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Oxford handbook of respiratory medicine PDF

933 Pages·2014·8.12 MB·English
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OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Respiratory Medicine Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation Programme 4e Oxford Handbook of Acute Medicine 3e Oxford Handbook of Anaesthesia 3e Oxford Handbook of Applied Dental Sciences Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Laboratory Investigation 3e Oxford Handbook of Clinical Dentistry 5e Oxford Handbook of Clinical Diagnosis 2e Oxford Handbook of Clinical Examination and Practical Skills 2e Oxford Handbook of Clinical Haematology 3e Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine – Mini Edition 8e Oxford Handbook of Clinical Medicine 9e Oxford Handbook of Clinical Pathology Oxford Handbook of Clinical Pharmacy 2e Oxford Handbook of Clinical Rehabilitation 2e Oxford Handbook of Clinical Specialties 9e Oxford Handbook of Clinical Surgery 4e Oxford Handbook of Complementary Medicine Oxford Handbook of Critical Care 3e Oxford Handbook of Dental Patient Care Oxford Handbook of Dialysis 3e Oxford Handbook of Emergency Medicine 4e Oxford Handbook of Endocrinology and Diabetes 3e Oxford Handbook of ENT and Head and Neck Surgery 2e Oxford Handbook of Epidemiology for Clinicians Oxford Handbook of Expedition and Wilderness Medicine Oxford Handbook of Forensic Medicine Oxford Handbook of Gastroenterology & Hepatology 2e Oxford Handbook of General Practice 4e Oxford Handbook of Genetics Oxford Handbook of G enitourinary Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Medicine 2e Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Evidence Oxford Handbook of Medical Dermatology Oxford Handbook of Medical Imaging Oxford Handbook of Medical Sciences 2e Oxford Handbook of Medical Statistics Oxford Handbook of Neonatology Oxford Handbook of Nephrology and Hypertension 2e Oxford Handbook of Neurology 2e Oxford Handbook of Nutrition and Dietetics 2e Oxford Handbook of Obstetrics and Gynaecology 3e Oxford Handbook of Occupational Health 2e Oxford Handbook of Oncology 3e Oxford Handbook of Ophthalmology 2e Oxford Handbook of Oral and Maxillofacial Surgery Oxford Handbook of Orthopaedics and Trauma Oxford Handbook of Paediatrics 2e Oxford Handbook of Pain Management Oxford Handbook of Palliative Care 2e Oxford Handbook of Practical Drug Therapy 2e Oxford Handbook of Pre-Hospital Care Oxford Handbook of Psychiatry 3e Oxford Handbook of Public Health Practice 3e Oxford Handbook of Reproductive Medicine & Family Planning 2e Oxford Handbook of Respiratory Medicine 3e Oxford Handbook of Rheumatology 3e Oxford Handbook of Sport and Exercise Medicine 2e Handbook of Surgical Consent Oxford Handbook of Tropical Medicine 4e Oxford Handbook of Urology 3e 1 Oxford Handbook of Respiratory Medicine Third Edition Stephen Chapman Consultant and Senior Lecturer in Respiratory Medicine, Oxford University Hospitals, Oxford Grace Robinson Consultant in Respiratory Medicine, Royal Berkshire Hospital, Reading John Stradling Professor of Respiratory Medicine, University of Oxford, Oxford Sophie West Consultant in Respiratory Medicine, Freeman Hospital, Newcastle John Wrightson Specialist Registrar, Respiratory Medicine, Oxford Rotation, Oxford 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 204 The moral rights of the authors have been asserted First Edition published in 2005 Second Edition published in 2009 Third Edition published in 204 Impression:  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 98 Madison Avenue, New York, NY 006, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2049303 ISBN 978–0–9–870386–0 Printed in China by C&C Offset Printing Co. Ltd Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding. Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. v I’m always full of awe for the Herculean efforts of the authors when asked to write a foreword to a book. The long hours that the authors of the Oxford Handbook of Respiratory Medicine put into the first edition, published in 2005, have been compensated by the book’s clear value and popularity. Since 2005, research has increased our understanding of respiratory dis- ease, particularly in the areas of airway disease, lung cancer and interstitial lung disease. Large robust clinical trials have also informed our clinical prac- tice, and there have been subsequent modifications in national and interna- tional guidelines to reflect these. Our practice on the respiratory ward and clinic has been influenced as a result. Nationally the burden of respiratory disease is being increasingly recog- nised. The government responses to the harmful effects of cigarette smoke, currently focused on banning smoking in cars carrying children, and con- sidering plain packaging for cigarettes, highlight the ongoing prominence of smoking in respiratory health. This third edition reflects many of these updates and changes, and is therefore a reliable and useful information source. The same authors across the three editions bring consistency (and reflects admirable stamina); and the need to keep it ‘user friendly’ for the respiratory trainee has been recog- nised and a new author has been added to provide a trainee’s perspective. Ian Pavord MA DM FRCP Professor of Respiratory Medicine NDM Research Building University of Oxford This respiratory medicine handbook provides reliable and up-to-date information for the respiratory trainee. Its format is designed so that infor- mation is easily accessible and practical, with useful tips for investigation and management in the outpatient clinic and the ward. It summarizes the most recent guidelines from the British Thoracic Society when applicable in each chapter, along with a detailed discussion of each condition, perti- nent research and common practice. As such, it could be used as a learning resource when preparing for the MRCP Speciality Certificate Examination in Respiratory Medicine, or other respiratory assessments. The practical procedures section is particularly useful, with step-by-step ‘how to’ guides for all procedures encountered by the trainee, such as pleural aspiration, chest drains, thoracoscopy, and bronchoscopy. Dr Adam Hill Consultant Respiratory Physician and Honorary Reader Royal Infirmary of Edinburgh Specialist Advisory Committee Chair Respiratory Associate PG Dean SE Scotland (Quality Management) Forewords vi This Handbook of Respiratory Medicine has been written largely by special- ist registrars, for specialist registrars. Three of the four authors, Stephen Chapman, Grace Robinson, and Sophie West, are specialist registrars on the Oxford rotation and John Stradling is Professor of Respiratory Medicine in Oxford. It is in a format that the authors would like to have had when they started their specialist registrar training. However, we hope that any health worker or student with an interest in respiratory medicine will find this text a rapid and useful reference source. The layout of the book tries to fulfil the requirement to be able to look up a topic quickly when the clinical need arises, but also to provide a bit more insight into the more difficult areas. Therefore, the chapters are of necessity different in style and reflect the authors’ own views on how to best approach and understand an area. The handbook is divided into five sections: clinical presentations and approaches to symptoms and problems; the clinical conditions themselves; supportive information; procedures; and useful appendices (also on the inside covers), containing more technical and reference information. We hope you find it helpful. Feedback on errors and omissions would be much appreciated. Please post your comments via the OUP website: M http://www.oup.com/uk/medicine/handbooks. June 2005 The second edition of this book has allowed us to make several improve- ments in response to readers’ suggestions. We have changed the order of chapters within each section to alphabetical and improved the index, to make the contents more rapidly accessible. We have added new content such as more detailed radiology, pandemic influenza, and pulmonary com- plications of sickle cell disease. In addition, we have updated and enhanced topics where there have been new guidelines and relevant publications. The overall aim of the book, to provide a rapid and comprehensive resource for all those involved in respiratory medicine, has remained paramount. October 2008 The third edition has allowed us to review and update all the existing chap- ters and include new clinical guidelines and significant research. New sec- tions on thoracic ultrasound and indwelling pleural catheters reflect changes in routine clinical practice since the previous editions. There are also new chapters on safe sedation and cardiopulmonary exercise testing. We wel- come the contribution of our new co-author, John Wrightson, who has helped maintain the specialist registrar perspective. September 203 Prefaces vii We would like to offer our grateful thanks to the following friends and col- leagues for their reviewing and advice on various sections of this book. First edition Dr Nicholas Bates, Dr Lesley Bennett, Dr Rachel Bennett, Dr Malcolm Benson, Dr Penny Bradbury, Mrs Debbie Buttar, Dr James Calvert, Dr Jane Collier, Dr Graham Collins, Dr Chris Conlon, Dr Chris Davies, Dr Helen Davies, Dr Rob Davies, Dr Thearina de Beer, Mrs Joan Douglass, Dr Rachael Evans, Dr Fergus Gleeson, Dr Maxine Hardinge, Dr Ling Pei Ho, Dr Andrew Jeffreys, Dr Nick Maskell, Dr Phil Mason, Dr Kim McAnaulty, Dr Fiona McCann, Dr Sarah Menzies, Dr Annabel Nickol, Dr Jayne Norcliffe, Dr Jeremy Parr, Mrs Lisa Priestley, Dr Naj Rahman, Dr Catherine Richardson, Mrs Jo Riley, Dr Peter Sebire, Mrs Gerry Slade, Dr Mark Slade, Dr S Rolf Smith, Dr Catherine Swales, Dr Denis Talbot, Dr David Taylor, Dr Catherine Thomas, Dr Estée Török, Dr David Waine, Dr Chris Wathen, Dr John Wiggins, and Dr Eleanor Wood. Second edition: additional acknowledgements Dr Luke Howard, Dr Clare Jeffries, Dr Stuart Mucklow, Dr Andrew Stanton, and Mrs Jan Turner-Wilson. Dr Fergus Gleeson and Dr Rachel Benamore provided considerable help with the radiology section. Third edition: acknowledgements Dr Henry Bettinson, Mr Peter Close, Dr Helen Davies, Mrs Julia De Soyza, Dr Prosenjit Dutta, Dr Rachael Evans, Dr Julia Fuller, Dr Helmy Haja-Mydin, Dr Bernard Higgins, Dr Ling-Pei Ho, Dr Rachel Hoyles, Ms Elaina Jamieson, Dr Alastair Moore, Dr Ben Prudon, Dr Naj Rahman, Mrs Jo Riley, Professor John Simpson, Dr Catherine Thomas, Mrs Jan Turner-Wilson, Dr Ann Ward. Acknowledgements viii Symbols and abbreviations xii Part  Clinical presentations—approaches to problems  Breathlessness 3 2 Chest pain 7 3 Chronic cough and a normal CXR  4 Critically ill patient with respiratory disease 2 5 Diffuse alveolar haemorrhage 27 6 Diffuse lung disease 3 7 Haemoptysis 43 8 Pleural effusion 49 9 Post-operative breathlessness 6 0 Pregnancy and breathlessness 65  Preoperative assessment 69 2 Pulmonary disease in the immunocompromised (non-HIV) 73 3 Pulmonary disease in the immunocompromised (HIV) 83 4 Sleep and ventilation 89 5 Unexplained ventilatory failure 95 Part 2 Clinical conditions 6 Acute respiratory distress syndrome 05 7 Asbestos and the lung  8 Asthma 25 9 Bronchiectasis 53 Contents SYMBOLS AND ABBREVIATIONS ix CONTENTS 20 Bronchiolitis 63 2 Chronic obstructive pulmonary disease (COPD) 69 22 Connective tissue disease and the lung 89 23 Cor pulmonale 205 24 Cystic fibrosis 209 25 Eosinophilic lung disease 23 26 Extreme environments—flying, altitude, diving 239 27 Gastrointestinal disease and the lung 247 28 Hypersensitivity pneumonitis 253 29 Hyperventilation syndrome 259 30 Idiopathic interstitial pneumonias 265 3 Lung cancer 283 32 Lung transplantation 39 33 Mediastinal abnormalities 33 34 Paediatric lung disorders pertinent to adult patients 339 35 Pleural effusion 343 36 Pneumoconioses 36 37 Pneumothorax 37 38 Pulmonary hypertension 383 39 Pulmonary thromboembolic disease 397 40 Respiratory infection—bacterial 47 4 Respiratory infection—fungal 46 42 Respiratory infection—mycobacterial 485 43 Respiratory infection—parasitic 523 44 Respiratory infection—viral 529 45 Sarcoidosis 549 46 Sickle cell disease—pulmonary complications 565 SYMBOLS AND ABBREVIATIONS x CONTENTS 47 Sleep apnoea and hypoventilation 569 48 Toxic agents 597 49 Unusual lung diseases 63 50 Upper airway diseases 64 5 Vasculitis and the lung 65 Part 3 Supportive care 52 Ethical issues 665 53 Financial entitlements 669 54 Immunosuppressive drugs 673 55 Inhalers and nebulizers 68 56 Intensive care unit (ICU)—when to involve 687 57 Non-invasive ventilation 69 58 Oxygen therapy 703 59 Palliative care 75 60 Pulmonary rehabilitation 727 6 Smoking cessation 733 Part 4 Practical procedures 62 Airway management 74 63 Bronchoscopy 747 64 Chest drains 76 65 Cricothyroidotomy 769 66 Miscellaneous diagnostic tests 773 67 Pleural biopsy 777 68 Pleurodesis 783 69 Pneumothorax aspiration 789 70 Safe sedation—general principles 79 7 Thoracentesis 797 SYMBOLS AND ABBREVIATIONS xi CONTENTS 72 Thoracic ultrasound 80 73 Thoracoscopy (medical) 83 74 Tracheostomy 89 Appendices  Blood gases and acid–base balance 825 2 BMI calculator; height and weight converter 839 3 CT anatomy of the thorax 84 4 CT patterns of lung disease 849 5 Drugs used for bronchoscopy and sedation 86 6 Lung function and cardiopulmonary exercise testing 867 7 Plain radiograph and lobar collapses 883 8 Radiological investigations and radiation exposure 887 9 Useful websites 89 Index 893 FEV nomogram—males inside cover FEV nomogram—females inside cover xii 22 don’t dawdle d decreased i increased l leading to ♀ female ♂ male ° primary 2° secondary 7 approximately 8 approximately equal to ± plus/minus > greater than < less than ≥ equal to or more than ° degree °C degree celsius α alpha β beta γ gamma +ve positive £ pound sterling ® registered trademark α-AT α-antitrypsin A–a alveolar to arterial gradient Ab antibody ABG arterial blood gas ABPA allergic bronchopulmonary aspergillosis ACCP American College of Chest Physicians ACE angiotensin-converting enzyme AChR acetylcholine receptor ACTH adenocorticotropic hormone ADH antidiuretic hormone A&E accident and emergency AF atrial fibrillation AFB acid-fast bacillus; autofluorescent bronchoscopy AFP alpha-fetoprotein AIA aspirin-induced asthma AIDS acquired immune deficiency syndrome AIP acute interstitial pneumonia AJCC American Joint Committee on Cancer Symbols and abbreviations SYMBOLS AND ABBREVIATIONS xiii ALP alkaline phosphatase ALT alanine aminotransaminase AMTS abbreviated mental test score ANA antinuclear antibody ANCA antinuclear cytoplasmic antibody ANP atrial natriuretic peptide APC argon–plasma coagulation APTT activated partial thromboplastin time ARDS acute respiratory distress syndrome ART antiretroviral therapy AST aspartate aminotransferase ASV adaptive servo-ventilation ATRA all-trans retinoic acid ATS American Thoracic Society AV arteriovenous AVM arteriovenous malformation BHCG beta human chorionic gonadotrophin BAL bronchoalveolar lavage BCG bacille Calmette–Guérin bd twice a day BDP beclomethasone BHR bronchial hyperreactivity or hyperresponsiveness BiPAP bi-level positive airways pressure bLVR bronchoscopic lung volume reduction BMI body mass index (kg/m2) BNP B-type natriuretic peptide BOOP bronchiolitis obliterans organizing pneumonia BOS bronchiolitis obliterans syndrome BP blood pressure BPD bronchopulmonary dysplasia bpm beats per minute BSAC British Sub-Aqua Club BTS British Thoracic Society CABG coronary artery bypass graft CAP community-acquired pneumonia CCB calcium channel blocker CCF congestive cardiac failure CCPA chronic cavitary pulmonary aspergillosis CF cystic fibrosis CFA cryptogenic fibrosing alveolitis CFT complement fixation test CFTR cystic fibrosis transmembrane conductance regulator cfu colony-forming unit CHART continuous hyperfractionated accelerated radiotherapy SYMBOLS AND ABBREVIATIONS xiv Chr chromosome CI contraindication CK creatine kinase Cl– chloride ion CLD chronic lung disease CLL chronic lymphocytic leukaemia cm centimetre cmH2O centimetre of water CMV cytomegalovirus CNS central nervous system CO carbon monoxide CO2 carbon dioxide COHb carboxyhaemoglobin COP cryptogenic organizing pneumonia COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure CPD continuous professional development CPET cardiopulmonary exercise testing CPK creatine phosphokinase CPPE complicated parapneumonic effusion CRP C-reactive protein CSA central sleep apnoea CSF cerebrospinal fluid CT computed tomography CTPA computed tomographic pulmonary angiogram CTEPH chronic thromboembolic pulmonary hypertension CVA cerebrovascular accident CVD cardiovascular disease CVP central venous pressure CXR chest radiograph 2D two-dimensional 3D three-dimensional DEXA dual-energy X-ray absorptiometry DFA direct fluorescent antibody DIC disseminated intravascular coagulation DIF direct immunofluorescence test DIOS distal intestinal obstructive syndrome DIP desquamative interstitial pneumonitis dL decilitre DM dermatomyositis DNA deoxyribonucleic acid DOT directly observed therapy (usually tuberculosis) DPI dry powder inhaler dsDNA double-stranded DNA DVLA Driver and Vehicle Licensing Agency

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