Respiratory Respiratory SystemSystem

Dr. Mohamad Nidal KhabazDr. Mohamad Nidal KhabazAssistant Professor of Pathology,Assistant Professor of Pathology,Pathology Department, Faculty of Pathology Department, Faculty of

Medicine,Medicine,Jordan University of Science and Jordan University of Science and

TechnologyTechnology

Components of the Components of the Respiratory SystemRespiratory System

VentilationVentilation The movement of air between the The movement of air between the

atmosphere and the respiratory atmosphere and the respiratory portion of the lungsportion of the lungs

PerfusionPerfusion The flow of blood through the lungsThe flow of blood through the lungs

DiffusionDiffusion The transfer of gases between the air-The transfer of gases between the air-

filled spaces in the lungs and the bloodfilled spaces in the lungs and the blood

Structural Organization Structural Organization of the Respiratory of the Respiratory

SystemSystem Consists of the air passages and the Consists of the air passages and the

lungslungs Divided into two parts by function: Divided into two parts by function:

Conducting airways:Conducting airways: through through which air moves as it passes which air moves as it passes between the atmosphere and the between the atmosphere and the lungslungs

Respiratory tissues of the lungs:Respiratory tissues of the lungs: where gas exchange takes placewhere gas exchange takes place

Structures of the Structures of the Conducting AirwaysConducting Airways

Nasal passagesNasal passages Mouth and pharynxMouth and pharynx LarynxLarynx TracheaTrachea BronchiBronchi Bronchioles Bronchioles

Respiratory TreeRespiratory Tree LarynxLarynx Trachea – supplies both lungsTrachea – supplies both lungs Primary bronchi – supplies each lungPrimary bronchi – supplies each lung Secondary bronchi – supplies each lobeSecondary bronchi – supplies each lobe Tertiary bronchi – supplies each Tertiary bronchi – supplies each

bronchopulmonary segment (lobule)bronchopulmonary segment (lobule) BronchiolesBronchioles Terminal bronchiolesTerminal bronchioles Respiratory bronchiole (capable of gas Respiratory bronchiole (capable of gas

exchange)exchange) Alveolar ducts (capable of gas exchange)Alveolar ducts (capable of gas exchange) Alveolar sacs with alveoli (capable of gas Alveolar sacs with alveoli (capable of gas

exchange)exchange)

VentilationVentilation

Depends on the conducting Depends on the conducting airways:airways: Nasopharynx and oropharynxNasopharynx and oropharynx LarynxLarynx Tracheobronchial treeTracheobronchial tree

Function:Function: Moves air in and out of the lung but Moves air in and out of the lung but

does not participate in gas exchangedoes not participate in gas exchange

Pulmonary ventilationPulmonary ventilation

Inspiration is due to muscle Inspiration is due to muscle contraction which increases thoracic contraction which increases thoracic cage size.cage size.

The compliant lungs inflate due to The compliant lungs inflate due to the negative pressure created in the the negative pressure created in the pleural cavitypleural cavity

Expiration is due to the elasticity of Expiration is due to the elasticity of the thoracic soft tissue and the lungs the thoracic soft tissue and the lungs themselves.themselves.

Structures of the LungsStructures of the Lungs

Soft, spongy, cone-shaped organs Soft, spongy, cone-shaped organs located side by side in the chest cavitylocated side by side in the chest cavity Separated from each other by the Separated from each other by the

mediastinum and its contentsmediastinum and its contents divided into lobes (3 in the right lung, 2 in divided into lobes (3 in the right lung, 2 in

the left).the left). Apex:Apex: upper part of the lung; lies upper part of the lung; lies

against the top of the thoracic cavityagainst the top of the thoracic cavity Base:Base: lower part of the lung; lies lower part of the lung; lies

against the diaphragmagainst the diaphragm

Composition of the Composition of the Alveolar StructuresAlveolar Structures

Type I alveolar cells Type I alveolar cells Flat squamous epithelial cells across Flat squamous epithelial cells across

which gas exchange takes placewhich gas exchange takes place Type II alveolar cells Type II alveolar cells

Produce surfactant, a lipoprotein Produce surfactant, a lipoprotein substance that decreases the surface substance that decreases the surface tension in the alveoli and allows for tension in the alveoli and allows for greater ease of lung inflationgreater ease of lung inflation

Lung CirculationLung Circulation Pulmonary circulationPulmonary circulation

Arises from the pulmonary arteryArises from the pulmonary artery Provides for the gas exchange Provides for the gas exchange

function of the lungsfunction of the lungs Bronchial circulation Bronchial circulation

Arises from the thoracic aortaArises from the thoracic aorta Supplies the lungs and other lung Supplies the lungs and other lung

structures with oxygenstructures with oxygen Distributes blood to the conducting Distributes blood to the conducting

airwaysairways Warms and humidifies incoming airWarms and humidifies incoming air

Ventilation and Gas Ventilation and Gas ExchangeExchange

VentilationVentilation The movement of gases into and out of The movement of gases into and out of

the lungsthe lungs InspirationInspiration

Air is drawn into the lungs as the Air is drawn into the lungs as the respiratory muscles expand the chest respiratory muscles expand the chest cavitycavity

ExpirationExpiration Air moves out of the lungs as the chest Air moves out of the lungs as the chest

muscles recoil and the chest cavity muscles recoil and the chest cavity becomes smallerbecomes smaller

Respiratory PressuresRespiratory Pressures

Intrapulmonary pressure or Intrapulmonary pressure or alveolar pressurealveolar pressure Pressure inside the airways and Pressure inside the airways and

alveoli of the lungsalveoli of the lungs Intrapleural pressureIntrapleural pressure

Pressure in the pleural cavityPressure in the pleural cavity Intrathoracic pressure Intrathoracic pressure

Pressure in the thoracic cavityPressure in the thoracic cavity

Lung Compliance Lung Compliance

Lung complianceLung compliance (C) = (ΔV)/(ΔP)(C) = (ΔV)/(ΔP) The change in lung volume (ΔV) The change in lung volume (ΔV)

that can be accomplished with a that can be accomplished with a given change in respiratory given change in respiratory pressure (ΔP)pressure (ΔP)

Airway ResistanceAirway Resistance

Airway ResistanceAirway Resistance The volume of air that moves into and The volume of air that moves into and

out of the air exchange portion of the out of the air exchange portion of the lungslungs

Directly related to the pressure Directly related to the pressure difference between the lungs and the difference between the lungs and the atmosphere atmosphere

Inversely related to the resistance the Inversely related to the resistance the air encounters as it moves through the air encounters as it moves through the airwaysairways

Lung VolumesLung Volumes Tidal volume (TV)Tidal volume (TV)

Amount of air that moves into and out Amount of air that moves into and out of the lungs during a normal breath of the lungs during a normal breath

Inspiratory reserve volume (IRV)Inspiratory reserve volume (IRV) The maximum amount of air that can The maximum amount of air that can

be inspired in excess of the normal TVbe inspired in excess of the normal TV Expiratory reserve volume (ERV)Expiratory reserve volume (ERV)

Maximum amount of air that can be Maximum amount of air that can be exhaled in excess of the normal TVexhaled in excess of the normal TV

Residual volumeResidual volume The air that remains in the lungs after The air that remains in the lungs after

forced respirationforced respiration

Lung CapacitiesLung Capacities

Vital capacity:Vital capacity: equals the IRV plus the TV plus the equals the IRV plus the TV plus the ERV ERV The amount of air that can be exhaled from the The amount of air that can be exhaled from the

point of maximal inspirationpoint of maximal inspiration Inspiratory capacity: Inspiratory capacity: equals the TV plus the IRVequals the TV plus the IRV

The amount of air a person can breathe in The amount of air a person can breathe in beginning at the normal expiratory level and beginning at the normal expiratory level and distending the lungs to the maximal amountdistending the lungs to the maximal amount

Functional residual capacity:Functional residual capacity: sum of the RV and sum of the RV and ERVERV The volume of air that remains in the lungs at the The volume of air that remains in the lungs at the

end of normal expirationend of normal expiration Total lung capacity:Total lung capacity: the sum of all the volumes in the sum of all the volumes in

the lungsthe lungs

Pulmonary Function Pulmonary Function StudiesStudies

Maximum voluntary ventilation Maximum voluntary ventilation The volume of air a person can move into The volume of air a person can move into

and out of the lungs during maximum and out of the lungs during maximum effort lasting for 12 to 15 secondseffort lasting for 12 to 15 seconds

Forced expiratory vital capacity (FVC) Forced expiratory vital capacity (FVC) Involves full inspiration to total lung Involves full inspiration to total lung

capacity followed by forceful maximal capacity followed by forceful maximal expiration. expiration.

Forced expiratory volume (FEV) Forced expiratory volume (FEV) The expiratory volume achieved in a The expiratory volume achieved in a

given time periodgiven time period Forced inspiratory vital flow (FIF) Forced inspiratory vital flow (FIF)

The respiratory response during rapid The respiratory response during rapid maximal inspirationmaximal inspiration

Processes of Pulmonary Gas Processes of Pulmonary Gas ExchangeExchange

Ventilation Ventilation The flow of gases into and out of the The flow of gases into and out of the

alveoli of the lungsalveoli of the lungs Perfusion Perfusion

The flow of blood in the adjacent The flow of blood in the adjacent pulmonary capillariespulmonary capillaries

Diffusion Diffusion Transfer of gases between the Transfer of gases between the

alveoli and the pulmonary capillariesalveoli and the pulmonary capillaries

Types of Air Movement in Types of Air Movement in the lungthe lung

Bulk flow Bulk flow Occurs in the conducting airways Occurs in the conducting airways Controlled by pressure differences Controlled by pressure differences

between the mouth and that of between the mouth and that of airways in the lungairways in the lung

Diffusion Diffusion The movement of gases in the alveoli The movement of gases in the alveoli

and across the alveolar capillary and across the alveolar capillary membranemembrane

Types of Dead SpaceTypes of Dead Space

Anatomic dead spaceAnatomic dead space That contained in the conducting That contained in the conducting

airwaysairways Alveolar dead spaceAlveolar dead space

That contained in the respiratory That contained in the respiratory portion of the lungportion of the lung

Physiologic dead space Physiologic dead space The anatomic dead space plus The anatomic dead space plus

alveolar dead space alveolar dead space

Types of ShuntsTypes of Shunts

Anatomic shuntAnatomic shunt Blood moves from the venous to the Blood moves from the venous to the

arterial side of the circulation without arterial side of the circulation without moving through the lungsmoving through the lungs

Physiologic shuntPhysiologic shunt Mismatching of ventilation and Mismatching of ventilation and

perfusion with the lungperfusion with the lung Results in insufficient ventilation to Results in insufficient ventilation to

provide the oxygen needed to provide the oxygen needed to oxygenate the blood flowing through oxygenate the blood flowing through the alveolar capillariesthe alveolar capillaries

Factors Affecting Alveolar-Factors Affecting Alveolar-Capillary Gas ExchangeCapillary Gas Exchange

Surface area available for diffusionSurface area available for diffusion Thickness of the alveolar-capacity Thickness of the alveolar-capacity

membranemembrane Partial pressure of alveolar gasesPartial pressure of alveolar gases Solubility and molecular weight of Solubility and molecular weight of

the gasthe gas

Matching Ventilation and Matching Ventilation and PerfusionPerfusion

Required for exchange of gases between Required for exchange of gases between the air in the alveoli and the blood in the air in the alveoli and the blood in pulmonary capillaries pulmonary capillaries

Two factors interfere with the process:Two factors interfere with the process: Dead air space and shuntDead air space and shunt

The blood oxygen level reflects the The blood oxygen level reflects the mixing of blood from alveolar dead space mixing of blood from alveolar dead space and physiologic shunting areas as it and physiologic shunting areas as it moves into the pulmonary veinsmoves into the pulmonary veins

Mechanisms of Carbon Mechanisms of Carbon Dioxide TransportDioxide Transport

Dissolved in carbon dioxide (10%)Dissolved in carbon dioxide (10%) Attached to hemoglobin (30%) Attached to hemoglobin (30%) Bicarbonate (60%) Bicarbonate (60%)

Acid-base balance is influenced by Acid-base balance is influenced by the amount of dissolved carbon the amount of dissolved carbon dioxide and the bicarbonate level in dioxide and the bicarbonate level in the bloodthe blood

Control of BreathingControl of Breathing Automatic regulation of ventilation Automatic regulation of ventilation

Controlled by input from two types of sensors Controlled by input from two types of sensors or receptors:or receptors: Chemoreceptors:Chemoreceptors: monitor blood levels of monitor blood levels of

oxygen, carbon dioxide and adjust oxygen, carbon dioxide and adjust ventilation to meet the changing metabolic ventilation to meet the changing metabolic needs of the bodyneeds of the body

Lung receptors:Lung receptors: monitor breathing monitor breathing patterns and lung functionpatterns and lung function

Voluntary regulation of ventilationVoluntary regulation of ventilation Integrates breathing with voluntary acts such Integrates breathing with voluntary acts such

as speaking, blowing, and singingas speaking, blowing, and singing These acts, initiated by the motor and These acts, initiated by the motor and

premotor cortex, cause a temporary premotor cortex, cause a temporary suspension of automatic breathingsuspension of automatic breathing

Mechanisms Involved in Mechanisms Involved in DyspneaDyspnea

Stimulation of lung receptorsStimulation of lung receptors Increased sensitivity to changes in Increased sensitivity to changes in

ventilation perceived through central ventilation perceived through central nervous system mechanismsnervous system mechanisms

Reduced ventilatory capacity or Reduced ventilatory capacity or breathing reservebreathing reserve

Stimulation of neural receptors in the Stimulation of neural receptors in the muscle fibers of the intercostals and muscle fibers of the intercostals and diaphragm and of receptors in the diaphragm and of receptors in the skeletal jointsskeletal joints

Respiratory Tract Respiratory Tract InfectionsInfections

Areas Involved in Areas Involved in Respiratory Tract Respiratory Tract

InfectionsInfections Upper respiratory tract Upper respiratory tract

Nose, oropharynx, and larynxNose, oropharynx, and larynx Lower respiratory tract Lower respiratory tract

Lower airways and lungsLower airways and lungs Upper and lower airwaysUpper and lower airways

Common Respiratory Common Respiratory InfectionsInfections

Common coldCommon cold InfluenzaInfluenza PneumoniaPneumonia TuberculosisTuberculosis Fungal infections of the lungFungal infections of the lung

Factors Affecting the Signs Factors Affecting the Signs and Symptoms of and Symptoms of Respiratory Tract Respiratory Tract

InfectionsInfections

The function of the structure involvedThe function of the structure involved The severity of the infectious processThe severity of the infectious process The person’s age and general health The person’s age and general health

statusstatus

Rhinitis and SinusitisRhinitis and Sinusitis

Rhinitis Rhinitis Inflammation of the nasal mucosa Inflammation of the nasal mucosa

Sinusitis Sinusitis Inflammation of the paranasal sinusesInflammation of the paranasal sinuses

Types of SinusesTypes of Sinuses Paranasal sinusesParanasal sinuses

Air cells connected by narrow openings or Air cells connected by narrow openings or ostia with the superior, middle, and inferior ostia with the superior, middle, and inferior nasal turbinates of the nasal cavity nasal turbinates of the nasal cavity

Maxillary sinusMaxillary sinus Inferior to the bony orbit and superior to the Inferior to the bony orbit and superior to the

hard palatehard palate Its opening is located superiorly and medially Its opening is located superiorly and medially

in the sinus, a location that impedes drainagein the sinus, a location that impedes drainage Frontal sinuses Frontal sinuses

Open into the middle meatus of the nasal Open into the middle meatus of the nasal cavitycavity

Types of Sinuses (cont.)Types of Sinuses (cont.)

Sphenoid sinusSphenoid sinus Just anterior to the pituitary fossa behind Just anterior to the pituitary fossa behind

the posterior ethmoid sinusesthe posterior ethmoid sinuses Its paired openings drain into the Its paired openings drain into the

sphenoethmoidal recess at the top of the sphenoethmoidal recess at the top of the nasal cavitynasal cavity

Ethmoid sinusesEthmoid sinuses Comprise 3 to 15 air cells on each side, Comprise 3 to 15 air cells on each side,

with each maintaining a separate path to with each maintaining a separate path to the nasal chamberthe nasal chamber

Classifications of Classifications of RhinosinusitisRhinosinusitis

Acute rhinosinusitis Acute rhinosinusitis May be of viral, bacterial, or mixed May be of viral, bacterial, or mixed

viral-bacterial origin viral-bacterial origin May last from 5 to 7 days up to 4 weeksMay last from 5 to 7 days up to 4 weeks

Subacute rhinosinusitis Subacute rhinosinusitis Lasts from 4 weeks to less than 12 Lasts from 4 weeks to less than 12

weeksweeks Chronic rhinosinusitisChronic rhinosinusitis

Lasts beyond 12 weeksLasts beyond 12 weeks

Allergic RhinosinusitisAllergic Rhinosinusitis

Occurrence Occurrence Occurs in conjunction with allergic rhinitisOccurs in conjunction with allergic rhinitis Mucosal changes are the same as allergic Mucosal changes are the same as allergic

rhinitisrhinitis SymptomsSymptoms

Nasal stuffiness, itching and burning of Nasal stuffiness, itching and burning of the nose, frequent bouts of sneezing, the nose, frequent bouts of sneezing, recurrent frontal headache, watery nasal recurrent frontal headache, watery nasal dischargedischarge

TreatmentTreatment Oral antihistamines, nasal decongestants, Oral antihistamines, nasal decongestants,

and intranasal cromolynand intranasal cromolyn

Types of Influenza Types of Influenza VirusesViruses

Type AType A Most common typeMost common type Can infect multiple speciesCan infect multiple species Causes the most severe diseaseCauses the most severe disease Further divided into subtypes based on Further divided into subtypes based on

two surface antigens: hemagglutinin two surface antigens: hemagglutinin (H) and neuraminidase (N)(H) and neuraminidase (N)

Type B Type B Has not been categorized into subtypesHas not been categorized into subtypes

Antiviral DrugsAntiviral Drugs

AmantadineAmantadine RimantadineRimantadine ZanamivirZanamivir OseltamivirOseltamivir

Types of Influenza Types of Influenza VaccinationsVaccinations

Trivalent inactivated influenza Trivalent inactivated influenza vaccine (TIIV)vaccine (TIIV) Developed in the 1940sDeveloped in the 1940s Administered by injectionAdministered by injection

Live, attenuated influenza vaccine Live, attenuated influenza vaccine (LAIV)(LAIV) Approved for use in 2003Approved for use in 2003 Administered intranasallyAdministered intranasally

PneumoniaPneumonia DefinitionDefinition

Respiratory disorders involving inflammation Respiratory disorders involving inflammation of the lung structures (alveoli and of the lung structures (alveoli and bronchioles)bronchioles)

CausesCauses Infectious agents: such as bacteria and Infectious agents: such as bacteria and

viruses viruses Noninfectious agents: such as gastric Noninfectious agents: such as gastric

secretions aspirated into the lungssecretions aspirated into the lungs Factors Facilitating Development of Factors Facilitating Development of

PneumoniaPneumonia An exceedingly virulent organismAn exceedingly virulent organism A large inoculumA large inoculum Impaired host defensesImpaired host defenses

TuberculosisTuberculosis

Infectious disease caused by the Infectious disease caused by the bacterium bacterium Mycobacterium Mycobacterium tuberculosistuberculosis

Symptoms include fever, night Symptoms include fever, night sweats, weight loss, a racking cough, sweats, weight loss, a racking cough, and splitting headacheand splitting headache

Treatment entails a 12-month course Treatment entails a 12-month course of antibioticsof antibiotics

Positive Tuberculin Skin Positive Tuberculin Skin TestTest

Results from a cell-mediated Results from a cell-mediated immune response immune response Implies that a person has been infected Implies that a person has been infected

with M. tuberculosis and has mounted a with M. tuberculosis and has mounted a cell-mediated immune responsecell-mediated immune response

Does not mean the person has active Does not mean the person has active tuberculosistuberculosis

Disorders of Disorders of Ventilation and Ventilation and Gas ExchangeGas Exchange

Disorders of Lung Disorders of Lung InflationInflation Causes Causes

Conditions that produce lung Conditions that produce lung compression or lung collapsecompression or lung collapse Compression of the lung by an Compression of the lung by an

accumulation of fluid in the intrapleural accumulation of fluid in the intrapleural spacespace

Complete collapse of an entire lung as Complete collapse of an entire lung as in pneumothoraxin pneumothorax

Collapse of a segment of the lung as in Collapse of a segment of the lung as in atelectasisatelectasis

Pleural EffusionPleural Effusion

DefinitionDefinition An abnormal collection of fluid in the An abnormal collection of fluid in the

pleural cavity pleural cavity Types of fluidTypes of fluid

TransudateTransudate ExudateExudate Purulent drainage (empyema)Purulent drainage (empyema) ChyleChyle BloodBlood

Pleural Effusion Pleural Effusion Diagnosis and TreatmentDiagnosis and Treatment Diagnosis Diagnosis

Chest radiographs, Chest ultrasoundChest radiographs, Chest ultrasound Computed tomography (CT)Computed tomography (CT)

Treatment: Treatment: Directed at the cause of Directed at the cause of the disorderthe disorder ThoracentesisThoracentesis Injection of a sclerosing agent into the Injection of a sclerosing agent into the

pleural cavitypleural cavity Open surgical drainageOpen surgical drainage

Pneumothoraxes: TypesPneumothoraxes: Types

Spontaneous pneumothorax Spontaneous pneumothorax Occurs when an air-filled blister on the Occurs when an air-filled blister on the

lung surface ruptureslung surface ruptures Traumatic pneumothoraxTraumatic pneumothorax

Caused by penetrating or non-Caused by penetrating or non-penetrating injuriespenetrating injuries

Tension pneumothoraxTension pneumothorax Occurs when the intrapleural pressure Occurs when the intrapleural pressure

exceeds atmospheric pressureexceeds atmospheric pressure

AtelectasisAtelectasis Definition

The incomplete expansion of a lung or portion of a lung

Causes Airway obstruction Lung compression such as occurs in

pneumothorax or pleural effusion Increased recoil of the lung due to loss of

pulmonary surfactant Types of AtelectasisTypes of Atelectasis

Primary: Primary: Present at birth Present at birth Secondary: Secondary: Develops in the neonatal Develops in the neonatal

period or later in lifeperiod or later in life

Chronic Obstructive Chronic Obstructive Pulmonary Diseases (COPD)Pulmonary Diseases (COPD)

COPD are Asthma, Chronic bronchitis, COPD are Asthma, Chronic bronchitis, Emphysema, Cystic fibrosis, Bronchiectasis. Emphysema, Cystic fibrosis, Bronchiectasis.

Patients have a history of:Patients have a history of: SmokingSmoking Dyspnea, where labored breathing occurs Dyspnea, where labored breathing occurs

and gets progressively worseand gets progressively worse Coughing and frequent pulmonary infectionsCoughing and frequent pulmonary infections

COPD victims develop respiratory failure COPD victims develop respiratory failure accompanied by hypoxemia, carbon dioxide accompanied by hypoxemia, carbon dioxide retention, and respiratory acidosisretention, and respiratory acidosis

AsthmaAsthma Chronic inflammatory disorder characterized by Chronic inflammatory disorder characterized by

hyperactive airways leading to episodic, hyperactive airways leading to episodic, reversible bronchospasms owing to increased reversible bronchospasms owing to increased responsiveness of the tracheobronchial free to responsiveness of the tracheobronchial free to various stimuli.various stimuli.

It has been divided into two basic types:It has been divided into two basic types:1.1. Extrinsic asthma.Extrinsic asthma.2.2. Intrinsic asthma.Intrinsic asthma.

Characterized by dyspnea, wheezing, and chest Characterized by dyspnea, wheezing, and chest tightnesstightness

Airways thickened with inflammatory exudates Airways thickened with inflammatory exudates and occluded by thick mucous, which magnify and occluded by thick mucous, which magnify the effect of bronchospasms the effect of bronchospasms

AsthmaAsthma Extrinsic Asthma:Extrinsic Asthma: Initiated by type 1 Initiated by type 1

hypersensivity reaction induced by exposure to hypersensivity reaction induced by exposure to extrinsic antigen.extrinsic antigen. Subtypes include:Subtypes include:

atopic (allergic) asthma.atopic (allergic) asthma. occupational asthma.occupational asthma. allergic bronchopulmonary aspergillosis.allergic bronchopulmonary aspergillosis.

Intrinsic Asthma:Intrinsic Asthma: Initiated by diverse, non- Initiated by diverse, non-immune mechanisms, including ingestion of immune mechanisms, including ingestion of aspirin, pulmonary infections, cold, inhaled aspirin, pulmonary infections, cold, inhaled irritant, stress and exercise.irritant, stress and exercise.

AsthmaAsthma

Factors Contributing to the Factors Contributing to the Development of an Asthmatic AttackDevelopment of an Asthmatic Attack AllergensAllergens Respiratory tract infectionsRespiratory tract infections ExerciseExercise Drugs and chemicalsDrugs and chemicals Hormonal changes and emotional upsetsHormonal changes and emotional upsets Airborne pollutantsAirborne pollutants Gastroesophageal refluxGastroesophageal reflux

EmphysemaEmphysema

Enlargement of air spaces and destruction of Enlargement of air spaces and destruction of lung tissuelung tissue

Types: centriacinar and panacinar Types: centriacinar and panacinar Smoking historySmoking history Age of onset: 40 – 50 yearsAge of onset: 40 – 50 years Often dramatic barrel chestOften dramatic barrel chest Weight lossWeight loss Decreased breath soundsDecreased breath sounds Normal blood gases until late in disease processNormal blood gases until late in disease process Cor pulmonale only in advanced casesCor pulmonale only in advanced cases Slowly debilitating diseaseSlowly debilitating disease

Chronic BronchitisChronic Bronchitis Obstruction of small airwaysObstruction of small airways Smoking historySmoking history Age of onset 30 – 40 yearsAge of onset 30 – 40 years Barrel chest may be presentBarrel chest may be present Shortness of breath predominant early Shortness of breath predominant early

symptomsymptom Rhonchi often presentRhonchi often present Sputum frequent early manifestationSputum frequent early manifestation Often dramatic cyanosisOften dramatic cyanosis Hypercapnia and hypoxemia may be presentHypercapnia and hypoxemia may be present Frequent cor pulmonale and polycythemiaFrequent cor pulmonale and polycythemia Numerous life threatening episodes due to Numerous life threatening episodes due to

acute exacerbationsacute exacerbations

Cystic FibrosisCystic Fibrosis

DefinitionDefinition An autosomal recessive disorder An autosomal recessive disorder

involving fluid secretion in the exocrine involving fluid secretion in the exocrine glands, the epithelial lining of the glands, the epithelial lining of the respiratory, gastrointestinal and respiratory, gastrointestinal and reproductive tractsreproductive tracts

CauseCause Mutations in a single gene on the long Mutations in a single gene on the long

arm of chromosome 7 that encodes for arm of chromosome 7 that encodes for the cystic fibrosis transmembrane the cystic fibrosis transmembrane regulator (CFTR), which functions as a regulator (CFTR), which functions as a chloride (Clchloride (Cl--) channel in epithelial cell) channel in epithelial cell

Manifestations of Cystic Manifestations of Cystic FibrosisFibrosis

Pancreatic exocrine deficiencyPancreatic exocrine deficiency PancreatitisPancreatitis Elevation of sodium chloride in the Elevation of sodium chloride in the

sweatsweat Excessive loss of sodium in the sweatExcessive loss of sodium in the sweat Nasal polypsNasal polyps Sinus infectionsSinus infections Cholelithiasis Cholelithiasis

Diffuse Interstitial Lung Diffuse Interstitial Lung DiseasesDiseases

DefinitionDefinition A diverse group of lung disorders that A diverse group of lung disorders that

produce similar inflammatory and fibrotic produce similar inflammatory and fibrotic changes in the interstitium or interalveolar changes in the interstitium or interalveolar septa of the lungsepta of the lung

TypesTypes SarcoidosisSarcoidosis The occupational lung diseasesThe occupational lung diseases Hypersensitivity pneumonitisHypersensitivity pneumonitis Lung diseases caused by exposure to toxic Lung diseases caused by exposure to toxic

drugs drugs

Pulmonary EmbolismPulmonary Embolism DevelopmentDevelopment

A blood-borne substance lodges in a branch of A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flowthe pulmonary artery and obstructs the flow

TypesTypes Thrombus:Thrombus: air accidentally injected during air accidentally injected during

intravenous infusionintravenous infusion Fat:Fat: mobilized from the bone marrow after a mobilized from the bone marrow after a

fracture or from a traumatized fat depot fracture or from a traumatized fat depot Amniotic fluid:Amniotic fluid: enters the maternal enters the maternal

circulation after rupture of the membranes at circulation after rupture of the membranes at the time of deliverythe time of delivery

Prevention of Pulmonary Prevention of Pulmonary EmbolismEmbolism

Identification of persons at riskIdentification of persons at risk Avoidance of venous stasis and Avoidance of venous stasis and

hypercoagulability stateshypercoagulability states Early detection of venous thrombosisEarly detection of venous thrombosis

Secondary Pulmonary Secondary Pulmonary Hypertension Signs and Hypertension Signs and

SymptomsSymptoms

Dyspnea and fatigue Dyspnea and fatigue Peripheral edemaPeripheral edema AscitesAscites Signs of right heart failure (cor Signs of right heart failure (cor

pulmonale)pulmonale)

Cor PulmonaleCor Pulmonale Right heart failure resulting from Right heart failure resulting from

primary lung disease and long-standing primary lung disease and long-standing primary or secondary pulmonary primary or secondary pulmonary hypertensionhypertension

Involves hypertrophy and the eventual Involves hypertrophy and the eventual failure of the right ventriclefailure of the right ventricle

Manifestations include the signs and Manifestations include the signs and symptoms of the primary lung disease symptoms of the primary lung disease and the signs of right-sided heart failureand the signs of right-sided heart failure

Causes of ARDSCauses of ARDS Aspiration of gastric contentsAspiration of gastric contents Major trauma (with or without fat Major trauma (with or without fat

emboli)emboli) Sepsis secondary to pulmonary or Sepsis secondary to pulmonary or

non-pulmonary infectionsnon-pulmonary infections Acute pancreatitisAcute pancreatitis Hematologic disordersHematologic disorders Metabolic eventsMetabolic events Reactions to drugs and toxinsReactions to drugs and toxins

Causes of Respiratory Causes of Respiratory FailureFailure

Impaired ventilationImpaired ventilation Upper airway obstructionUpper airway obstruction Weakness of paralysis of respiratory Weakness of paralysis of respiratory

musclesmuscles Chest wall injuryChest wall injury

Impaired matching of ventilation Impaired matching of ventilation and perfusionand perfusion

Impaired diffusionImpaired diffusion Pulmonary edemaPulmonary edema Respiratory distress syndromeRespiratory distress syndrome

Signs and Symptoms of Signs and Symptoms of HypercapniaHypercapnia

Increased Increased PCOPCO22 HeadacheHeadache Conjunctival hyperemiaConjunctival hyperemia Flushed skinFlushed skin Increased sedationIncreased sedation TachycardiaTachycardia DiaphoresisDiaphoresis Mild to moderate increase in blood Mild to moderate increase in blood

pressurepressure