Rapid Acquisition Of Key Concepts Pulmonology

Predictors of Survival After Lung Transplantation

1 Year Survival

≥10 Year Survival

Donor factors

HCV donor

Recipient factors

Age <70 years

Diagnosis other than pulmonary fibrosis, pulmonary hypertension, sarcoidosis, A1AT 

O2 requirement <5L

Cl >2

Outpatient at time of transplant 

Preserved recipient eGFR 

Total bilirubin <2

Age 18-35 years

Donor/Recipient Factors

Non female to male transplant 

Donor/recipient weight ratio >0.7

Higher levels of HLA matching

Operative factors

Avoidance of unplanned conversion to cardiopulmonary bypass 

Decreased ischemic time

Bilateral lung transplant 

Posttransplant factors

Pa07/Fi02>260 at 72h 

Absent need for postoperative ECMO support

Fewer hospitalizations for rejection

Other factors

Higher center volume

Higher center volume

Community acquired pneumonia

• The pneumonia which does not satisfy 
• HAP
• VAP
• HCALP
• Are known as community acquired Pneumonia.
• Patient admitted to hospital with another complaint.
• Pneumonia has occurred within 48 hours of hospitalisation. 
• No hospitalisation but pneumonia is present 

Hospital acquired pneumonia

• Pneumonia after 48 hours of hospitalisation
• Patient is not in intubation

Ventilator associated pneumonia

• Pneumonia > 48 hours after intubation

Healthcare associated pneumonia

• To identify the patients having multidrug resistant organism (earlier)

Definition

• Pneumonia (No HAP or VAP)
• History of
• Hospitalisation >48 hours in last 98 days 
• Within two are three months, if the patients had:
• IV infusion
• Chronic hemodialysis 
• Wound care
• Chemotherapy 

• HAP and VAP are studied as the single entity (Similar bacteria)

• Lobar Pneumonia (Typical) or
• Definitive sign on consolidation: Air bronchogram 
• Localization: Silhouette sign 
• Tracheal and esophageal shadows are obscured by white opacity:
• Upper lobe involvement
• Opacity is not distinguished from the cardiac border 
• Right mid lobe consolidation
• Opacity is not distinguished from the diaphragmatic margin 
• Lower lobe consolidation.

• Air filled sacs (Pneumatocele)
• Seen in staphylococcus infections.
• Seen in the paediatric population.
• Rare in adults

• Bulging Fissure sign 
• Indicates Klebsiella Pneumonia
• Clues can be – chronic alcoholism, red currant jelly sputum.
• Upper lobe consolidation
• Interlobar Fissure is bulging downwards

• Atypical Pneumonia
• Bilateral diffuse alveolar opacity

Initial Treatment Strategies for Outpatients with Community Acquired Pneumonia

Status

Standard Regimen

No comorbidities or risk factors for antibiotic resistance

Combination therapy with amoxicillin (1 g tid) + either a macrolide or doxycycline (100 mg bid)

or

Monotherapy with doxycycline (100 mg bid)

or

Monotherapy with a macrolide

With comorbidities ± risk factors for antibiotic resistance

Combination therapy with

amoxicillin/clavulanate or a cephalosporin + ether a macrolide or doxycycline (100 mg bid)

or

Monotherapy with a respiratory fluoroquinolone

Antibiotic treatment within the past 3 months or contact with the health care system. Azithromycin (500 mg on day 1, then 250 mg/d for 4 days), clarithromycin (500 mg bid), or clarithromycin ER (1000 mg/d). If local prevalence of pneumococcal resistance is < 25%. Including chronic heart, lung, liver, or kidney disease; diabetes mellitus; alcoholism; malignancy, or asplenia. 500/125 mg tid or 875/125 mg bid. Cefpodoxime (200 mg bid) or cefuroxime (500 mg bid). Levofloxacin (750 mg/d), moxifloxacin (400 mg/d) or gemifloxacin (320 mg/d).

Class

Name

Age

Asthma indication

Other indications

Anti-IgE

Omalizumab (SC)

≥ 6 years

Severe allergic asthma

Nasal polyposis, chronic spontaneous urticaria

Anti-IL5

Anti-IL5R

Mepolizumab (SC)

Resilizumab (IV)

Benralizumab (SC)

≥ 6 years

≥ 18 years

≥ 12 years

Severe eosinophilic/ Type 2 asthma

Mepolizumab; EGPA, CRSwNP, hypereosinophilic syndrome

Anti-IL4R

Dupilumab (SC)

≥ 6 years

Severe eosinophilic/ Type 2 asthma, or maintenance OCS

Moderate severe atopic dermatitis, CRSwNP

Anti-TSLP

Tezepelumab (SC)

≥ 12 years

Severe asthma

TNM 8th – Primary tumor characteristics

Tx

T0

Tis

Tumor is sputum/ bronchial washings but not be assessed in imaging or bronchoscopy

No evidence of tumor

Carcinoma in situ

T1

T1a(mi)

T1a

T1b

T1c

≤ 3 cm surrounded by lung/visceral pleura, not involving main bronchus

Minimally invasive carcinoma

≤ 1 cm

> 1 to ≤ 2 cm

> 2 to ≤ 3 cm

T2

T2a

T2b

> 3 to ≤ 5 cm or

Involvement of main bronchus without carcina, regardless of distance from carina or invasion visceral pleural or atelectasis or post obstructive pneumonitis extending to hilum

> 3 to ≤ 4 cm

> 4 to ≤ 5 cm

T3

> 5 to ≤ 7 cm in greatest dimension or tumor of any size that involves chest wall, pericardium, phrenic nerve or satellite nodules in the same lobe

T4

> 7 cm in greatest dimension or any tumor with invasion of mediastinum, diaphragm, heart, great vessels, recurrent laryngeal nerve, carina, trachea, oesophagus, spine or separate tumor in different lobe of ipsilateral lung

N1

2

3

Ipsilateral peribronchial and/or hilar nodes and intrapulmonary nodes

Ipsilateral mediastinal and/or subcarinal nodes

Contralateral mediastinal or hilar; ipsilateral/ contralateral scalene/ supraclavicular

M1

M1a

M1b

M1c

Distant metastasis

Tumor in contralateral lung or pleural/pericardial nodule/ malignant effusion

Single extrathoracic metastasis, including single non-regional lymphnode

Multiple extrathoracic metastasis in one or more organs