2. 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. 2

3. 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 CO 2 in the blood  Hypocapnia : Decreased levels of CO 2 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 3

4. 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: 1. bacteria. 2. viruses: the majority of upper respiratory tract infections are caused by viruses as rhinovirus and Para-influenza virus. 3. fungi. 4

5. 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 mucosa  Sinusitis :Inflammation of the sinus mucosa  Pharyngitis : Inflammation of the pharynx and throat  Headache  Nasal discharge and congestion 5

6. 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. 6

7. Symptoms of influenza infection:  Headache  Fever, chills  Muscle aches  Nasal discharge  Unproductive cough  Sore 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. 7

8. 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 8

9. 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,”) 9

10. 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 CO 2. 10

11. Treatment: Oxygen therapy Anti-inflammatory drugs Diuretics to reduce edema Correction of acid–base balance 11

12. SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES Cardinal Symptoms  Cough  Sputum  Hemoptysis  Dyspnea  Wheezes  Chest pain 12

13. Other presenting symptoms Apnea Hoarseness Stridor Snoring Fever Night sweating Weight loss 13

14. 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) 14

15. 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 15

16. 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 16

17. DISEASES OF THE RESPIRATORY SYSTE M 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.

18. 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. 18

19. 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. 19

20. TUBERCULOSIS The most common symptoms and signs of TB are: Fatigue fever weight loss coughing hemoptysis night sweats 20

21. 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 21

22. 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 22

23. 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 23

24. 24 Chronic bronchitisEmphysema Mild DyspneaDyspnea that may be severe Productive coughDry or no cough Cyanosis commonCyanosis rare Respiratory infection commonInfrequent infections Onset usually after 40 years of age Onset usually after 50 years of age History of cigarette smoking Cor pulmonale commonCor pulmonale in terminal stages Comparison of Symptoms for Chronic Bronchitis and Emphysema Comparison of Symptoms for Chronic Bronchitis and Emphysema

25. 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) 25

26. EMPHYSEMA Emphysema is a respiratory disease that is characterized by destruction and permanent enlargement of terminal bronchioles and alveolar air sacs 26

27. 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) 27

28. 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 28

29. 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 29

30. 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 30

31. Management: Beta 2 receptor agonist(Salbutamol) Corticosteroids Aminophylline (decreases bronchoconstriction) Anticholinergics(e.g. Ipratropium) may decrease muscle spasm 31

32. 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 32 BRONCHITIS

33. 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) 33

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