Dr. Hani Hussein, MD Respiratory department Jordan University Hospital Respiratory system Dr. Hani Hussein, MD Respiratory department Jordan University Hospital

Respiratory System Functions supplies the body with oxygen and disposes of carbon dioxide filters inspired air produces sound contains receptors for smell rids the body of some excess water and heat helps regulate blood pH

Organization and Functions of the Respiratory System Consists of an upper respiratory tract (nose to larynx) and a lower respiratory tract ( trachea onwards) . Conducting portion transports air. - includes the nose, nasal cavity, pharynx, larynx, trachea, and progressively smaller airways, from the primary bronchi to the terminal bronchioles Respiratory portion carries out gas exchange. - composed of small airways called respiratory bronchioles, alveolar ducts and alveoli.

The Respiratory Epithelium of the Nasal Cavity and Conducting System Figure 23.2

The symptoms of the respiratory disease Cough. Sputum production. Haemoptysis. Breathlessness(dyspnea). Chest pain. Wheeze Apnea. Others(weight loss, fever, fatigue…)

Cough Forced expulsive maneuver against initially closed glottis. Normal protective mechanism for clearing the tracheo-bronchial tree of secretions and foreign material. Patients seek medical advice when excessive, alteration their lifestyle or concern about ehe cause specially fear of cancer.

Can be voluntary or as reflex. Afferent pathway: receptors within the sensory distribution of the trigeminal, glossopharyngeal, superior laryngeal and vagus nerves. Efferent pathway: recurrent laryngeal nerve and the spinal nerves.

Acute: less than 3 weeks. Chronic: more than 8 weeks. The most common cause of acute cough is acute viral upper respiratory tract infection. frequency. Severity of cough: sever cough with airway obstruction cause cough syncope.

Causes Acute cough ( less than 3 weeks) Viral respiratory tract infection Bacterial infection(acute bronchitis) Inhaled foreign body Inhalation of irritant: dust/fumes. Pneumonia. Acute extrinsic allergic alveolitis Chronic cough(more than 8 weeks) GERD. Asthma Post viral hyper-reactivity. Chronic rhinitis/sinusitis Lung tumour. Tuberculosis. Interstitial lung disease. bronchiectasis Smoking . Medication: ACE inhibitors, Beta blocker

Sound: Bovine cough: hoarseness of voice suggest lung cancer invading the left recurrent laryngeal nerve. Whooping cough: pertusis. Moist cough: secretions(URTI, acute bronchitis, chronic bronchitis, bronchiactesis). Dry cough painful are seen in pneumonia and tracheitis.

Chronic dry cough: interstitial lung disease, drug induced cough, asthma. Timing of the cough: Morning productive cough: chronic bronchitis. Nocturnal cough: bronchial asthma. Daytime cough: GERD, chronic sinusitis. Cough that improved at weekends, holidays are seen in occupational asthma.

origin Common Causes Features Pharynx Post nasal drip persistent Larynx Laryngitis, croup, whooping cough, tumour Harsh, painful, persistent associated with stridor. Trachea Tracheitis Bronchitis (acute-chronic) Asthma Bronchial carcinoma Pneumonia Bronchiactesis Pulmonary edema Pulmonary TB Lung fibrosis Painful Productive, morning Dry or productive , worse at night or exposure to cold, allergens. Persistent with hemoptysis Dry initially then productive Excessive sputum, more in supine Night, white or pink sputum Different, fever, weight loss Dry ,irritant, disturbing Others Drug induced ACE inhibitors, Beta blocker

Sputum production Sputum expectoration always is abnormal. Amount. Viscosity. Color. Taste or smell. Solid material. Character.

Types of sputum Type Appearance Cause Serous Clear , watery Frothy may be pink. Acute pulmonary edema Alveolar cell CA(rare) Mucoid Clear, grey, white Viscid. Chronic bronchitis Asthma Purulent Yellow Green Acute bronchopulmonary infection Asthma (esinophils) Longer duration infection Pneumonia, cystic fibrosis, lung abscess, bronchiactasis Rusty Rusty red Pneumococcal pneumonia

Chronic bronchitis and COPD usually cause clear sputum if color changed this indicate infection. Yellow sputum: live neutropils in acute infection, esinophils in asthma. Green sputum due to lysed neutrophils. Rusty sputum caused by lysed RBCs. Foul smell or vile-tasting indicates anaerobic bacterial infection or empyema

Haemoptysis Coughing blood. Should always investigated. True haemoptysis or not. Amount of blood. Streaks of blood, fresh bright or clot. Duration: if more than one week think of LUNG CANCER.

causes of haemoptysis Tumour Malignant: Benign: Lung CA bronchial carcinoid Endobronchial metastases Infection Bronchiactesis, TB, lung abscess, cystic fibrosis Vascular Pulmonary infarction, AV malformation Vasculitis Wegner’s granulomatosis, goodpastures syndrome . Trauma Chest trauma, inhalation foreign body. Iatrogenic: due to procedure. Cardiac Mitral valve disease, acute left ventricular failure Hematological Bleeding disorders, anticoagulation

Breathlessness Undue awareness of breathing or the need to breath more. Shortness of breath, not enough air enter. Mode of onset: Sudden or gradual. Duration and progression. Variability, aggravating/ relieving factor. Severity. Associated symptoms.

Causes of dyspnea Non cardiopulmonary causes: Anemia, obesity, psychogenic, neurogenic, metabolic acidosis. Cardiac: Left ventricular failure, mitral valve disease, cardiomyopathy, percardial effusion, constrictive pericarditis.

Pulmonary: Airways: laryngeal tumor, foreign body, bronchial asthma, COPD, lung CA, bronchiactesis. Parenchyma: lung fibrosis, TB, pneumonia, sarcoidosis, tumor. Pulmonary circulation: PE, pulmonary HTN, pulmonary vasculitis.

Pleural: pneumothorax, effusion, diffuse pleural fibrosis Pleural: pneumothorax, effusion, diffuse pleural fibrosis. Chest wall: kyphoscoliosis, ankylosing spondylitis. Neuromascular: mysthenia gravis, neuropathies, muscular dystrophy, guillian barre syndrome.

Dyspnea (modes of onset, duration and progression) Minutes: PE asthma Pneumothorax acute left ventricular failure Inhaled foreign body Hours to days: Pneumonia Asthma Exacerbation of COPD. Weeks to months: Anemia respiratory neuromascular disorders Plueral effusion Months to years: Pulmonary fibrosis Pulmonary TB COPD

Chest pain Chest pain can originate from: The pleura The chest wall. The mediastinal structures. The lungs are not source of pain; autonomic innervations only.

Pleural pain: Sharp stabbing, increased by inspiration or coughing due to irritation to parietal pleura. Localized: upper six ribs Referred : irritation at the diaphragmatic part of the parietal pleura(phrenic nerve) to neck and shoulder. Lower six ribs: through intercoastal nerves, pain is in the upper abdomen

The most common causes of pleuritic chest pain : Pulmonary embolism. Pneumonia. Pneumothorax. Rib fracture

Chest wall pain: musculoskeletal Patient with chronic cough, asthma usually complaining from chest tightness. Sever lacerating may indicate malignancy. Mediastinal pain: Retrosternal,central pain. Pulmonary infarction, or tumor invading mediastinal structure.

Wheezing or stridor Wheeze: high pitched whistling sound produced by passage of air through narrowed small airways. usually during expiration, but may be in both inspiration and expiration in severe narrowing. stridor: rattling sound(loud) mostly during inspiration caused by partial obstruction of major airways

Wheeze: Bronchial asthma COPD Stridor: Upper airway obstruction Vocal cord dysfunction Tumor Foreign body

Apnea/hypopnea Apnea is absence of breathing, awareness of stoop breathing. Hypopnea: reduction in airflow or respiratory movements by more than 50% for 10 seconds or more. Obstructive sleep apnea: multiple apnea during sleep, excessive day time sleep, general weakness.

Weight loss: Consider significant weight loss if 10KG of weight during 3 months. Lung CA Pulmonary TB ,chronic infection or cystic fibrosis. Fever: High grade indicates infection Relapsing fever in Lung abscess or TB