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

3. 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

4. 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.

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

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

7. 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.

8. 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.

9. 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.

10. 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

11. 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.

12. 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.

13. 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

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

15. 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

16. 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

17. 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.

18. 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

19. 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.

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

21. 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.

22. 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.

23. 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

24. 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.

25. 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

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

27. 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.

28. 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

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

30. 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.

31. 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