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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


  • 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


  • 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 breathing re training
Pulmonary RehabilitationBreathing Re-training

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

Respiratory diseases

  • 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


  • 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