Differences

This shows you the differences between two versions of the page.

--- respiratory:start [2026/02/15 14:20] – andrew2393cns
+++ respiratory:start [2026/02/15 14:33] (current) – [How to Think About Dyspnea] andrew2393cns
@@ Line 1: / Line 1: @@
 ====== Respiratory Pharmacology ======
-{{tag>pharmacology respiratory}}
+==== Respiratory diseases fall into two fundamentally different categories: ====
-Respiratory pharmacology focuses on **airway tone**, **inflammation**, and **mucus**—the 3 big levers we manipulate in asthma/COPD and related conditions.
+<WRAP center round important 70%>
+  * AIRWAY PROBLEM → obstruction & bronchospasm → bronchodilators + inhaled anti-inflammatories
-Some respiratory diseases instead involve **alveolar injury and fibrosis**, which require completely different therapy (antifibrotics & immunosuppression).
+  *
+  * PARENCHYMAL PROBLEM → alveolar injury & fibrosis → antifibrotics & immunosuppression
+</WRAP>
 ----
-===== Quick Navigation =====
 <WRAP group>
 <WRAP half column>
-==== Obstructive Lung Disease (Core) ====
+===== Obstructive Physiology =====
+=== Airway Disease ===
+<WRAP info>
+  * Problem: Air Cannot Get OUT Of The Lung
+  * Usually Reversible
+</WRAP>
+==== Core Disorders ====
   * [[respiratory:asthma|Asthma]]
   * [[respiratory:copd|COPD]]
-  * [[respiratory:asthma_copd_step_therapy|Asthma vs COPD: Step Therapy (Quick Guide)]]
+  * [[respiratory:exacerbations|Acute Exacerbations]]
-  * [[respiratory:exacerbations|Acute Exacerbations (Asthma/COPD)]]
+  * [[respiratory:asthma_copd_step_therapy|Step Therapy Quick Guide]]
+----
 ==== Bronchodilators ====
   * [[respiratory:beta2_agonists|β2-Agonists (SABA/LABA)]]
   * [[respiratory:antimuscarinics|Antimuscarinics (SAMA/LAMA)]]
-  * [[respiratory:methylxanthines|Methylxanthines (Theophylline)]]
+  * [[respiratory:methylxanthines|Methylxanthines]]
-==== Interstitial Lung Disease ====
+----
-  * [[respiratory:ild:overview|ILD Overview]]
-  * [[respiratory:ild:ipf|Idiopathic Pulmonary Fibrosis]]
-  * [[respiratory:ild:sarcoidosis|Sarcoidosis]]
-  * [[respiratory:ild:hypersensitivity_pneumonitis|Hypersensitivity Pneumonitis]]
-</WRAP>
+==== Controllers (Reduce Inflammation) ====
+  * [[respiratory:inhaled_corticosteroids|Inhaled Corticosteroids]]
-<WRAP half column>
-==== Anti-Inflammatory Controllers ====
-  * [[respiratory:inhaled_corticosteroids|Inhaled Corticosteroids (ICS)]]
   * [[respiratory:leukotriene_modifiers|Leukotriene Modifiers]]
-  * [[respiratory:mast_cell_stabilizers|Mast Cell Stabilizers (Cromolyn)]]
+  * [[respiratory:mast_cell_stabilizers|Mast Cell Stabilizers]]
-  * [[respiratory:biologics|Biologics for Severe Asthma]]
-==== Pulmonary Fibrosis Therapy ====
+----
-  * [[respiratory:ild:antifibrotics|Antifibrotic Master Page]]
-  * [[respiratory:ild:nintedanib|Nintedanib]]
-  * [[respiratory:ild:pirfenidone|Pirfenidone]]
-==== Other Respiratory Topics ====
+==== Severe Asthma Biologics ====
-  * [[respiratory:cough_cold|Cough & Cold Medications]]
+  * [[respiratory:biologics|Biologics Master Page]]
-  * [[respiratory:allergic_rhinitis|Allergic Rhinitis Pharmacology]]
+  * [[respiratory:biologics:anti_ige|Anti-IgE]]
-  * [[respiratory:smoking_cessation|Smoking Cessation Pharmacology]]
+  * [[respiratory:biologics:anti_il5|Anti-IL-5 / IL-5R]]
-  * [[respiratory:antitussives_expectorants|Antitussives & Expectorants]]
+  * [[respiratory:biologics:anti_il4_13|Anti-IL-4/13]]
+  * [[respiratory:biologics:anti_tslp|Anti-TSLP]]
-</WRAP>
-</WRAP>
 ----
-===== Drug Classes =====
+==== Symptom Relief ====
+  * [[respiratory:antitussives_expectorants|Cough & Mucus Therapy]]
+  * [[respiratory:allergic_rhinitis|Allergic Rhinitis]]
+  * [[respiratory:smoking_cessation|Smoking Cessation]]
-==== β2-Agonists (Bronchodilators) ====
+</WRAP>
-  * [[respiratory:beta2_agonists:saba|Short-Acting β2 (SABA)]]
-  * [[respiratory:beta2_agonists:laba|Long-Acting β2 (LABA)]]
-==== Antimuscarinics (Bronchodilators) ====
+<WRAP half column>
-  * [[respiratory:antimuscarinics:sama|Short-Acting Muscarinic Antagonists (SAMA)]]
-  * [[respiratory:antimuscarinics:lama|Long-Acting Muscarinic Antagonists (LAMA)]]
-==== Inhaled Corticosteroids (Controllers) ====
+===== Restrictive Physiology =====
-  * [[respiratory:inhaled_corticosteroids:ics|ICS Master Page]]
+=== Parenchymal Disease ===
-  * [[respiratory:inhaled_corticosteroids:ics_laba|ICS/LABA Combinations]]
+<WRAP info>
+  * Problem: Lung Tissue Cannot Expand
+  * Usually Progressive
+</WRAP>
-==== Leukotriene Pathway ====
+==== Interstitial Lung Disease ====
-  * [[respiratory:leukotriene_modifiers:ltra|Leukotriene Receptor Antagonists (LTRA)]]
+  * [[respiratory:ild:overview|ILD Overview]]
-  * [[respiratory:leukotriene_modifiers:5lo|5-Lipoxygenase Inhibitor (Zileuton)]]
+  * [[respiratory:ild:ipf|Idiopathic Pulmonary Fibrosis]]
+  * [[respiratory:ild:sarcoidosis|Sarcoidosis]]
+  * [[respiratory:ild:hypersensitivity_pneumonitis|Hypersensitivity Pneumonitis]]
-==== Biologics for Severe Asthma ====
+----
-  * [[respiratory:biologics:anti_ige|Anti-IgE (Omalizumab)]]
-  * [[respiratory:biologics:anti_il5|Anti–IL-5 / IL-5R (Mepolizumab, Reslizumab, Benralizumab)]]
-  * [[respiratory:biologics:anti_il4_13|Anti–IL-4/13 (Dupilumab)]]
-  * [[respiratory:biologics:anti_tslp|Anti-TSLP (Tezepelumab)]]
-==== Antifibrotics (Pulmonary Fibrosis) ====
+==== Antifibrotic Therapy ====
+  * [[respiratory:ild:antifibrotics|Antifibrotic Master Page]]
   * [[respiratory:ild:nintedanib|Nintedanib]]
   * [[respiratory:ild:pirfenidone|Pirfenidone]]
-==== Immune-Mediated ILD Therapy ====
+----
+==== Immune-Mediated Lung Disease Treatment ====
   * [[immunology:steroids:systemic_glucocorticoids|Systemic Corticosteroids]]
   * [[immunology:dmards:mycophenolate|Mycophenolate]]
   * [[immunology:dmards:azathioprine|Azathioprine]]
   * [[immunology:biologics:rituximab|Rituximab]]
-==== Cough & Mucus ====
-  * [[respiratory:antitussives_expectorants:dextromethorphan|Dextromethorphan]]
-  * [[respiratory:antitussives_expectorants:benzonatate|Benzonatate]]
-  * [[respiratory:antitussives_expectorants:guaifenesin|Guaifenesin]]
-  * [[respiratory:antitussives_expectorants:mucolytics|Mucolytics (Acetylcysteine)]]
-==== Smoking Cessation ====
-  * [[respiratory:smoking_cessation:nrt|Nicotine Replacement Therapy (NRT)]]
-  * [[respiratory:smoking_cessation:varenicline|Varenicline]]
-  * [[respiratory:smoking_cessation:bupropion|Bupropion SR]]
 ----
-===== High-Yield Tables =====
+==== Key Clinical Distinction ====
+<WRAP center round tip 90%>
+  * Wheezing → bronchodilators
+  * Velcro crackles → antifibrotics
-^ Condition ^ First-Line Core ^ Add-Ons ^ Notes ^
+They treat completely different diseases.
-| Asthma | ICS (or ICS-formoterol strategy) | LABA, LAMA, LTRA, biologics | LABA **never** alone in asthma |
+</WRAP>
-| COPD | LAMA or LABA | LAMA/LABA, +/- ICS | ICS helps mainly with frequent exacerbations/eosinophils |
-| Pulmonary Fibrosis | Antifibrotic | Oxygen, transplant eval | Slows decline — does NOT reverse disease |
+</WRAP>
-| Acute bronchospasm | SABA | SAMA (esp COPD), systemic steroids | Think trigger + oxygenation |
+</WRAP>
 ----
-===== Build-Out Checklist (for you) =====
+===== High-Yield Comparison =====
-  * Create master pages: SABA/LABA, SAMA/LAMA, ICS, LTRA/5-LO, Biologics, Antifibrotics
-  * Add step therapy quick guides (Asthma & COPD) with 1-page algorithms
+<WRAP center round box 50%>
-  * Add device technique page (MDI vs DPI vs neb) + spacer pearls
+^ Feature ^ Airway Disease ^ Parenchymal Disease ^
-  * Add ILD pattern recognition quick guide (UIP vs NSIP vs HP)
+| Physiology | Obstructive | Restrictive |
+| Primary issue | Narrow airways | Scarred alveoli |
+| Reversibility | Often reversible | Progressive |
+| Main therapy | Bronchodilators ± ICS | Antifibrotics / Immunosuppression |
+| Clinical goal | Improve airflow | Slow decline |
+</WRAP>
 ----
-<WRAP info>
+===== How to Think About Dyspnea =====
-**Key Distinction:** Bronchodilators treat airway narrowing — antifibrotics treat lung scarring.
+<WRAP center round box 80%>
+  * Wheeze → Airway Drugs
+  * Crackles → Fibrosis Drugs
+  * Hypoxia Out Of Proportion → ILD Workup
 </WRAP>
+----