Respiratory system

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Respiratory system

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

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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

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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.

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

• Cough.
• Sputum production.
• Haemoptysis.
• Breathlessness(dyspnea).
• Chest pain.
• Wheeze
• Apnea.
• Others(weight loss, fever, fatigue)

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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.

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• 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.

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• 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.

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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
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• 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.

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• 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.

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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
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Sputum production

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

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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
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• 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

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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.

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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 Wegners 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
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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.

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Causes of dyspnea

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

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• 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.

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

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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
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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.

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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

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

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• 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.

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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

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

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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.

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• 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