates such as infection This test requires more cooperation than simple spirometry, as well as a minimum inspired v olume, and therefore cannot always be obtained. APPENDIX 5 Lung function testing 834 Respiratory muscle function, body plethysmography, and lung volumes Respiratory muscle func tion Respiratory failure and small VCs may be due to weak respiratory muscles. It is theref ore useful to be able to assess inspiratory and expira- tory muscle power. There may be glo bal weakness, or speci \201 c inspiratory weakness, usually due to diaphragm paralysis. In the clinic the simplest test is a lying and standing VC. If the diaphragm is paralyzed the n on lying down the abdominal contents will push up the diaphragm and limit inspiration. On standing the abdominal contents drop and aid inspiration. \200 \200 \200 A fall in VC of less than 10% on lying down is probably normal A fall of 10 \200\22320% is suspicious of diaphragm paralysis A fall of more than 20% is abnormal and suggests signi \201 cant, usually bilateral, diaphragm paralysis. In the laboratory there are various ways to test respiratory muscle function. The patient c an blow against a pressure meter after a maximum inspiration, and inspires against the mete r after a full expiration. This is, of course, highly effort dependent. A maneuver such as a sniff is very stereotypic and patients can reproduce this. Measuring the inspiratory pres sure pro- duced at the nose during this maneuver is a reasonably reliable way of screening for inspiratory muscle weakness. More accurate assessments of inspiratory muscle function, particularly the diaphragm, can be obtained using two oesophageal balloons placed above and below the diaphragm and connected to pressure transducers. The transdiaphragmatic pressure s during maximal inspiratory efforts, snif \201 ng, and breathing to TLC all provide repro ducible measures of diaphragm function, but depend on good co- operation and effort by the patient. Activating the phrenic nerve directly with a super \201 cial electrical stimulato r, or by using high-intensity magnetic stimulation over the nerve roots of C3 \200\223C5, p rovides non-effort-dependent ways to test diaphragm function. Body plethysmography requires the patient to climb into an airtight cabinet and breathe through a shuttered mouthpiece c onnected to the outside world. It has two particular advantages over simpler lung function tests. It is able to measure the total lung volume or capacity (TLC) in the thorax, and it provides a measure of airways obstruction involving little or no effort by the patient. The other main method of measuring TLC involves helium dilution as described during the TLC O measurement above. However, in the presence of lower airways obstruction, the helium may not \200\230reach \200\231 all parts of the lung during the 10 s breath hold, and the volu me of dilution will therefore be lower than the real TLC. The body plethysmograph relies on the pressure changes that occur when all the air in the chest is alternately compressed an d expanded by the patient making breathing efforts against an airway closed by a shutter at the mouth. The pressure changes produced in the oral cavity versus in the box are then pro portional to the volume of air being compressed and rare \201 ed, thus allowing calculatio n of the volume in the chest at the time. Note that this volume will include any bullae and the difference between the plethysmographic lung volume and the RESPIRATORY MUSCLE FUNCTION 835 helium dilution volume will re \202 ect the bullae volume, as well as areas not reached by the helium due to increased airways resistance. Measurement of airways resistance with the body box relies on a similar principle. If there were no airways resistance, then breathing in and out would not compress or rarefy the air in the chest. With increasing resist- ance, the air in the chest will be compressed during expiration and rare \201 ed on inspiration. It is this phenomenon that allows calculation of the airways resistance during quiet breathing or panting (the latter ensures the vocal chords are fully open and not contributing to the measured resistance). VC TLC VC TLC FRC RV VC RV FRC FRC TLC RV Normal Obstructive Restrictive Fig. A5.4 Lung volumes in normal, obstructive, and restrictive lung conditions. TLC = total lung capacity; VC = vital capacity; RV = residual volume; FRC = func- tional residual capa city; FEV1 = forced expiratory volume in 1 s. Derivative Obstructive Restrictive dd d FEV1 (% predicted) d or l d d VC (% predicted) l or i (increased recoil) d FEV1/VC ratio i or l i TLC (% predicted) d RV (% predicted) i d FRC (% predicted) i (gas trapping) l or d RV/TLC ratio Further reading Gibson GJ. Clinical Tests of Respiratory Function, 2nd edn. Hodder Arnold, 1995. APPENDIX 5 Lung function testing 836 Peak \202 ow reference ranges 680 660 640 620 600 580 560 540 520 500 480 460 440 420 400 380 360 340 320 Men 190/75 183/72 175/69 167/66 160/63 ) n m i / l ( w o l f k a e P Height (cm/in) Women 175/69 167/66 160/63 152/60 145/57 40 45 50 55 60 65 70 15 20 25 30 35 Age (years) Fig. A5.5 Normal values for peak \202 ow based on original Gregg and Nunn values (BMJ 197 3), but corrected for new EU scale peak \202 ow meters. Normal range is about 15% or ro ughly 100 l/min in men and 50 l/min in women. Old Wright peak \202 ow meters over-read in the middle of the scale (e.g. reading about 400 when actual value was 350 l/min), and were replaced from October 2004 by a corrected scale. Conversion calculator available at: http://www.mortonmedical.co.uk/ clement_clarke_mini_wri ght_EU.htm 837 Appendix 6 Plain radiograph and lobar collapses Posterior to anterior view 838 Left lateral view 839 Lobar collapses 840 8 3 8 Sterno-clavicular joint Posterior part of 5th rib Aortic knuckle Anterior part of 3rd rib L eft pulmonary artery Left atrial appendage Trachea Clavicle Right para-tracheal stripe (air both sides) A P P E N D X I 6 Carina Position of azygos vein P l a i n r a d o g r a p h Horizontal fissure i Right pulmonary artery Left border of descending aorta Left ventricle Right atrial edge Right pulmonary veins (entering mediastinum lower than arteries) Right ve ntricle a n d Left diaphragm visible across to aorta l o b a r Gastric bubble c o l l a p s e s Fig. A6.1 Normal PA chest radiograph. Trachea Scapula Approximate position of oblique fissure Brachiocephalic vessels Anterior mediastinal window Aortic arch Pulmonary trunk (right PA ant, left PA post) and hilum Approximate position of horizontal (right) fissure P L A N R A D O G R A P H A N D I Pulmonary arteries I Left atrium Right ventricle Vertebral bodies: each one should be darker than one above Right atrium L O B A R Right and left diaphragms C O L L A P S E S Fig. A6.2 Normal left lateral chest radiograph. 8 3 9 840 APPENDIX 6 Plain radiograph and lobar collapses Left upper lobe collapse Sharply defined posterior border due to anterior displacement of oblique fissure III-defined opacity Trachea deviated to L Indistinct elevated L hilum Left lower lobe collapse Oblique fissure displaced posteriorly Triangular opacity visible through the heart with loss of medical end of diaphragm Lingular consolidation Indistinct L heart border Right upper lobe collapse Trachea deviated to R Triangular opacity with well-defined margins Horizontal fissure and R hilum displaced upwards Right middle lobe collapse Horizontal fissure displaced down III-defined opacity adjacent to R heart border Loss of R heart border Well-defined triangular opacity running from hilum Right lower lobe collapse Oblique fissure and hilum displaced posteriorly Horizontal fissure displaced downwards Well-defined posterior opacity Well-defined opacity adjacent to R heart border (R heart border still visible) Fig. A6.3 Lobar collapse. 841 Appendix 7 Radiological investigations and radiation exposure 8 4 2 A P P E N D X Table A7.1 Common radiological investigations used in respiratory practice I Low dose CT V/Q scan 99mTcMAA and 133Xe Staging chest and abdo CT HRCT CT pulmonary angiogram PET scan MRI Head CT Plain CXR (AMBER) one view 7 R a d o l o g i c a l e.g. for brain metastases Better detection of malignant tissue invasion For detection of malignant deposits, and increasingly for areas of in \202 ammation For identifying perfusion defects without accompanying ventilation defects, as in pulmonary emboli Used in lung cancer screening For pulmonary emboli and visualization of pulmonary vasculature For diffuse lung disease, giving good resolution at level of secondary pulmonary lobule e.g. for staging lung cancer, usually with IV contrast to identify vascularity of structure s Indication Best technique for plain chest radiography i i n v e s t i g a t i o n s Radio- labeled glucose (18 F-FDG) \200\223 uptake proportional to metabolic activity IV radio labeled albumin macro- aggregates that lodge in the pulmonary arterioles to image vasculature, and inhaled xenon gas to image ventilated areas 0.6 mm slices at 0.6 mm intervals i.e. whole lung scanned at approx standard beam intens ity (50 mA) Approx 2 mm slices at 2 mm intervals 1.25 mm at 10 mm intervals i.e. only abut 10% of the lung scanned Commonly, 5 mm slices at 5 mm intervals with thinner slices reconstructed from same data. W hole lung scanned. 200 \200\223400 mA beam intensity Technique Multiple beam equalization improves contrast by varying beam intensity depending on tissue density 5 or 10 mm slices at 5 or 10 mm intervals i.e. whole brain scanned Variable, approximately 1 1.5 \200\2232 7 0 2 1 4 Probable higher effective dose due to contrast medium scattering of radiation 0.04 Variable, approximately 4 to 8 (higher in US where 400 mA more common). Larger doses of con trast medium scatter more radiation into nearby tissues Radiation dose mSy or mGy (x 100 for mrad) R A D O L O G C A L I I I N V E S T G A T O N S A N D I 5 days 2 years 4 months 1.3 years 4 months 7 months 2.3 years 0 8 months Radiation dose (equivalent to background radiation in UK) I 1 150 25 100 23 44 175 0 50 Radiation dose (equivalent to numbers of CXRs) R A D A T O N E X P O S U R E I I Lower resolution Usually combined with CT so add on up to another 6 mSy No structural information or the ability to make alternative diagnoses Same as ordinary CT Lower beam intensity produces lower resolution 8.5 mm gaps, so early cancers may be missed Limitations Poorer resolution so secondary pulmonary lobule not visualized 8 4 3 APPENDIX 7 Radiological investigations 844 Different departments/countries will use different protocols, e.g. some will always do a st andard CT as well as an HRCT in case a malignant nodule is missed. Radiation dose estimates are fraught with many assumptions and estimates, there is signi \201 cant uncertainty in some areas. 1 mSy in the dose of absorbed radiation produced by exposure to 1 mGy of radiation 1 mSy=10 0 mrad absorbed dose (mSy includes quality factor (type of radiation and nature of tissue), but for Xrays and most tissues, mSy and mGy are numerically identical (for alpha emitters 1 mGy causes 20mSy)). Background radiation approximately 3 mSy/year (mainly from radiation in the home, and varie s across the country); transatlantic \202 ight = extra 0.03 mSy. 845 Appendix 8 Useful websites APPENDIX 8 Useful websites 846 Thoracic societies American College of Chest Physicians www.chestnet.org American Thoracic Society www.thoracic.org British Society for Allergy and Clinical Immunology www.bsaci.org British Thoracic Society www.brit-thoracic.org.uk Canadian Thoracic Society www.lung.ca Eur opean Respiratory Society dev.ersnet.org Society of Thoracic Surgeons www.sts.org Thoracic Society of Australia and New Zealand www.thoracic.org.au Thoracic journals American Journal of Respiratory and Critical Care Medicine ( \200\230Blue journal \200\231) ajrccm.atsjournals.org American Journal of Respiratory Cell and Molecula r Biology www.ajrcmb.atsjournals.org Chest www.chestjournal.org European Respiratory Journa l access via www.ersnet.org Thorax thorax.bmj.com General journals British Medical Journal bmj.bmjjournals.com Free medical journals site www .freemedicaljournals.com Journal of the American Medical Association jama.ama-assn.org The Lancet www.thelancet.com National Library of Medicine (Pub Med) www.ncbi.nlm.nih.gov/entrez /query.fcgi New England Journal of Medicine content.nejm.org Teaching resources Drugs that cause lung disease www.pneumotox.com Evidence-based medicine site www.bestbets.org Simple thoracic and other anatomy site www.anatomy.uams.edu Cardiotho racic imaging www.info.med.yale.edu/intmed/cardio/imaging/ Supercourse lectures on public h ealth www.pitt.edu/ super1 University of New South Wales teaching/pathology site web.med.un sw.edu.au/pathmus Fitness to drive www.dvla.gov.uk Charities British Lung Foundation www.lunguk.org www.charitiesdirect.com www.charity-commis sion.gov.uk 847 Index prognosis 113 treatment 113 amyloidosis 612 abscess classi \201 cation 594 de \201 nition 594 epidemiology 594 lung involvement 614 pathophys iology 600 lung 446, 448, 450 peripheral cold 491 ACE see angiotensin converting enzyme ascariasis 525 aspergilloma 157, 466, 474 aspergillosis allergic bronchopulmonary acetazolamide 179 acid-base balance 798, 802 acid maltase de \201 ciency 93 ACTH, ectopic 283 actinomycosis 454 acupuncture/acupressure, 220, 229, 467 anaphylaxis 642 bronchopulmonary 468 invasive 470 semi-invasive 466, 472 Aspergillus fumigatus 466 Aspergil lus lung management 642 ANCA 651 angiotensin converting enzyme 535 angiotensin converting and smoking cessation 710 acute respiratory disease 466, 475 enzyme inhibitors, and cough 19 anion gap 800 ankylosing spondylitis 197 anthrax 456 antibi otics 76 aspiration 376 aspiration pneumonia 192, assessment service 179 acute respiratory distress 195, 442 clinical features 444 syndrome 101 clinical features 103 complications 104 de \201 nition and aspirin-induced asthma 125 bronchiectasis 154 community-acquired asthma 121 acute severe 128 etiology 122 Aspergillus 467 aspirin-induced 125 in children 342 chronic 1 32 clinical features 124 cough 16 de \201 nition 122 diagnosis 124 differential diagnosis 127 dif \201 cult/refractory 138 epidemiology 122 hospital treatment 130 investigations 12 6 non-pharmacological management 136 pneumonia 430 \200\2231, 433 epidemiology 102 COPD 173 desensitization 214 intravenous 214 pneumocystis diagnosis 103 future developments 105 management 104 pathology and pneumonia 460 diagnosis 102 pulmonary sepsis 210, 212 resistance 431 see also individual drugs prognosis 104 adrenaline, nebulized 641 adult respiratory distress antihistamines syndrome 31 air embolism 416 airway 22 allergic rhinitis 148 cough 14 anti-TNF agents, pulmonary anesthetic help 742 management 741 post-lung transplant 326 toxicity 512 l-antitrypsin de \201 ciency 33, 182 airway bypass 181 aldehydes, toxicity 602 allergen avoidance 136, 148 allergic bronchopulmo nary aspergillosis 220, 229, 467 anxiety 718, 720 Arnold-Chiari malformation occupational 142 pathophysiology 122 in pregnancy 140 referral 130 risk factors 128 severit y 128 steroid-resistant 139 vocal cord 92, 574 arti \201 cial lungs 105 asbestos 107, 364 allergic rhinitis 148 allergy, fungal spore 467 altitude sickness 238 aluminum 364 alveolar hemorrhage 190 alveolar microlithiasis 611 ambisentan 395 amikacin 509 aminoglycosides 211 aminophylline 130, 178 amiodarone 596 ammonia, toxicity 603 amniotic \202 uid compensation 118 diffuse pleural thickening 110 lung disease 108 mechanisms of dysfunction 146 atelectasis 190 rounded 111 exposure 108 mesothelioma 114 pleural effusion 110 pleural plaques 110 rounded atelectasis 111 attendance allowance 672 autoantibodies 198 auto \202 uorescent asbestosis 31, 112 bronchoscopy 754 causes 112 clinical features 112 de \201 nition 112 diagnosis 113 differential diagnosis 1 12 investigations 112 azathioprine 264, embolism 416 amoebic pulmonary disease 525 amoxicillin 431, 433 amylase, pleural \202 uid 55 676, 678 pulmonary toxicity 596 sarcoidosis 555 azithromycin 163, 509 848 INDEX multicentric 336 pathophysiology 150 progressive bacterial colonization 154 rheumatoid arthritis 188 Bacillus anthracis see anthrax bacterial infections 419 catamenial pneumothorax 383 see also individual infections CD4 count 80 ceforoxime 433 cefotaxime 431, 433 ceftazidime 433 ceftriaxone 431, 433 cefuro xime 431 central airway barium sulfate 364 barotrauma 240 BCGosis 516 BCG vaccination 515 beclomethasone 132 bronchiolitis 159 acute 163 causes 161 constrictive 160, 161 de \201 nition 160 epidemiology 160 management 162 pathophysiology 160 proliferative 160, 161 inhaler 686 Beh et \200\231s syndrome 198 benzylpenicillin 431, 433 beraprost 394 berylliosis 370 bery llium 364 biomarkers 127 biopsy obstruction 752 central sleep apnoea 582 causes and clinical features 584, 586 bronchitis, acute 647 bronchoalveolar lavage 36, investigations 588 sleep studies 588 70, 750 chemical pleurodesis 379, HIV patients 82 bronchial 750 lung see lung biopsy transbronchial 750 776 bronchodilators 172, 178 reversibility 126, 175 complications 777 sclerosants 777 bronchopulmonary aspergillosis 468 bronchoscopy 745, 70, blastomycosis 482 bleomycin, pulmonary chemical pneumonitis 444 chest drains 757, 376 complications 758 contraindications 758 indi cations 758 insertion technique 760 management 762 types of 758 toxicity 596 blood gasses 96, 791 127, 286 auto \202 uorescent 754 central airway A-a gradient diagram 796 \200\2237, 799 interpretation 792 \200\2234, 797 obstruction 752 HIV patients 82 indications and risks 746 interventional 754 patient preparation 748 proced ure 750 rigid 755 sampling techniques 750 therapeutic Bode index 169 body mass index converter 806 chest pain 7 acute pleuritic 8 chronic 9 body plethysmography 834 bosentan 395 brachytherapy 755 brain metastases 718 breast feeding , and antituberculosis drugs 503 breathing 22 breathlessness see chest wall deformity 700 chest X-ray 838 \200\2239 Cheyne-Stokes breathing 4, 575 procedures 755 altitude-associated 586 left ventricular failure 586 tuberculosis 488 bullectomy 180 bupropion (Zyban) 732 Burkholderia cepacia 208, children asthma 342 lung disorders 339 obstructive sleep apnoea 578 Chlamydia burnetti, dyspnoea 212 British Orphan Lung Disease (BOLD) project 610 bronchial biopsy 750 bronchial brushings 750 bronchial provocation Burkholderia pseudomallei see meliodosis busulphan, pulmonary antibiotic treatment 433 Chlamydia pneumoniae 421 antibiotic treatment 433 toxicity 597 Buteyko breathing technique 136 tests 126 Chlamydia psittaci 421 bronchial stent 755 bronchial thermoplasty 139 bronchial tumor 40 bronchial washings 750 br onchiectasis 31, 40, 149 calcium channel blockers 394 antibiotic treatment 433 chlorambucil, pulmonary candidal pneumonia 485 candidiasis 644 Caplan \200\231s syndrome 189, 367 capreomycin 509 c arbon monoxide poisoning 606 management 607 carbon monoxide transfer 833 toxicity 597 chlorine, toxicity 603 chloroquine, etiology 150 and aspergillus 156 causes 151 clinical features 152 complications 156 compute d sarcoidosis 555 chronic eosinophilic pneumonia 232 radiation-induced 601 chronic lung disease of prematurity 340 chronic obstructive tomography 822 carcinoid tumors 310 de \201 nition 150 diagnosis 152 epidemiology 150 investigations 152 \200\2233 management 154, 156 thymic 334 pulmonary disease 165, 319 Castleman \200\231s disease 336 angio-follicular Bode index 169 clinical features 167 hyperplasia 336 INDEX 849 de \201 nition and congenital de \201 nition 166 diagnosis 168 ethical issues 668 exacerbations 176 \200\2237 management 178 investigations 168 MRC dyspnoea scale 169 nocturnal hypoxia 581 non-pharmacological ma nagement 170 pathophysiology 206 abnormalities 343 diagnosis 207 fertility 224 genetics 206 hypertonic saline 218 management 207, 216, connective tissue disease 185 differential diagnosis 186 investigations 187 see also individual conditions 218 non-pulmonary disease 222 physiotherapy 218 pneumothorax 383 pulmonary sepsis 208, consolidation 34 continuous positive airway pressure 694 outpatient sleep apnoea 86, 574 management 174 overlap syndrome 581 pathology 166 pharmacological COPD see chronic 210, 212 obstructive pulmonary disease recombinant DNase 218 screening 206 cystic teratoma 335 cysts 336 cytokine modulators 138 c ytomegalovirus cor pulmonale 201 management 172 pulmonary function causes and pathophysiology 202 tests 168 severity 169 signs 167 surgical treatment 180 chronic thromboembolic clinical features 203 de \201 nition 202 investigations 203 management 203 pneumonia 535 D-dimer 408 corticosteroids see steroids Corynebacterium diptheriae 646 pulmonary hypertension 398 modi \201 ed Geneva Score 409 test interpretation Churg-Strauss cough syndrome 31, 229, 233, 651, 660 409 etiology and clinical assessment 12 decongestants 148 depression 720 dermatomyositis 192 chylothorax 51, 54 ciclesonide 132 cilomilast 173 cipro \202 oxacin 433, 509 circulation 2 2 cirrhosis 51, 223 clarithromycin 431, 433, causes 15 chronic 11 palliative care 718, 721 post-infectious 18 treatment 14 cough syncope 12 Coxiella burnetti 421 creatine kinase 192 CREST syndrome 194 cricothyroidotomy 763, diagnosis 193 desquamative interstitial pneumonia 276 dextromethorphan 14 diabetes 509 cystic \201 brosis- related 223 and tuberculosis 505 diaphragmatic hernia 343 diffuse alv eolar coal dust 364 coal-workers \200\231 pneumoconioses 366 764 \200\2235 co-amoxiclav 431 cocaine, toxicity 603 coccidioidomycosis critically ill patients 21 cause of illness 22 intensive therapy unit 689 treatment aims 23 Crohn \200\231s disease 248 crycoarytenoid arthritis 189 cryptococcosis 484 cryptogenic hemorrhage 25 investigations 26 management 27 483 codeine 14 coeliac disease 248 colchicine 264 cold agglutinins 163 collagen vascular di sease 399 community-acquired pneumonia 420 diffuse lung disease 29 anatomy 30 causes 30 \200\2231 clinical assessment and imaging 32 haemoptysis 42 cryptogenic organizing pneumonia 270 diagnosis 34 investigations 36 diffuse pleural antibiotics 430 \200\2231, 433 clinical features 422 follow-up 434 investigations 426 manag ement 428 organisms causing 421 severity assessment 424 \200\223 CURB pneumonia severity thickening 110 dipro \202 oxacin 433 diro \201 lariasis 526 disability 22 disability livi ng score 424, 438 cyclophosphamide 264, 676, 680 pulmonary toxicity 598 regimes 681 sarcoidosis 547 cystic adenomatoid allowance 672 disabled persons tax 5 credit 672 treatment failure 432 computed tomography lung 343 distal intestinal obstructive cystic \201 brosis 205, 151, 320 syndrome 222 patterns of lung disease 815 asthma 220 clinic visits 226 diuretics 76 diving 240 \200\2231 thoracic anatomy 807 850 INDEX in \202 ammatory bowel disease 248 portopulmonary endothelin receptor antagonists 395 eosinophilia, tropical DNase nebulized 156 recombinant 218 hypertension 246 pulmonary 230, 527 doxapram 179 Dressler \200\231s syndrome 51 drug-induced lung disease 594 amiodarone 596 an ti-TNF agents 596 azathioprine 596 bleomycin 596 busulphan 597 chlorambucil 597 cyclophosph amide 598 gold 598 methotrexate 598 nitrofurantoin 599 oxygen 599 penicillamine 599 present ation and causative gastro-oesophageal re \202 ux disease 16 eosinophilic lung disease 228 ge \201 tinib 293 gentamicin 211, 433 germ cell tumor 335 giant cell arteritis 651, 662 gl actomannan 471 gold causes 229, 230, 232 de \201 nition 228 eosinophil inhibitors 138 epiglottitis, acute 640 epoprostenol 394 Epworth Sleepiness Scale 89, 570 erdosteine 173 erlotinib 293 erythromycin 163, 431, 433 etanercept, pulmonary pulmonary toxicity 598 side effects 186 Goodpasture \200\231s syndrome 27, 33, 36, 651, 657 granuloma 549 ground-glass change 34 Guillain-Barr toxicity 596 ethambutol 496, 498 adverse reactions 506 ethical issues 665 syndrome 93 agents 594 sulphasalazine 599 talc 599 chronic obstructive pulmonary disease 668 lung cancer 670 neurological disease 670 haematopoietic stem cell transplant 68, 74 hemoglobin dissociation curve 803, 802, 802 Haem ophilus in \202 uenzae see drug-induced pulmonary eosinophilia 231 Duchenne muscular dystrophy 93 ethionamide 509 excessive daytime sleepiness 87 in \202 uenza dyspnoea 4 haemoptysis 40, 221, cardiac vs respiratory extreme environments 475, 490 diagnosis 40 differential diagnosis 40 examination 40 history 40 investigations 42 management 43 massive 221 causes 6 235 causes 5 clinical assessment 4 episodic/intermittent 6 investigations 4 MRC dyspnoea scale 169 normal chest X-ray 6 palliative care 716 \200\22317, 720 physiological altitude sickness 238 diving 240 \200\2231 \202 ying 236 extrinsic allergic alveolitis see hypersensitivity pneumonitis exudative pleural effusion 5 0 haemosiderosis, idiopathic pulmonary 613, 620 mechanisms 4 post-operative 57 pregnancy 61 haemothorax 360 Hamman-Rich fat embolism 417 \201 brinolytics 351 \201 brosis see idiopathic pulmonary \201 brosi s \201 nancial entitlements 671 \202 ow-volume loop 828 \200\2239 \202 uoroquinolone 433 \202 uticasone 132 inhaler 686 syndrome 103 Hand-Schueller-Christian Echinococcus syndrome 622 hantavirus pulmonary syndrome 539 granulosus 524 Echinococcus multilocularis 524 hay fever 148 Heaf test 493, 552 height converter 806 heliox 641 hepatic hydrothorax 244 he patopulmonary syndrome 244 economy class syndrome 405 embolectomy 413 Empey index 831 emphysema 166, 337 \202 ying 236 thromboembolism prophylaxis 415 computed Form DS1 500 673 Francisella tularensis see tomography 818 congenital lobar 343 empyema 51, 352, 448 bacteriology 354 investigations 35 4 management 356 hereditary haemorrhagic telangiectasia 389, 618 hernia, diaphragmatic 343 hilar amyloidosis 614 hilar/mediastinal tularaemia fungal infections 465 see also individual infections fungal spore allergy 467 lymphadenopathy 550 differential diagnosis 551 dif \201 culties in 357 gastrointestinal disease 243 hepatic hydrothorax 244 hepatopulmonary syndrome 244 outcome 357 histoplasmosis 33, 480 home oxygen therapy empyema necessitatis 353 endobronchial 706, 710 ultrasound 754 INDEX 851 Kartagener \200\231s syndrome 151 Kussmaul \200\231s breathing 798 Kvein test 552 idiopathic pulmonary \201 brosis 262, 320 honey and lemon 14 hospital-acquired causes and pneumonia 436 pathophysiology 262 management 436, 438 risk factors 436 \200\2237 Lady Windermere syndrome 518 clinical features 262 de \201 nition 262 diagnosis 263 differential human immunode \201 ciency Lambert-Eaton myasthenic virus 79 syndrome 283 clinical assessment 80 investigations 80 non-tuberculous Langerhans \200\231 cell diagnosis 263 epidemiology 262 histology 263 investigations 262 management 264, 266 histiocytosis 33, 622 computed mycobacterial 520 tomography 818 laryngeal amyloidosis 614 laryngeal mask airway 743 laryngitis 647 laryngosc opy 127 latex allergy 144 Legionella spp., antibiotic pneumothorax 383 pulmonary hypertension iloprost 395 imipenem 433 immunocompromised 389, 399 respiratory disease 83 tuberculosis 504 see also patients 67 causes of disease 72 clinical assessment 68 differential diagnosis 74 HIV see human immunocompromised patients hydatid disease 524 hydatid embolus 417 hydrocarbon toxicity 604 hydroxychloroquine 555 hygiene hypothesis 123 hypercalcaemia 304, 556 treatment 433 Legionella pneumophilia 421 Lemierre \200\231s syndrome 446, immunode \201 ciency virus 646 investigations 70 treatment 76 leptospirosis 462 differential diagnosis 463 Letterer-Siwe disease 622 leukotriene receptor antagonists 148 immunotherapy 675 management 304 hypereosinophilic asthma 136 patient advice and monitoring 676 syndrome 229, 232 levo \202 oxacin 431 Light \200\231s criteria 46 liver disease 504 lobar collapse 840 L f \202 er \200\231s syndrome 229, 230 L fgren \200\231s syndrome 550 low molecular weight hypersensitivity tuberculosis 509 see also individual drugs pneumonitis 249, 466 causes 250 computed tomography 824 de \201 nition 250 diagnosis 252 differential diagnosis 253 epidemiology 250 management 254 pathophysiology 251 prognosis 254 incapacity bene \201 t 672 industrial diseases disablement bene \201 t 672 in \202 ammatory bowel disease 248 heparin 412 in \202 iximab, pulmonary lung abscess toxicity 596 clinical features 446 diagnosis 448 differential diagnosis 449 management 450 lung biopsy 7 71, 37, 70 in \202 uenza 208, 210, 421 antibiotic treatment 433 diagnosis 532 management 534 vaccination 173, 434, 535 hyperthyroidism 399 hypertrophic pulmonary osteo-arthropathy 283 asthma 127 HIV patients 82 mesothelioma 115 radiologically guided 287 hyperventilation inhalational lung injury syndrome 255 clinical features 256 de \201 nition 256 diagnosis 256 differential diagnosis 257 management 257 pathophysiology 256 prognosis 257 602, 604 inhalers 684 instructions for use 687 types of 686 lung cancer 279 adenocarcinoma 280 alveolar cell carcinoma 280 carcinoid tumors 310 diagnostic intensive therapy unit 689 intubation 742 invasive aspergillosis 470 ipratropium bromide procedures 286 hypnosis, and smoking cessation 732 epidemiology 280 ethical issues 665 hypercalcaemia 304 investigations 284 non-small cell inhaler 686 iron oxide 364 isoniazid 494, 496, 498 hypoxia chronic 398 palliative care 720 adverse reactions 506 interactions 499 itraconazole 475 chemotherapy 292 radiotherapy 294 \200\2235 surgery 290 idiopathic cough 19 idiopathic interstitial Japanese pneumonia 259, 261 palliative care 714 pulmonary nodules panbronchiolitis 162 de \201 nition 260 diagnosis 260 treatment 260 kanamycin 509 Kaposi \200\231s sarcoma 82 312, 314 852 INDEX computed mandibular advancement lung cancer (cont.) radio-frequency ablation 298 tomography 826 devices 573 see also individual infections Mantoux test 493, 552 measles 539 mediastinal Mycobacterium avium complex 518 screening 316 small cell 280, 296 spinal cord Mycobacterium kansasii 518 Mycobacterium abnormalities 331 approach to patient 333 nature of 333 compression 308 malmoense 518 squamous cell Mycobacterium tuberculosis mediastinal amyloidosis carcinoma 280 see tuberculosis 614 staging 288 \200\2239 superior vena caval Mycobacterium xenopi 518 Mycoplasma mediastinal anatomy 332 mediastinal \201 brosis 337 mediastinal lymph node obstruction 300, 300 symptoms and signs 282 WHO histological pneumoniae 421 antibiotic treatment 433 stations 751 mediastinitis 337 mediastinoscopy 286 mediastinotomy 286 melioidosis 460 menth ol 14 meropenem 433 mesothelioma 51, 114 mycoses, endemic classi \201 cation 281 lung function tests 827 lung metastases 823 lung transplant 317, 18 0, blastomycosis 482 coccidioidomycosis 483 histoplasmosis 33, 480 paracoccidioidomycosis 218, 266 complications 483 myotonic dystrophy 93 acute rejection 328 airway 326 chronic rejection 328 disease recurrence 329 drug-related 32 7 early graft biopsy 115 clinical course 117 clinical features 114 de \201 nition 114 differential diagn osis 114 histological narcolepsy 87 nasopharyngeal airway 742 nebulizers 684 nedocromil sodium inhaler 686 negati ve pressure ventilators 694 dysfunction 326 subtypes 115 investigations 114 palliative care 714 peritoneal 117 staging 115 treatment 11 6 infection 326 malignancy 329 neuromuscular contraindications 319 follow-up 324 indications 318 investigations 322 outcomes 324 patient selection 318 routine surgery after 324 sarcoidosis 547 surgical approaches 322 timing of referral 320 underlying conditions 318 weakness 700 neurosarcoma 334 nicotine replacement therapy 732 metabolic acidosis 798 metabolic alkalosis 798 methacholine challenge Nijmegen hyperventilation score 258 nitric oxide 105 nitrofurantoin, pulmonary testing 769 methaemoglobin 607 methotrexate 676, 680 toxicity 599 nitrogen dioxide toxicity 604 nocardiosis 452 nocturnal hypoventilation pulmonary toxicity 598 sarcoidosis 547 side effects 186 methyl isocyanate toxicity 603 lung volume 828, 835 lung volume reduction see central sleep apnoea surgery 180 lupus pernio 556 lupus pneumonitis 190 lymphadenopathy 35 lymphangioleio microscopic polyangiitis non-invasive ventilation 27, 651, 656 693, 178 mineral oil toxicity 604 mometasone 132 motor neuron disease 93 moxi \202 oxacin 431 MRC d yspnoea scale 169 MRSA 212 mucolytics 173 mucous gland acute respiratory failure 698 chronic respiratory failure 700 myomatosis 624 diagnosis and contraindications 697 COPD 701 cystic \201 brosis 701 indications 696 sleep apnoea 701 management 626 lymphangitis carcinomatosis 283 computed hyperplasia 166 Murray lung injury score 102 tomography 825 see also continuous positive pressure ventilation troubleshooting 699 non-speci \201 c int erstitial pneumonitis 268 lymphoid interstitial pneumonia 278 lymphoma 196, 336 myasthenia gravis 93 Eaton-Lambert syndrome 93 MacLeod \200\231s syndrome 343 macrolide antibiotics 155 magnesium sulfate 130 Mallampati i ndex 591 mycetoma 474 mycobacterial computed infections 487 tomography 822 INDEX 853 clinical features 346 coronary artery bypass pleuritic 715 palliative care 713 anxiety 718, 720 brain metastases 718 cough 718, 721 dysp noea 716 \200\22317, 720 hypoxia 720 lung cancer and non-tuberculous mycobacteria 220, 518 graft 361 management 520 diagnostic algorithm 48 differential diagnosis 51 exudative 50 HIV patients 83 imaging 346 malignant 348 obesity 93, 590 obstructive sleep apnoea 568, 579 alternative diagnosis 574 Cheyne-Stokes mesothelioma 714 non-malignant respiratory management 350 palliative care 718 pleural thickening 348 pulmonary embolism 360 rheumatoid arthritis 188 rheumatoid arthritis- associated 360 ventilation 575 in children 578 clinical features 570 continuous positive airway disease 720 pleural effusion 718 poor appetite 718 panbronchiolitis diffuse 162 Japanese 162 pressure 574 \200\2235 de \201 nition and epidemiology 582 transudative 49 tuberculous 358 pancreatic enzymes 222 pancreatitis 51, 222, 248 paracoccidioidomycosis driving advice 576 future developments 580 management 572 overlap syndrome 581 pathophysiol ogy 582 sleep studies 571, 572, 572 pleural \202 uid amylase 55 analysis 52, 54 appearance 53 aspiration 114 differential cell count 53 pH 54 tr iglyceride and 483 paragonimiasis 527 parapneumonic effusion 51, 352 occupational asthma 142 bacteriology 354 investigations 354 management 356 causes 143 diagnosis 142 management 144 risk factors 142 cholesterol 54 pleural plaques 110 pleurisy 196 pleuritic chest pain 8 pleuritis 188 pleuro desis 775, 351 chemical 379, 776 dif \201 culties in 357 outcome 357 oesophageal rupture 51 o \202 oxacin 509 omalizumub 134 opiates 716 cough 14 paraquat poisoning 600 parasitic infection 523 see also individual infections parenchymal amyloid 614 PAR (patient at risk) scoring oral allergy syndrome 125 organizing pneumonia pleuroperitoneal shunts 354 system 691 188, 192 computed pneumoconioses 363 PAS 509 peak \202 ow measurements berylliosis 370 causative mineral dusts 364 \200\2235 coal-workers \200\231 366 silicosis 3 68 SWORD 365 tomography 816 radiation-induced 602 oropharyngeal airway 742 orthopnoea 4 Osler-Weber-Rend u syndrome see hereditary haemorrhagic telangiectasia osteoporosis 223 overlap syndromes 19 4 oxygen 703, 172, 178, 377 126, 830, 832 reference ranges 836 penicillamine pulmonary toxicity 599 side effects 186 Pneumocystis jiroveci 476 pneumocystis pneumonia peri-operative complications, risk factors 66 diagnosis 476 treatment 478 peripheral nerve sheath pneumonia tumors 334 acute eosinophilic 232 acute interstitial 272 aspiration see aspiration acute therapy 704 home therapy 706, 710 long-term therapy 706 portable supply 711 practical issues 710 pulmonary toxicity peritoneal mesothelioma 117 pharyngitis, acute 646 pholcodine 14 phosgene toxicity 604 phosphodiestera se pneumonia candidal 485 chronic eosinophilic 232 community-acquired see community-acquired pneumonia 599 inhibitors 138, 395 photodynamic therapy 755 piperacillin 433 pleural biopsy see lung suppliers 711 oxygen alert card 705, 705 ozone toxicity 604 PaCO2 92 pain cryptogenic organizing 270 cytomegalovirus 535 desquamative biopsy pleural effusion 45, 345, bone metastases 715 breakthrough 715 neuropathic 715 palliative care 714 35, 73 interstitial 276 eosinophilic, computed tomography 816 asbestos-related 110 clinical assessment 46 854 INDEX chronic obstructive pneumonia (cont.) management 59 pulmonary disease 168 hospital-acquired see hospital-acquired pneumonia post-polio syndrome 584 Pott \200\231s disease 491 pregnancy pulmonary hypertension 385, 190, 195 chronic idiopathic interstitial 259 invasive aspergillus 466 lymphoid interstitial 278 non-speci \201 c asthma in 140 dyspnoea 61 normal physiological thromboembolic 398 classi \201 cation 387, 386 \200\2237 idiopathic 321, 388 changes 62 clinical features 390 disease-targeted therapy 394 end of life care 396 management 392 surg ical treatments 376 interstitial 268 pulmonary embolism 414 tuberculosis 502 organizing see organizing pneumonia pneumocystis see pneumocystis pneumonia usual interstitial 31 varicella 537 venti lator-acquired 440 viral 530 pneumonitis pre-operative assessment 65 primary ciliary dyskinesia 628 progressive systemic sclerosis 27 non-idiopathic causes 398 management 400 pulmonary nodules 188, prostacyclin analogs 394 prothionamide 509 pseudochylothorax 54 Pseudomonas aeruginosa 312, 314 pulmonary oedema cardiogenic 31 computed chemical 444 hypersensitivity see hypersensitivity pneumonitis 155, 208, 210 antibiotic treatment 433 pulmonary alveolar proteinosis 630 clinical features 631 diagnosis and tomography 825 re-expansion 383 lupus 190 non-speci \201 c pulmonary sepsis 208 \200\2239 antibiotics 210, 212 interstitial 268, 822 pneumothorax 373, 220 treatment 632 epidemiology 630 histology 630 pathophysiology 612 pulmonary arteriovenous ma lformations 634 pulmonary thromboembolic disease see pulmonary embolism aspiration 779 catamenial 383 causes and pyrazinamide 494, 496, 498 interactions 499 pathophysiology 374