Respiratory System Pathologies

Sympathetic Nervous System (bronchodilation and constriction)

Activates beta 2 receptors which causes relaxation of bronchial smooth muscle, causing dilation

Parasympathetic Nervous System (Bronchodilation and constriction)

Causes contraction of bronchial smooth muscle, resulting in narrowing of the airway, known as constriction. 

Bronchodilators

Drugs that activate beta 2 receptors

Bronchoconstriction 

These drugs result in shortness of breath and labored breathing. 

Upper respiratory Disorders

Impacts the nose, paranasal sinuses, pharynx, larynx, and trachea. result of an allergic reaction to an allergen and an antibody response to an antigen (i.e., virus). 

Treatment for Upper respiratory Disorders

Treatment includes decreasing the allergic response, supportive care, or antibiotics. 

Lower respiratory disorders

Impacts the lungs, bronchi, and alveoli- infectious vs noninfectious. A result of bronchial hypersensitivity. Results in inflammation and decreased airflow.

Lower respiratory disorders treatment

Includes decreasing inflammation and restoring airflow through dilation and treating cause. 

Lower respiratory chronic conditions

COPD, Asthma, Emphysema, Chronic Bronchitis, Cystic Fibrosis

Lower respiratory Acute infectious

Bronchiolitis, Acute Bronchitis, Pneumonia

Chronic inflammatory disorder of airways (ASTHMA)

Recurrent episodes of reversible airway obstruction, hyperreactive airways, incidence greatest in industrialized countries. 

Acute inflammatory response

Stimulates the secretion of histamine and other inflammatory mediators 

Bronchoconstriction

narrows the airway in response to a triggering agent. 

Triggers for asthma

Allergies, infections, exercise, and medications.

Asthma etiology

Unkown etiology

Classification considerations for Asthma

Clinical presentations, precipitating factors or triggers, and allergies. 

Risk factors for Asthma

Genetics, History, Gender, Obesity, Exposure to allergens, irritants, and tobacco smoke. 

Allergic Asthma (most common)

An allergen causes a type 1 hypersensitivity response.

Recurrent Asthma

Airways are remodeled, bronchial smooth muscles hypertrophy, increasing the capacity for bronchoconstriction.

Status ashamticus

The term for a severe, prolonged form of asthma that is unresponsive to drug treatment and may result in respiratory failure. (Always have an inhaler ready!)

Asthma Clinical Manifestations

Recurrent chest tightness, shortness of breath, wheezing, cough with or without production of thick sputum, severe episodes, tachypnea, and tachycardia.

Severity classifications of Asthma

Mild intermittent asthma, mild, moderate, or severe persistent asthma. 

Diagnosis Asthma

Medical history and physical examination, PFTs before and after bronchodilator use, challenge test, and exhaled nitrogen oxide.

Treatment for asthma

environmental control, asthma education.

Two goals of therapy

To terminate acute bronchospasms in progress with quick-relief medications AND to reduce the frequency of asthma attacks with long-acting meds.

Bronchodilators should always be administered before anti-inflammatory meds

Priority is to open bronchioles.

Quick-relief meds

Beta 2 adrenergic agonists, anticholinergics, systemic corticosteroids.

Long-acting meds

Inhaled corticosteroids, leukotriene modifiers, long-acting beta 2 adrenergic agonists, methylxanthines, and immunomodulators. 

Management of ASTHMA

A- Adrenergics (Beta 2 Agonists) (Albuterol), S- Steroids

T- Theophylline

H- Hydration (IV)

M- Mask O2

A- Anticholinergics  (A lot of mucous production)

Chronic Obstructive Pulmonary Disease (COPD)

Progressive airflow limitations that are not fully reversible. Includes chronic bronchitis and emphysema. Linked to cigarette smoking. Gradual onset with slowly progressive symptoms of dyspnea and shortness of breath (SOB). 

COPD Risk Factors

Direct and environmental tobacco smoke, genetics, occupational exposure, indoor air pollution, severe respiratory infections. 

COPD Etiology

Chronic airflow limitation due to abnormal inflammatory response to inhaled particles and gases in the lung. 

COPD mild

mild airflow limitation, possible chronic cough and sputum production, possible unawareness of the individual that lung function is abnormal. 

COPD Moderate

Worsening airflow limitations, SOB on exertion, possible cough and sputum production, and chronic respiratory symptoms lead person to seeking care. 

COPD Severe

Further worsening of airflow limitations, greater SOB. Reduced exercise capacity, fatigue, and repeated exacerbations. An affect on patients quality of life. 

COPD Very severe

Severe airflow limitations plus chronic respiratory failure.

COPD Pathophysiology

Airway obstruction occurs when fixed airways have increased resistance, slowing the rate of airflow. chronic inflammation, structural remodeling of lung tissue, alterations in vascular structure, and destruction of pulmonary structures. Hypercapnia, hyperinflation. 

Chronic Bronchitis

Fixed airway obstruction caused by scarring that thickens the basement membranes. Increased number and size of mucus glands. Loss of support for small airways. persistent, inflammation-induced narrowing of airways. Symptoms: copious mucus production (causes a mucus plug), chronic productive cough. 

Emphysema 

Damage to the lung parenchyma, destruction of the gas-exchanging pulmonary surfaces. pulmonary hyperinflation. cigarette smoking (primary).

Chronic bronchitis (charactersisitcs)

Productive cough for three months in two consecutive years. Progressively worsening dyspnea with SOB and dyspnea on exertion (DOE)

Emphysema (characterstics)

Increased DOE, Barrel chest, respiratory muscles, hypoxemia, foot and ankle swelling, 

Advanced COPD

-Reduced capacity for gas exchange, deterioration of pulmonary function. 

Early Hypoxia

Restlessness, anxiety, low vs

COPD Diagnosis

PFTs, Spirometry, Body plethysmography. X-ray

COPD Treatment

Assessment and monitoring, reducing risk factors, managing stable COPD, managing acute exacerbations

Cystic Fibrosis

The most common lethal genetic disorder. Reabsorption of sodium is enhanced in epithelial exocrine cells. lifelong morbidity. 

Cystic Fibrosis Pathophysiology

A recessive genetic disorder, affects epithelial transport of fluids. 

Cystic Fibrosis Clinical manifestations

Thick pulmonary secretions, frequent respiratory infections, chronic cough, abdominal distention, large, fatty, foul-smelling stools. 

Cystic Fibrosis Diagnosis

Skin Sweat Test

Cystic Fibrosis Treatment

Antibiotics for secondary infections, vitamin supplements, and pancreatic digestive enzyme replacement.

Infectious diseases of the lower respiratory tract: clinical manifestations

Cough, malaise, fever, sore, inflamed throat, enlarged lymph nodes, mucoid or purulent sputum, wheezing, fine crackles on auscultation (CHF will hear crackles).

Acute Bronchitis infectious causes

Bacteria and viruses

Acute Bronchitis Noninfectious triggers

Asthma, air pollutants, inhaling irritating substances. 

Clinical manifestations for acute bronchitis

Bronchial inflammation with mucosal congestion and cough. Sore throat with hoarseness, dyspnea, chest pain, and myalgias (lack of energy). Differentiated from pneumonia by chest x-ray. 

Bronchiolitis clinical manifestations

Necrosis of the respiratory epithelium, excess mucus production and submucosal swelling. can have both inspiratory and expiratory wheezing. 

Bronchiolitis Treatment

Supportive management of respiratory symptoms.

Pneumonia Characteristics.

Inflammation of the lung parenchyma, lung consolidation with alveoli filled with exudate. major cause of morbidity.

pneumonia causes

Hospital-acquired pneumonia (HAP), Ventilator-associated pneumonia (VAP), Healthcare-associated pneumonia (HCAP). 

Pneumonia Classifications

Location where the patient was exposed to the pathogen. causative pathogen, location of pathogen within the lung. 

Pneumonia Pathogenesis

Opportunistic pneumonia. Zoonotic infections, infections with bioterrorism potential. Bacterial vs viral. 

pneumonia clinical manifestations

Typical: abrupt onset of high fever, chills, productive cough with mucopurulent sputum. Atypiacal: milder symptoms that last longer

Pneumonia diagnosis

X-ray and sputum analyses

Treatment for pneumonia

Supportive measures, supplemental oxygen, antibiotics, and antivirals.