CHEST Board Review: SEEK Sessions-SEEK Board Review Session 2023: Dr. Darcy Marciniuk

Video Transcription
Video Summary
In this video, the speaker discusses various topics related to pulmonary medicine. The first topic is spirometry, specifically the conduct and interpretation of spirometry. The speaker presents a question regarding the required usability criteria for spirometry and provides four choices. The correct answer is "no glottal closure in the first second of expiration." The speaker explains that quality assurance in spirometry has traditionally been based on acceptability and repeatability criteria, but the concept of usability has been introduced in recent technical statements to enable clinical utility even when all technical acceptability criteria are not met. The speaker also highlights the minimum usability criteria, which include a back extrapolated volume of less than 5% of the forced expiratory capacity or 100 ml, whichever is greater.<br /><br />The second topic discussed is the initiation of long-term nocturnal non-invasive ventilation in patients with COPD. The speaker presents a case and four choices representing different patient scenarios, and the correct answer is a patient who was discharged from the hospital with an acute exacerbation of COPD four weeks ago, with a PACO2 of 52 mmHg and a pH of 7.36, and who is clinically stable. The speaker explains that there is evidence supporting the use of non-invasive ventilation in stable patients with significant COPD and hypercapnic respiratory failure. The guidelines recommend considering initiation of nocturnal non-invasive ventilation in stable patients with a PCO2 greater than 46 mmHg or 52 mmHg, depending on the guideline, and the patient should be supervised by experienced practitioners who routinely care for chronic hypercapnic COPD patients.<br /><br />The third topic is the use of triple inhaled therapy (ICS-LABA-LAMA) versus dual bronchodilator inhaled therapy (LABA-LAMA) in patients with moderate to severe COPD and a history of frequent or severe exacerbations. The speaker presents a question asking which statement is true, and the correct answer is that triple therapy improves lung function, health-related quality of life, and reduces exacerbations and mortality compared to LABA-LAMA therapy. The speaker explains that there is evidence demonstrating the benefits of triple therapy in this patient population, including improvements in lung function, symptoms, health status, and a reduced risk of exacerbations and mortality.<br /><br />The fourth topic is the interpretation of a methacholine challenge test in a patient with shortness of breath. The speaker presents a case of a patient who underwent a methacholine challenge test while on inhaled medication and has negative results. The speaker explains that long-acting beta-agonists and anticholinergics can decrease bronchial hyperresponsiveness, causing false negative results. The next most appropriate step in management would be to repeat the methacholine challenge test at least 36 hours following the last administered dose of the inhaled corticosteroid long-acting beta-agonist combination. This is because these medications need to be withheld for an appropriate period of time to accurately assess bronchial reactivity.<br /><br />The video concludes with references to the sources and guidelines mentioned throughout the presentation.
Keywords
pulmonary medicine
spirometry
usability criteria
non-invasive ventilation
COPD
triple therapy
methacholine challenge test