The Respiratory System

1
The Respiratory System

• Dr Enmei Liu
• Division of Respiratory Disorders
• Childrens Hospital

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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemoptysis
• Chest pain
• Breathlessness
• Wheeze

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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemopysis
• Chest pain
• Breathlessness
• Wheeze

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Cough
Origin Common causes Nature/characteristics
Pharynx Post-nasal drip Usually persistent
Larynx Laryngitis,tumor Harsh,barking
Trachea Tracheitis Painful
Bronchi Bronchitis Dry or productive
Asthma Dry or productive, Worse at night
Pneumonia Dry initially, productive later
Bronchiectasis Productive.Changes in posture induce sputum production



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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemoptysis
• Chest pain
• Breathlessness
• Wheeze

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Sputum
Type Appearance Cause
Serous Clear,watery,frothy, may be pink Acute pulmonary oedema
Mucoid Clear,grey,white, Chronic bronchitis, Asthma
Purulent Yellow, green, brown All types of bacterial infection
Rusty Rusty,golden yellow Pneumococcal pneumonia
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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemoptysis
• Chest pain
• Breathlessness
• Wheeze

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Causes of Haemoptysis
Common Uncommon Others
Pulmonary infarction Mitral stenosis Foreign body inhalation
Bronchial carcinoma Aspergilloma Chest trauma
Tuberculosis Bronchial adenoma Latrogenic
Lung abscess Metastatic pulmonary Bronchoscopy Transbronchial biopsy
Acute bronchitis Malignant disease
Chronic bronchitis Laryngeal tumours
COPD

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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemopysis
• Chest pain
• Breathlessness
• Wheeze

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Disorders--Causes of Chest Pain
Pleural Pneumonia Pulmonary infarction TB Malignant disease
Chest wall Rib fractures Direct invasion of chest by tumour Spinal nerve root involvement
Retrosternal Tracheitis Mediastinal tumours Oesophageal disorders
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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemopysis
• Chest pain
• Breathlessness
• Wheeze

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Increased Work of Breathing
Airflow obstruction Bronchial Asthma Chronic bronchitis and emphysema Tracheal obstruction
Decreased pulmonary compliance Pulmonary oedema Pulmonary fibrosis Extrinsic allergic alveolitis
Restricted chest expansion Ankylosing spondylitis Respiratory muscle paralysis Kyphoscoliosis
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Causes of Breathlessness
Physiological Exercise High altitude
Pathological Obesity Anaemia Respiratory disorders Cardiac disorders
Pharmacological Drug-induced respiratory disorders Drug-induced cardiac disorders
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Symptoms of Respiratory Disease

• Cough
• Sputum
• Haemopysis
• Chest pain
• Breathlessness
• Wheeze

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Case Study
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History
An 8-month-old girl presented to the emergency
room in respiratory distress associated with
wheezing and a temperature of 38.8C. She had
been ill for 2-3 days with a cold and have
awoken that morning with tachypnea, cough, and
wheezing.She had had a similar episode about 2
months before. In addition, she had a chronic
pruritic rash on the face, trunk, and extremeties
for 2 months which improved when treated with
cortisone-type cream. Her nose was always
running according to the mother. She had been a
very colicky baby for the first 6 months, but not
bothered by milk at present. A 10-year-old
brother had had a similar history in infancy, but
had outgrown these problems, having only
occasional hay fever now.
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Physical Examination
The infant was tachypneic, coughing and crying
with slight duskiness of the lips. Nasal exam
showed swollen, red nasal turbinates.There was
increased anterior-posterior diameter of the
chest with marked retractions. On auscultation
the air exchange was good with rhonchi and
diffuse wheezes heard throughout both lung
fields. An eczematous type rash was noted on the
face,trunk, and extremities. The child was given
an adrenalin shot with only slight improvement.
She was, therefore, admitted to the ward.
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Laboratory Data

• Chest film showed marked hyperaeration with no
• evidence of pneumonia
• CBC (complete blood count) showed normal
• Viral cultures several weeks later reported the
  recovery
• of respiratory syncycial virus (RSV).

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Clinical Course
After several days of supportive measures
including intravenous hydration and oxygen She
made an uneventful recovery.
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Questions
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This child probably has

1. recurrent brochiolitis
2. bronchial asthma
3. asthmatic bronchitis
4. wheezy bronchitis

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Which of the following suggests the correct
diagnosis?
A.     History of previous episodes B.    
Response to adrenalin C.     Family history D.
Presence of eczema, rhinitis, and
possible allergic gastroenteritis
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Answer this question true or false
The isolation of RSV helps distinguish
bronchiolitis from asthma.
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Which test might be useful in distinguishing
bronchiolitis from asthma?
A.     Peripheral blood and nasal
eosinophilia B.     Total serum IgE C.    
Allergic skin tests D. All of the above
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The most useful therapeutic Modalities for this
childs immediate problem include
A.     adequate hydration B.     humidified
oxygen C.     antibiotics D.
bronchodilators E. steroids
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To prevent future episode, which measures should
be taken?
A.     Allergy workup B.    Good dust and
animal avoidance C.     Nothing, since the child
will outgrow this D. Elimination
diet
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Summary
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Bronchial Asthma
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Asthma is a Major Public Health Problem

• Nearly 5 million children have asthma (6.9 of
  children under 18)
• It is one of the most common chronic childhood
  illnesses
• It is a leading cause of school absences

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In 1994, 17 countries in WHO GINA ? Global
Initiative for Asthma?
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Asthma is a chronic inflammatory disorder of the
airways in which many cells and cellular elements
play a role, in particular, mast cells,
eosinophils, T lymphocytes, macrophages,
neutrophils and epithelial cells. In susceptible
individuals, this inflammation causes recurrent
episodes of wheezing, breathlessness, chest
tightness, and coughing, particularly at night or
in the early morning. These episodes are usually
associated with widespread but variable airflow
obstruction that is often reversible either
spontaneously or with treatment. The inflammation
also causes an associated increase in the
existing bronchial hyperresponsiveness to a
variety of stimuli.
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What is Asthma?

• A disease that
• Is chronic
• Produces recurring episodes of breathing problems
• Coughing
• Wheezing
• Chest tightness
• Shortness of breath

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Environmental factors
Genetic predisposition
Bronchial Inflammation
Upper respiratory tract infection Allergens Exerc
ise Emotional upset
Bronchial Hyperreactivitytrigger factors
Oedema Bronchoconstriction Mucus Production
Airways Narrowing
Symptoms
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What are the Symptoms of Asthma?

• Shortness of breath
• Wheezing
• Tightness in the chest
• Coughing at night or after physical activity
  cough that lasts more than a week
• Waking at night with asthma symptoms (a key
  marker of uncontrolled asthma)

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What Happens During an Episode of Asthma?

• The lining of the airways becomes swollen
  (inflamed)
• The airways produce a thick mucus
• The muscles around the airways tighten and make
  airways narrower

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What Makes Asthma Worse?

• Allergens
• Warm-blooded pets (including dogs, cats, birds,
  and small rodents)
• House dust mites
• Cockroaches
• Pollens from grass and trees
• Molds (indoors and outdoors)

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What Makes Asthma Worse?

• Irritants
• Cigarette smoke and wood smoke
• Scented products such as hair spray, cosmetics,
  and cleaning products
• Strong odors from fresh paint or cooking
• Automobile fumes and air pollution
• Chemicals such as pesticides and lawn treatments

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What Makes Asthma Worse?

• Infections in the upper airways, such as colds (a
  common trigger for both children and adults)
• Exercise
• Strong expressions of feelings (crying, laughing)
• Changes in weather and temperature

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Investigation

• Eosinophil-eosinphilia
• Serum IgE
• Skin test
• Chest X-rayhyperinflation
• Lung functionFEV1, peak expiratory flow
  rate(PEFR with peak flow meter)

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Differential Diagnosis

• Brochiolitis
• Inhaled foreign body
• Tuberculosis
• Congenital abnormality of lung, airway or heat
  idiopathic

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Causes of Recurrent Wheezing

• Aspiration (i.e., gastroesophageal reflux)
• Asthma
• Bronchiolitis
• Bronchopulmonary dysplasia
• Cardiac disease
• Cystic fibrosis
• Foreign-body aspiration
• Mediastinal masses

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Is There A Cure For Asthma?
Asthma cannot be cured, but it can be controlled.
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How Is Asthma Controlled?

• Follow an individualized asthma management plan
• Avoid or control exposure to things that make
  asthma worse
• Use medication appropriately
• Long-term-control medicine
• Quick-relief medicine

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Drugs in Asthma Type of Drug
Drug Beta2 bronchodilators Short-acting
Salbutamol Long-acting

Salmeterol Anticholinergic bronchodilator
Ipratropium Bromide Preventative/prophylactic
treatment Inhaled steroids
Budesonide
Beclomethasone

Fluticasone Sodium cromoglycate Methyl xanthines
Theophylline Oral
steroids
Prednisolone
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How Is Asthma Controlled?

• Monitor response to treatment
• Symptoms
• Peak flow
• Get regular follow-up care

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How are Asthma Episodes Controlled?

• Know the signs that asthma is worsening
• Treat symptoms or drop in peak flow at first
  signs of worsening
• Monitor response to therapy
• Seek a doctors help when it is needed

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What Should People with Asthma Be Able To Do?

• Be active without having asthma symptoms this
  includes participating in exercise and sports
• Sleep through the night without having asthma
  symptoms
• Prevent asthma episodes (attacks)
• Have the best possible lung function (e.g., good
  peak flow number)
• Avoid side effects from asthma medicines