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  <head>
    <title>015-02 Respiratory phenotypes, progression mechanisms, and treatment selection</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Respiratory phenotypes, progression, and treatment selection">
      <outline text="Asthma beyond episodic bronchospasm">
        <outline text="Type two inflammation: eosinophils, immunoglobulin E"/>
        <outline text="Neutrophilic, mixed, and paucigranulocytic patterns"/>
        <outline text="Phenotype guides steroids and biological therapy"/>
        <outline text="Remodelling: epithelial injury, muscle, matrix">
          <outline text="Variable obstruction can become partly fixed"/>
        </outline>
        <outline text="Breathless despite controlled airway inflammation">
          <outline text="Dysfunctional breathing, obesity, reflux, deconditioning"/>
        </outline>
        <outline text="Intubation risk: lost tone, worsened trapping"/>
      </outline>
      <outline text="Chronic obstructive disease as traits">
        <outline text="Emphysema, small airways, mucus, exacerbation, frailty"/>
        <outline text="Spirometry confirms physiology, not burden"/>
        <outline text="Dynamic hyperinflation cuts inspiratory capacity">
          <outline text="Bronchodilation improves exercise despite modest spirometry"/>
        </outline>
        <outline text="Inhaled corticosteroid: fewer exacerbations, more pneumonia">
          <outline text="Guided by exacerbations, eosinophils, asthma overlap"/>
        </outline>
        <outline text="Rehabilitation breaks the dyspnoea and inactivity cycle"/>
      </outline>
      <outline text="Bronchiectasis and microbial ecology">
        <outline text="Mucus, cilia, immunity, aspiration, microbial community"/>
        <outline text="Repeated broad antibiotics select resistance"/>
        <outline text="Stable sputum baseline, exacerbation comparison"/>
        <outline text="Macrolides: antimicrobial and immunomodulatory effect">
          <outline text="Check repolarisation, hearing, resistance, mycobacteria"/>
        </outline>
        <outline text="Treat the driver, not only the infection"/>
      </outline>
      <outline text="Interstitial disease and progressive fibrosis">
        <outline text="Inflammation, fibrosis, granuloma, exposure, or vessels"/>
        <outline text="Ground-glass opacity is non-specific">
          <outline text="Filling, thickening, inflammation, haemorrhage, oedema"/>
        </outline>
        <outline text="Traction and distortion mean established change"/>
        <outline text="Vital capacity stable when emphysema offsets restriction"/>
        <outline text="Progression across symptoms, physiology, or imaging"/>
        <outline text="Ask tasks, materials, ventilation, protection, hobbies"/>
      </outline>
      <outline text="Pulmonary vascular classification">
        <outline text="Pre-capillary: resistance without left-sided pressure"/>
        <outline text="Post-capillary follows left-heart pressure"/>
        <outline text="Lung disease and hypoxia constrict and reduce bed"/>
        <outline text="Chronic thromboembolic obstruction, then microvascular change"/>
        <outline text="Echocardiography estimates, catheterisation measures"/>
        <outline text="Vasodilators can harm left-heart or lung disease"/>
        <outline text="Embolism risk: pressure, right-heart function, biomarkers"/>
      </outline>
      <outline text="Infection, pleura, and source control">
        <outline text="Infection plus parenchymal response, imaging may lag"/>
        <outline text="Microbiology when severity or resistance changes therapy"/>
        <outline text="Detection is not causation: colonisation, shedding"/>
        <outline text="Aspiration site follows position and anatomy">
          <outline text="Chemical pneumonitis can settle with support"/>
        </outline>
        <outline text="Pleural infection: invasion, acidity, loculation">
          <outline text="Undrained space keeps sepsis despite susceptibility"/>
        </outline>
        <outline text="Tuberculosis joins individual and public health"/>
      </outline>
      <outline text="Lung cancer and treatment reserve">
        <outline text="Staging plus molecular and immune profiling"/>
        <outline text="Obtain enough tissue for histology and biomarkers"/>
        <outline text="The easiest lesion may set the highest stage"/>
        <outline text="Resectability: predicted function, exercise, cardiac risk"/>
        <outline text="Checkpoint therapy can inflame lung and organs"/>
        <outline text="New dyspnoea needs a broad differential"/>
      </outline>
      <outline text="Synthesis and longitudinal review">
        <outline text="Name the compartment and dominant physiological defect"/>
        <outline text="Cause or exposure, activity, structural reversibility"/>
        <outline text="Exacerbation risk and systemic consequence"/>
        <outline text="One broad label makes treatment imprecise"/>
        <outline text="Track symptoms, function, gas exchange, burden"/>
        <outline text="Keep rapid access for sudden deterioration"/>
      </outline>
      <outline text="Multimorbidity and valued outcomes">
        <outline text="One improved measurement may not restore function"/>
        <outline text="Anaemia, heart failure, weakness still limit exercise"/>
        <outline text="Undernutrition, depression, disturbed sleep as well"/>
        <outline text="Walking improves through peripheral muscle efficiency">
          <outline text="Breathing technique and reduced anxiety help"/>
        </outline>
        <outline text="Judge activities, exacerbations, admissions, medication burden"/>
      </outline>
      <outline text="Oxygen and exacerbation review">
        <outline text="Oxygen follows stable-state hypoxaemia and criteria"/>
        <outline text="Symptoms alone do not justify long-term oxygen"/>
        <outline text="Exacerbation oxygen reassessed after recovery"/>
        <outline text="Walking or sleep desaturation made explicit"/>
        <outline text="Safety, flame, portability, flow, humidification"/>
        <outline text="Look for a new process, not variation">
          <outline text="Infection, missed doses, technique, allergen, smoke"/>
          <outline text="Heart failure, embolism, or pneumothorax"/>
        </outline>
        <outline text="Sputum colour alone is not bacterial infection"/>
        <outline text="Rebuild the model when response fails"/>
      </outline>
    </outline>
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