Respiratory diseases | Definitions, Causes, Symptoms and Major Types

Respiratory disorders

  • Can be divided into those of the upper and lower respiratory tract
  • Can further be divided into those that are caused by infectious particles like viruses, bacteria, and other causes.

The upper respiratory system consists of the nasal and laryngopharynx including the larynx while the lower respiratory tract consists of the trachea, bronchi and the alveoli. The bronchi are lined by the respiratory epithelium. Cilia trapping bacteria consists of the pseudostratified ciliated columnar epithelium.

Terms

Dyspnoea

  • Difficulty breathing
  • Can further be broken down into orthopnoea where the difficulty in breathing is related to the position of the body laying down breath is difficult but more manageable when upright

Apnoea

  • Means not breathing
  • Can be a medical emergency if prolonged

If there is a partial blockage in the airway causing dyspnoea, you may also hear wheezing. This can be inspiratory or expiratory. Inspiratory is usually associated with the obstruction of the small airways and expiratory with COPD and asthma

If Dyspnoea is severe, it can lead to hypoxaemia  which will often result in cyanosis, a blush ting that can be seen in the lips and nail beds

Coughing

  • Results for irritation of the airways or fluid or mucus collecting in the lungs. This can result in a productive cough. Coughing up blood is a serious sign and is called Haemoptysis
  • Clubbing relates to low circulation and poor circulation at the ends of the fingers. Causes connective tissue hypertrophy and curvature of the fingernails.
  • A barrel chest is a sign of the use of the accessory chest muscle to improve breathing over an extended period of time for example emphysema
  • Tachypnoea is when the breathing rate is faster than normal.
  • Bradypnoea is when the breathing rate is slower than normal.
  • Hyperventilation is increased tidal volume.
  • Hypoventilation is decreased tidal volume.

Upper Respiratory Infections

  • Most of them are viral
  • The common cold is the most common caused by rhinovirus (50%) and coronaviruses 15-20% for which antibiotics are ineffective but may be needed if a secondary infection occurs
  • Treatments include rest, fluids while cough suppressant and antihistamines may help the symptoms they do not speed recovery.
  • There are over 100 strains of the rhinovirus alone and their surface antigens keep on changing as the new strains develop
  • Spread via droplet transmission and contact

Pharyngitis

  • Inflammation of the throat
  • Can viral or bacterial
  • Bacterial caused by S, pyogenes which is 5-10%, pyogenes produce streptolysins that kill cells and leukocytes therefor antibiotics are necessary

Epiglottis

  • Inflammation of the epiglottis caused by the Haemophilus influenza type B. can reach the point where it blocks the trachea in children thereby becoming life-threatening
  • The bacteria also causes Meningitis

Laryngitis

  • The inflammation of the larynx
  • Maybe caused by bacterial or viral infection  environmental irritant or following other URI’s

Sinusitis

  • Inflammation of the mucous membranes of the sinuses
  • Can be a consequence of the common cold or other infections
  • Problems associated with nasal cavities
  • If the sinus drainage is a blockage, there is pressure build-up resulting in breathing problems, headaches and dizziness

LRI’s

Pneumonia

  • Can be bacterial or viral
  • General term for solidification, consolidation, of the cells and the lungs

Bacterial pneumonia

  • Generally is talking about  the consolidation of the whole lobe of the lung while bronchopneumonia is talking about scattered consolidation In either the same lung or more than one lobe
  • Most are caused by bacteria that occurs in the Oro and laryngopharynx, while a lot of condition predisposes to the infection
  • Bacteria involved is most often S, Pneumoniae usually following a viral infection
  • And K, pneumonia and less commonly Staphyloccocal and Legionella sp.
  • Pathology of pneumococcal infection in early stages sees a protein-rich fluid containing the organisms entering and filling the alveoli
  • There is a connection between the capillaries and an influx of the leukocytes. this causes an intra- alvoeili haemorrhage followed by Haemoptysis
  • The stage is followed by the lysis of the leukocytes and macrophages infiltration to clean up the exudate

Viral pneumonia

  • Of the lung cells causes an interstitial( as opposed to the alveoli) pneumonia and alveoli damage
  • Initially affect the alveoli epithelium casing phagocytic infiltrations of the interstitial tissue followed by the necrosis of certainty of the epithelial cells
  • Causes; cytomegalovirus particularly in the immune compromised and also seen in infants, measles virus, varicella virus( chicken pox and herpes zoster)

Influenza

  • Viral condition with a rapid onset of chills, fever, muscle pain and headaches
  • The spikes in the viral make H and N are able to change meaning that the immune system would not be able to recognise the new variation and an epidemic can occur
  • The virus spreads through the large population, and secondary bacterial infection is common

Acute bronchitis

  • Short-term problems involving the inflammation of the bronchi generally after a URI or other environmental factors and can be followed by a secondary infection
  • COPD is included here because it is a non-specific term for chronic bronchitis and or emphysema showing a reduced FEV

Chronic Bronchitis

  • Is having a productive cough with readily determined cause for more than 2 years and is most often seen in cigarette smokers
  • Hyperplasia and hypertrophy seen in mucus-secreting cells and increased mucus cells
  • Other changes are variable but include bronchial wall thickening( mucus gland hypertrophy) thereby reducing bronchial lumen which causes mucus in the central and peripheral airways, increase goblet cells and smooth muscles.The disease is often accompanied by emphysema

Emphysema

  • Caused by the enlarging of the airspaces that are distal to the terminal bronchioles, destroying the wall but not resulting in fibrosis
  • Cigarette smoking is the main cause of
  • Increased neutrophils are seen which contain elastase that destroy elastin in the walls of the air spaces, it is morphologically defined according to three types, CENTRILOBULAR, PANANINAR, AND LOCALISED
  • Most sufferers are over 60 years with a long history of exertional dyspnoea and non-productive cough
  • Radiologically overinflation of the lung is most prominent and a barrel chest seen
  • The outlook is a steady decline in respiratory function evident by progressive and no treatment is adequate

Asthma

  • Variable obstruction of the air flow with airways themselves hyporesponsive to different stimuli
  • Clinical sign are wheezing, dyspnoea, and coughing
  • Can reach the severe stage that treatment would not work and is called status asthmatics
  • The most studied form of asthma involves inducing an attack by inhaling an allergen. The allergen react with IgE on the surface of the mast cells which de-granulate releasing histamine that cause smooth muscle contraction and increased mucus secretions
  • This happens along an increase in permeability of the blood vessel causing oedema which can cause obstruction of the airways even further
  • A whole compliment of leukocytes release factors which aggravate the bronchial constriction, impair ciliary and function and damage the epithelial cells
  • It is thought that damaging the epithelial cells stimulates the nerve ending in the mucosa to discharge causing further airways narrowing and mucus secretion
  • The factors that the leukocytes release brig more leukocytes to the area so that whole response is amplified almost like a positive feedback mechanism
  • A chronic result is mucus gland hyperplasia and hypertrophy of the smooth muscle which will exacerbate the asthma

Lung abscess

  • Pus accumulation in the small areas of the lungs where there are damage and obstruction of the alveoli, airways and blood vessels
  • The most common cause is the aspiration of the bacteria from the oropharynx a complication of bacterial pneumonia and infected pulmonary emboli
  • Alcoholism is the most common condition that will predispose an individual to lung abscess( followed by overdose, epileptic seizures)and about 20% will develop bleeding
  • Symptoms are a cough and fever
  • Complication an occur this includes the abscess draining into the bronchus spreading the infection to other parts of the lungs
  • Although antibiotics have good effects, death still occurs

Pulmonary TB

  • Not really a problem in Australia
  • Caused by Mycobacterium tuberculosis
  • Adult respiratory distress syndrome is a reaction of the parenchyma cells in the normal lungs to acute trauma where there is interstitial inflammation and formation of alveolar exudate trauma includes respiratory viral infection, shock, gastric aspiration
  • The alveolar are danged by inflammatory response meaning oxygen cannot diffuse well in the into the blood
  • Respiratory failure and an overall mortality rate of over 50%is the result, and in person, over the age 50 the mortality rate can reach to 90%

Pleura

  • Pneumothorax this is where the air is present in the pleura pace can be a result of the perforation of the pleura
  • In reality, traumatic pneumothorax is iatrogenic following fluid aspiration from the pleura, lungs or pleura biopsies and ventilation using positive pressure
  • Spontaneous pneumothorax is often seen, young adults
  • Pleura effusion is the accumulation of fluid in the pleural cavity
  • Pleurisy is the inflammation of the visceral and partial pleura is caused by bacterial infection of the pleura or secondary infection
  • Sharp chest pain when inspiring or coughing in the primary symptom that may mimic cardiac pain

Pulmonary oedema

This is caused by increased fluid in the alveoli and interstitium of the lungs casing deceased cardiac exchange resulting in hypoxia and hypercapnia. Caused by the hemodynamic changes in the hear that increase the hydrostatic pressure in the capillaries of the lungs and blocks lymph drainage. fluid moves from the capillaries to the interstitium to the alveoli

Symptoms are dyspnoea, orthopnoea and bloody, frothy sputum as a result of fluid leaking from the capillaries.

References

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins.

Crescimanno, G., Greco, F., & Marrone, O. (2016). Autonomic arousals, sleep respiratory disorders and autonomic nervous system activity in neuromuscular diseases.

 

Disclaimer: Not to be for diagnosis, if you these symptoms seek medical help