VA AM Report (Tapas-Report) Pearls: Dyspnea Pearls

VA AM Report Mini-Pearls

We had Tapas-Report at the VA this AM (educational small-plates) and the following are just a small sampling of the many flavors we tasted. Bon Apetit!

Mini Pearl from Jim Brown via Jeff Kohlwes and Goop: A rule of thumb to follow in the management of reactive airway disease is as follows: Ok to give beta blockers as long as there is no concurrent wheezing. If the patient is wheezing, they have demonstrated that they don’t have much wiggle room left and giving beta blockade might not be safe.

Mini Pearl from Geoff Stetson: The latest on COPD/Asthma Overlap Syndrome (see attached) from Drazen. N Egl J Med 373;13

ACOS – Asthma-COPD overlap syndrome is now the accepted term for the clinical condition in which a patient has features of both asthma and COPD.

Both of these conditions are characterized by airway inflammation BUT the difference is this:

-Asthma: inflammation involves eosinophils and Th2 lymphocytes

-COPD: inflammation involves neutrophils and CD8 lymphocytes

Future research will look to better characterize patients with an end to better defining this syndrome and linking patients to optimal treatment modalities.

Mini Pearl from LT: When a patient presents with dyspnea, pulmonary edema on CXR, and a story that isn’t necessarily consistent with the usual suspects, don’t forget about Toxin-Related Noncardiogenic Pulmonary Edema (NCPE).

NCPE can be caused by inhaled irritants such as chlorine (very common), ammonia, and acid fumes, scorpion envenomation, and the inhalation of the smoke of certain woods such as poison oak. As always the HISTORY is key!

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