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Respiratory Diseases. Pathophysiology and Medical Treatments. Respiratory System. Lungs airways alveoli blood vessels defense system Respiratory pump Central controller spinal cord motor nerves muscles. Respiratory Diseases. Lungs airways-asthma alveoli-COPD, pulmonary fibrosis

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respiratory diseases

Respiratory Diseases

Pathophysiology and Medical Treatments

respiratory system
Respiratory System
  • Lungs
    • airways
    • alveoli
    • blood vessels
    • defense system
  • Respiratory pump
    • Central controller
    • spinal cord
    • motor nerves
    • muscles
respiratory diseases1
Respiratory Diseases
  • Lungs
    • airways-asthma
    • alveoli-COPD, pulmonary fibrosis
    • blood vessels-pulmonary hypertension
    • defense system- inadequate cough, aspiration, immune dysfunction
  • Respiratory pump
    • Central controller-central alveolar hypoventilation
    • spinal cord- SCI
    • motor nerves- ALS
    • muscles- muscular dystrophy
discussion topics
Discussion Topics
  • Lung diseases
    • Asthma
    • COPD
    • Pulmonary fibrosis
    • Lung Transplant
    • Pneumonia
  • Respiratory Pump Diseases
    • Muscular Dystrophy
    • Spinal Cord Injury
asthma
Asthma
  • Defined as reversible obstruction or narrowing of the airways
    • between episodes patients feel normal and have normal pulmonary function tests
  • If you were to see the asthmatic airway under the microscope you would see:
    • narrowed, edematous airways
    • inflammation in the airway walls
    • excess mucous secretion and plugging
asthma1
Asthma
  • Allergy Related (extrinsic)
    • Immunoglobulin E (IgE)
    • Pollens, and animal danders, etc.
    • Seasonal
    • Younger individuals
  • Unrelated to allergy (intrinsic)
    • Aspirin sensitivity
    • Not seasonal
asthma symptoms
Asthma- Symptoms
  • Shortness of breath (dyspnea)
  • Wheezing
  • Chest tightness
  • “Feeling of suffocating”
  • Cough
  • Exercise induced
asthma physical findings
Asthma- Physical Findings
  • Rapid breathing (tachypnea)
  • Perspiring
  • Using “accessory” muscles of respiration
    • sternoclydomastoid, platysma, pectoralis major and minor
  • cyanosis
  • tachycardia
  • pulsus paradoxus
asthma acute treatment
Asthma- Acute Treatment
  • Bronchodilation (opening the airways)
    • inhaled B-agonists (B2 receptors bronchodilate)
      • albuterol, salmeterol, pirbuterol, bronkosol
    • parenteral B-agonists
      • epinephrine, terbutaline, isoproterenol
    • inhaled anticholinergics (cholinergic receptors constrict)
      • ipatroprium bromide, glycopyrrolate
    • Theophylline
asthma treatment acute
Asthma Treatment-Acute
  • Anti-inflammatory
    • parenteral steroids
  • Artificial ventilation
    • Noninvasive-facemask
    • Invasive-endotracheal tube
      • High risk
asthma chronictreatment
Asthma - ChronicTreatment
  • anti-inflammatories are key to prevent exacerbations
    • inhaled steroids at high dose
      • triamcinalone, budesonide, fluticasone, beclomethasone
    • mast cell stabilizing drugs
      • nedocromil, cromolyn
  • B-agonists and anticholinergics as needed
  • Leukotriene inhibitors
    • zafirleukast (zyflo)
    • Montelukast (singulair_
  • “Stepped care”
    • Gradual addition of medications
chronic obstructive pulmonary disease copd
Chronic Obstructive Pulmonary Disease (COPD)
  • Is a general term for patients with chronic airflow obstruction that may be due a number of causes
    • emphysema
    • chronic bronchitis
    • chronic severe asthma
  • > 90% of cases are due to smoking
  • Lungs are obstructed and overinflated
physiologic derangements in copd
Physiologic Derangements in COPD
  • Destruction of Alveolar Tissue
  • Loss of lung elastic recoil
  • Airway obstruction
chronic obstructive pulmonary disease copd1
Chronic Obstructive Pulmonary Disease (COPD)
  • Functional consequences of airway disease and chronic lung injury
    • Obstruction to airflow
    • Hyperinflation of the chest
    • Improper respiratory muscle function
    • Increase work of breathing
copd symptoms
COPD- Symptoms
  • gradually progressive shortness of breath (over years)
    • may end up disabled with dyspnea at rest
    • may require oxygen
  • cough frequently productive of sputum
  • leg swelling
  • anxiety
copd physical signs
COPD- Physical Signs
  • Barrel chest
  • Tachypnea
  • “Pursed-lip” breathing
  • Use of accessory muscles
  • Diaphragm dysfunction
    • Hoover sign
    • lack of outward movement of abdomen
  • Reduced and prolonged expiratory airflow
copd treatment
COPD- Treatment
  • B-agonists
  • Anticholinergics
  • Theophylline
  • Steroids
    • only 20 % of patients are steroid responsive
copd treatment1
COPD Treatment
  • Pulmonary Rehabilitation
  • Lung Transplant
  • Lung Volume Reduction Surgery (LVRS)
pulmonary rehabilitation teaching
Pulmonary RehabilitationTeaching
  • Biology of disease
  • Medications
  • Oxygen
  • Travel
  • Minimizing energy expenditure
  • Interpersonal relationships
copd surgical interventions
COPD-Surgical interventions
  • Lung volume reduction surgery (LVRS)
  • Lung transplantation
slide27
LVRS
  • Hypothesis: Hyperinflation of the lungs in COPD is the primary cause of dyspnea. Reducing the sized of the lungs will reduce dyspnea and increase expiratory airflow
  • Procedure: Sternotomy with resection of 25 to 30% of each lung
lung transplantation
Lung Transplantation
  • For very advanced disease
  • Age < 65 years
  • No other major medical problems
  • Post transplant immunosupression
    • 15-20 medications
pulmonary fibrosis
Pulmonary Fibrosis
  • Scarring of the lung tissue due to inflammation
  • Lungs become too small- “restricted”
  • Due to a wide range of causes:
    • drugs
    • toxic exposures
    • rheumatologic diseases
    • idiopathic- “IPF”
pulmonary fibrosis symptoms
Pulmonary Fibrosis- Symptoms
  • Dyspnea
  • Exercise intolerance
  • Cough
  • Symptoms associated with systemic disease
pulmonary fibrosis exam findings
Pulmonary Fibrosis- Exam Findings
  • Rapid, shallow breathing
  • clubbing of the fingers
  • “velcro” rales or crackles in the lungs
  • cyanosis
  • findings associated with systemic disease
pulmonary fibrosis treatment
Pulmonary Fibrosis- Treatment
  • Steroids
  • Cytotoxic agents
    • imuran
    • cyclophosphamide
  • Lung Transplant
pneumonia
Pneumonia
  • Common pulmonary disease
  • Usually there is an associated host defense problem
    • aspiration
    • foreign body
    • immune suppression
      • recent viral illness
      • More global immune problem
    • Ciliary problem
      • smoking
      • Cystic Fibrosis
pneumonia symptoms and physical findings
Pneumonia- Symptoms and Physical Findings
  • Cough
  • Chest pain
  • Fever, chills
  • Dyspnea
  • Evidence of consolidation on lung exam
    • “bronchial breath sounds”
    • egophony
    • dullness to percussion
pneumonia treatment
Pneumonia- Treatment
  • One or more antibiotics
  • Choice will depend on patients age, immune status, seriousness of clinical condition
  • Sputum sample with Gram’s stain can be helpful
spinal cord injury
Spinal Cord Injury
  • Level of spinal cord injury is critical
  • C2 or above clearly ventilator dependent
  • C3-C5- likely ventilator dependent at least partially
  • C5 and below usually ventilator independent but cough and secretion clearance is a problem
  • Lung volumes appear “restricted”
  • Cough and expiratory flow always an issue
spinal cord injury respiratory treatment
Spinal Cord Injury- Respiratory Treatment
  • Will depend entirely on level of injury
  • Maintaining adequate ventilation is of utmost importance, almost all patients will initially be on a mechanical ventilator
  • Clearance of secretions and prevention of pneumonia is also of critical importance
    • The leading cause of death in the first year following injury is pneumonia
  • Techniques of Secretion Management
    • Chest physical therapy, assisted cough
    • Tracheal suctioning
    • In-exsufflator
spinal cord injury respiratory treatment1
Spinal Cord Injury- Respiratory Treatment
  • Some patients may need only partial ventilation at night
  • Non-invasive ventilation may be an option
    • No tracheostomy
    • Less complications
muscular dystophy
Muscular Dystophy
  • Many varieties
    • Frequently genetic
  • Muscle and not nerves are affected
  • Progressive loss of function over years
  • Primary cause of death is pneumonia
  • Currently no medical treatment
    • Future: ? Gene therapy
muscular dystrophy
Muscular Dystrophy
  • Often associated with scoliosis
  • Patients will be short of breath
  • Patients will often breath less well at night and have associated sleep apnea
  • Treatment will be aimed at relieving symptoms and prolonging life
  • Noninvasive ventilation is a definite option
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