(1)
Hôpital Ambroise Paré Service de Réanimation Médicale, Boulogne (Paris-West University), France
Pathophysiological Reminder of the Disease
These two diseases were put together for the sake of simplicity, since both are bronchial diseases where the respiratory hindrance comes from acute or chronic obstruction of the lumen, due to inflammatory, mechanical, or muscular actions.
The Usual Ways of Diagnosis
The dyspnea is classically more expiratory than inspiratory. Auscultation shows a major sign, wheezing. A stethoscope is usually required. Radiography shows distended lungs. Blood gases show classically hypocapnia in severe asthma and hypercapnia in EACOPD.
How Does the BLUE-Protocol Proceed? Which Signs? Which Accuracy?
The BLUE-protocol provides a basic piece of information: the patients have usually the A-profile (89 %). The A-profile calls for a venous investigation, which will be, by definition, negative. A DVT found in such patients would clearly indicate that the bronchial crisis, even if genuine, has maybe been generated by a genuine pulmonary embolism. When the venous network is free, the examiner comes back to the lungs, at the PLAPS-point. These locations will be, by definition, negative (if positive, the bronchial crisis is due to an external factor, likely a pneumonia). The whole profile (A-profile, no DVT, no PLAPS) is called the nude profile.
Asthma and COPD were analyzed separately. For asthma, the nude profile (A-profile, no DVT, no PLAPS) was seen in 94 % of cases. For COPD, the same nude profile was seen in 77.5 % of cases, PLAPS were present in 10 %, the B-profile in 6 %, and the C-profile in 2 %. We saw in Chap. 20 that such rates are maybe due to frequent diagnostic issues in COPD.