Chronic Lung Disease Update

Family physicians are often the first to diagnose and treat individuals with chronic lung conditions. Chronic obstructive pulmonary disease affects more than 10% of the adult population and is the fourth-leading cause of mortality in the United States. Asthma is the most common chronic condition in childhood, and its prevalence is increasing in adults. Interstitial lung disease and cystic fibrosis are being managed more effectively so individuals with these conditions are living longer. For family physicians, ongoing challenges in caring for individuals with chronic lung disease include following patients from diagnosis through, possibly, end-of-life care and managing the interactions of chronic lung disease with other common comorbidities.

This edition of FP Essentials^TM will outline advances in the management of these four chronic lung conditions. The monograph should be approximately 10,000 words in length, divided into four sections of approximately 2,500 words each, plus a preface, key practice recommendations, a maximum of 15 tables and figures, recommended readings, and references. The monograph should focus on what’s new in each topic and should answer the key questions listed for each section. Each section should begin with an illustrative case, similar to those in the examples provided, with modifications to emphasize key points.The references listed below include information that should be considered in preparation of this edition of FP Essentials^TM. However, these references are only a useful starting point that should be used to identify additional information to review.

(Note: An edition of FP Essentials^TM on chronic obstructive pulmonary disease [COPD] was published in 2008, so the emphasis of this section of the monograph should be on new developments in COPD.)

Example case: Marcus, 52-year-old man, presents to your office reporting progressive shortness of breath and a cough that produces scant nonbloody phlegm during the past 6 months. The symptoms are interfering with his ability to function in his work as a carpenter. He has smoked 1 to 2 packs of cigarettes daily since he was a young man. While performing lung auscultation, you notice diminished breath sounds and scattered wheezes. Describe the most effective approach to the diagnosis and management of Marcus’s condition.

Key questions to consider:

Example case: The Smith family moved to the area from another state 6 months ago, and are presenting to your office for the first time. The parents are concerned about their 7-year-old daughter and 4-year-old son, who have each experienced increasing shortness of breath with vigorous activity and a dry cough at nighttime. The mother has a history of childhood asthma. The father smokes 1 pack of cigarettes daily but smokes outside the home. The Smiths recently brought a kitten into their home. Describe the diagnosis and management of asthma in these two children. Based on their ages, should there be differences in the approach to each patient?

Key questions to consider:

Example case: Alan, a 53-year-old man, presents to your office because of increasing shortness of breath associated with walking up stairs. He recently retired from the US Navy after a 30-year career in shipbuilding. He smoked as a young man but quit more than 20 years ago. The lung examination results reveal diffuse dry crackles. Describe the diagnosis and management of this man’s condition.

Key questions to consider:

Example case: Gina, a 24-year-old woman, has recently moved to the area and presents to your office for continued management of cystic fibrosis. Her prior physician, a pediatrician, retired a year ago and she recently ran out of her maintenance drug. On examination, she is thin but not frail. The lung examination results reveal adequate air movement with mild scattered rhonchi that easily clear with coughing. She asks you to renew the drug prescription and to review the current treatment plan. Describe the most effective management plan for this patient.

Key questions to consider: