AIRWAY

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INTRODUCTION

These respiratory diseases include:

1. Infections such as pneumonia.

2. Obstructive disorders that obstruct airflow into and out of

the lungs such as asthma, bronchitis and emphysema.

3. Restrictive disorders are conditions that limit normal

expansion of the lungs such as pneumothorax,

atelectasis, respiratory distress syndrome and cystic

fibrosis.

4. Cancers or exposure to Inhaled particles alter the

pulmonary function.

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GENERAL SYMPTOMS OF RESPIRATORY DISEASE

Hypoxia : Decreased levels of oxygen in the tissues

Hypoxemia : Decreased levels of oxygen in arterial blood

Hypercapnia : Increased levels of CO2 in the blood

Hypocapnia : Decreased levels of CO2 in the blood

Dyspnea : Difficulty breathing

Tachypnea : Rapid rate of breathing

Cyanosis : Bluish discoloration of skin and mucous

membranes due to poor oxygenation of the blood

Hemoptysis : Blood in the sputum

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RESPIRATORY INFECTIONS

Infections of the respiratory tract can occur in:

1. The upper respiratory tract or

2. The lower respiratory tract, or

3. Both.

Organisms capable of infecting respiratory structures include:

4. bacteria.

5. viruses: the majority of upper respiratory tract infections are caused by viruses as rhinovirus and Para-influenza virus.

6. fungi.

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THE COMMON COLD

The most common viral pathogens for the “common cold” are rhinovirus, parainfluenza virus, respiratory syncytial virus, adenovirus and corona virus.

• Manifestations of the common cold include:Rhinitis: Inflammation of the nasal mucosaSinusitis :Inflammation of the sinus mucosaPharyngitis : Inflammation of the pharynx and

throatHeadacheNasal discharge and congestion

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INFLUENZA

• Influenza is a viral infection that can affect the upper or

lower respiratory tract.

• Three distinct forms of influenza virus have been

identified: A ( the most common and causes the most

serious illness) B and C.

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Symptoms of influenza infection: HeadacheFever, chillsMuscle achesNasal dischargeUnproductive coughSore throat

Treatment of influenza: Bed rest, fluids, warmth Antiviral drugs Influenza vaccine :Provides protection against certain

A and B influenza strains that are expected to be prevalent in a certain year.

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ATELECTASIS

Atelectasis is a condition in which there is incomplete expansion of lung tissues due to blockage of the airways or compression of the alveolar sacs.

Manifestations of atelectasis:

• Dyspnea, cough.

• Reduced gas exchange.

• Shunting of blood to areas of the lungs that are inflated.

Treatment of atelectasis:

• Removal of airway blockage

• Removal of air, blood, fluids, tumors, etc. that are compressing lung

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ADULT RESPIRATORY DISTRESS SYNDROME (ARDS)

• ARDS is a syndrome associated with destruction of alveolar membranes and their related capillaries

• It may occur as a result of direct injury to the lungs or as a result of dramatic decreases in blood flow to the lung (“shock lung,”)

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Causes:• Septicemia, uremia• Trauma• Near drowning• Inhalation of toxic gases or agents• Aspiration of gastric contents• Widespread pneumonia• Drug overdose• Systemic shock• Dyspnea, tachypnea.• Hypoxemia/ Hypocapnia• Accumulation of fluids in alveoli and around alveolar

spaces.• Changes in blood pH due to altered blood levels of CO2.

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Treatment:• Oxygen therapy• Anti-inflammatory drugs• Diuretics to reduce edema• Correction of acid–base balance

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SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES

Cardinal Symptoms Cough Sputum Hemoptysis Dyspnea Wheezes Chest pain

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Other presenting symptoms

Apnea

Hoarseness

Stridor

Snoring

Fever

Night sweating

Weight loss

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a) Acute cough Acute bronchitis Pneumonia Pulmonary Embolism

b) Chronic cough (>2 weeks) Bronchial asthma Chronic bronchitis Lung cancer

c) Sputum Lung abscess ( Foul smelling, more on lying on

the other side of lesion) Pneumonia ( yellowish, streaks of blood) Pulmonary edema ( Pink frothy)

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d) Hemoptysis Lung cancer ( clots) Tuberculosis Pneumonia

e) Dyspnea

Acute dyspnea (hours to days) Bronchial asthma Pneumonia Massive pleural effusion Pulmonary edema

Chronic dyspnea (months to Years) Chronic bronchitis Emphysema

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f) Wheezes (Rhonchi) Bronchial asthma COPD Pulmonary embolism Lung cancer

g) Chest pain Pulmonary infarction Pneumonia Angina pectoris

h) Cyanosis (>5gm% of Hb deoxygenated)• Central (blue hands & tongue) COPD, Asthma,

Pneumonia, PE• Peripheral (blue hands & red tongue) Cold weather

DISEASES OF THE RESPIRATORY SYSTEM• Chronic Bronchitis results from irritation of the bronchi

and bronchioles. This causes more tissues to secrete excess mucous. In chronic bronchitis, the air passages clog with mucous. This causes a constant cough. This disease can result from cigarette smoking.

• Chronic Obstructive Pulmonary Disease (COPD) is a combination of asthma, emphysema, and chronic bronchitis. It usually results from exposure to cigarette smoke.

• Lung cancer It usually results from smoking or prolonged exposure to dangerous materials in the air.

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PNEUMONIA

• Pneumonia is an infection of the alveoli. Bacteria or viruses can cause it. Fluid collects in the alveoli. This means they cannot exchange oxygen and carbon dioxide efficiently.

Signs/symptoms:• High fever• Chills• Shortness of breath• Increased breathing rate• A worsening cough that may produce discolored or bloody

sputum (phlegm)• Sharp chest pains – caused by inflammation of the

membrane that lines the lungs.

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Types:

a. Community acquired pneumonia (CAP)

b. Aspiration pneumonia

c. Hospital

–Hospital acquired pneumonia (HAP)

–Ventilator associated pneumonia (VAP)

–Healthcare associated pneumonia (HCAP)

Treatment of pneumonia:

• Antibiotics if bacterial in origin.

• Oxygen therapy for hypoxemia.

• A vaccine for pneumococcal pneumonia is currently available and highly effective.

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TUBERCULOSIS

• The most common symptoms and signs of TB are:•Fatigue •fever• weight loss•coughing•hemoptysis•night sweats

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ACUTE PULMONARY OEDEMA

• It occurs when fluid quickly accumulates in the lungs and fills the alveoli

• This can cause problems with the exchange of gas (oxygen and carbon dioxide), resulting in breathing difficulty and poor oxygenation of blood.

• Treatment： oxygen, digitalis, diuretics

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CHRONIC OBSTRUCTIVE PULMONARY DISEASE( COPD)

• It is a chronic, progressive disorder characterized by airway obstruction and little/no reversibility.

Comprises of:• chronic bronchitis• emphysema• asthma

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Chronic Bronchitis:

It is defined clinically as cough, productive of sputum, on most days for 3 months of 2 successive years.

Emphysema:

Is defined histologically as enlargement of the air spaces distal to the terminal bronchioles, with destruction of the alveolar walls

Asthma:

Characterized by recurrent episodes of dyspnea, cough(often nocturnal) and wheeze caused by reversible airway obstruction

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Chronic bronchitis EmphysemaMild Dyspnea Dyspnea that may be

severe

Productive cough Dry or no cough

Cyanosis common Cyanosis rare

Respiratory infection common

Infrequent infections

Onset usually after 40 years of age

Onset usually after 50 years of age

History of cigarette smoking

History of cigarette smoking

Cor pulmonale common Cor pulmonale in terminal stages

Comparison of Symptoms for Chronic Bronchitis and Emphysema

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CATEGORIES OF COPD• Type A - “Pink Puffer”- predominantly emphysema• Type B - “Blue Bloaters- predominantly chronic bronchitis.

Investigations:• ABG• CXR to exclude infection and pneumothorax• FBC, U&E, ECG• blood cultures( if pyrexial)

Management:• Controlled oxygen therapy• Nabulized bronchodilators e.g. albuterol (ventolin)• Antibiotics if evidence of infection (amoxicillin)

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EMPHYSEMA

• Emphysema is a respiratory disease that is characterized by destruction and permanent enlargement of terminal bronchioles and alveolar air sacs

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Signs and symptoms of emphysema• barrel-chest appearance• non productive cough• severe exertional dyspnea• pink skin color(pink puffer)• wheezing and ronchi• pursed-lip breathing(prolonged inspiration)

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Asthma

It is characterized by recurrent episodes of dyspnoea, cough and wheeze caused by reversible airways obstruction.

Contributing factors:

Bronchial muscle contraction, mucosal swelling/inflammation, increased mucosal production

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Manifestations of asthma :

Coughing, wheezing Difficulty breathing Rapid, shallow breathing Increased respiratory rate Excess mucus production Significant anxiety Hyper inflated chest Hyper resonant percussion note

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Common Asthma causes:• Animals (pet hair or dander) • Dust • Changes in weather (most often cold weather) • Chemicals in the air or in food • Exercise • Mold • Pollen • Respiratory infections, such as the common cold • Strong emotions (stress) • Tobacco smoke

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Management:

Beta 2 receptor agonist(Salbutamol)

Corticosteroids

Aminophylline (decreases bronchoconstriction)

Anticholinergics(e.g. Ipratropium) may decrease muscle spasm

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Manifestations of chronic bronchitis:• Productive, chronic cough• Production of purulent sputum• Frequent acute respiratory infections• Dyspnea, shortness of breath, wheezing, fatigue• Hypoxia, cyanosis• Fluid accumulation (edema) in later stages

BRONCHITIS

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• Chronic inflammation and swelling of the peripheral airways

• Excessive mucus production and accumulation• Partial or total mucus plugging• Hyperinflation of alveoli (air-trapping)• Smooth muscle constriction of bronchial airways

(bronchospasm)

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