PP#6 Pulmonary Disease

Respiratory System

The organ system responsible for gas exchange, consisting of the lungs, airways, and associated structures that facilitate the INTAKE of oxygen and the EXPULSION of carbon dioxide.

Gas Exchange

The PRIMARY function of the respiratory system, involving the TRANSFER of oxygen into the blood and the REMOVAL of carbon dioxide from the blood.

Upper Respiratory Tract

The part of the respiratory system that includes the nose, nasal cavity, sinuses, pharynx, and larynx primarily responsible for FILTERING, WARMING, and HUMIDIFYING the air we BREATHE.

Lower Respiratory Tract

The portion of the respiratory system that includes the trachea, primary bronchi, and lungs, primarily responsible for gas exchange and CONDUCTING air to the alveoli.

Alveoli

SMALL air sacs in the lungs where gas exchange occurs, allowing oxygen to ENTER the bloodstream and carbon dioxide to be REMOVED.

Classes of Pulmonary Disease

Obstructive & Restrictive

Restrictive Pulmonary Disease

Diseases that RESTRICT lung expansion leading to DECREASED lung volume, primarily occurring during INSPIRATION.

Components of Restrictive Pulmonary Disease

• DECREASED volumes during pulmonary function test (PFT)

• Lesion

• Occurs during INSPIRATION (It’s difficult to fully fill lungs with air)

Lesion

An ABNORMAL change in lung tissue that can affect its function, often located in alveoli, pleural cavity, and external chest wall.

Causes of Restrictive Pulmonary Disease in Alveoli

• Acute Respiratory Distress Syndrome (ARDS)

• Pulmonary Fibrosis

• Pulmonary Edema

Pulmonary Edema

LEAKAGE of fluid from pulmonary capillaries into the alveoli, causing IMPAIRED gas exchange.

Causes of Restrictive Pulmonary Disease in Pleural Cavity

• Pneumothorax (PTX)

• Pleural Fluid

• Empyema

Causes of Restrictive Pulmonary Disease in External Chest Wall

• Obesity

• Pregnancy

• Scoliosis

• Ascites

Obstructive Pulmonary Disease

Diseases characterized by REDUCED airflow due to airway obstruction, primarily during EXHALATION.

Components of Obstructive Pulmonary Disease

• DECREASED flow rates during pulmonary function test (PFT)

• Lesion (Usually in the airways)

• Occurs during EXHALATION (It’s difficult to exhale all the air in the lungs)

Examples of Obstructive Pulmonary Disease

• Chronic Obstructive Pulmonary Disease (COPD)

• Emphysema

• Bronchitis

• Asthma

• Bronchiectasis

• Cystic Fibrosis

COPD (Chronic Obstructive Pulmonary Disease)

A long-term lung disease that makes it HARD to BREATHE because the airways are inflamed, damaged, or blocked, usually from SMOKING or long-term EXPOSURE to harmful particles.

Emphysema

An obstructive disease in which alveolar and vascular tissue are DESTROYED, causing a LOSS of elastic recoil.

Bronchitis

An inflammatory condition of the bronchial tubes, often characterized by coughing, mucus production, and difficulty breathing.

Airway Inflammation

A condition characterized by SWELLING and IRRITATION of the airways, which can lead to narrowed passages, difficulty in breathing, and INCREASED mucus production.

Causes of Airway Inflammation

• Mucosal Edema

• Bronchospasm (Smooth Muscle Constricting)

• PRODUCTION of THICK mucus

• Encroach on the airway lumen

• HARD for air to FLOW through the airways

• Harder to get O₂ in

• Hardest to get CO₂ out

Treatment for Airway Inflammation (Re-establish Airway Patency - Drugs)

Drugs ()

• Reduce mucosal edema

• Reduce bronchospasm

• Reduce viscosity of mucus

Treatment for Airway Inflammation (Re-establish Airway Patency - Oral/Systemic Hydration)

• Reduce viscosity of mucus

• Keep viscosity of mucus normal

Treatment for Airway Inflammation (PRNs)

Oxygen PRN & Mechanical ventilation PRN

Common Cold

A viral infectious disease of the upper respiratory tract, characterized by symptoms such as a runny nose, sore throat, and cough.

Etiology of Common Cold

Viral in Origin

Pathology of Common Cold

Acute inflammation of the mucus membrane of the upper respiratory tract.

Croup

A viral infection causing laryngeal spasms, high-pitched inspiratory sounds (stridor), labored breathing, and dyspnea, mainly in young kids.

Laryngeal Spasm

A SUDDEN tightening of the muscles in the larynx that can BLOCK airflow, often occurring in response to irritation or infection.

Stridor

A high-pitched sound resulting from obstruction in the trachea or larynx, often indicating respiratory distress.

Epiglottitis

A medical emergency in OLDER children caused by H. influenza (Type B), leading to epiglottis SWELLING that BLOCKS airflow, with symptoms like stridor and drooling.

Thumb Sign in Epiglottitis

A SWOLLEN epiglottis on a lateral neck X-ray that looks like a THUMB and signals a possible airway emergency.

Acute Bronchitis

An acute inflammation of the bronchial tubes, usually caused by a viral infection, characterized by coughing, mucus production, and sometimes wheezing.

Etiology of Acute Bronchitis

• Complication of a viral infection

• Bacteria

• Irritants

Pathology of Acute Bronchitis

• Inflammation of the lining of the bronchial tubes

• Typically occurs in small children, chronically ill, or elderly

Manifestations of Acute Bronchitis

• Chest pain

• Dyspnea

• Cough

• Fever

• Mucus (Possibly with pus)

Treatment of Acute Bronchitis

• Self-resolves in 2-3 weeks

• OTC cough suppressant

• Humidifier

Asthma

A reversible inflammation of the bronchi and bronchioles that makes BREATHING hard due to airway tightening, swelling, or mucus, triggered by things like exercise, allergies, or cold air.

Etiology (Triggers) of Asthma

• Allergens

• Inhaled

• Food

• Infections

• Stress

• Emotion

• Noxious Fumes

• Cold Air

• Physical Exertion

Spirometry

A test used to measure lung volumes and classify pulmonary diseases.

Cor Pulmonale

Heart failure due to lung disease, a complication often seen in COPD.

Coccidioidomycosis

A fungal disease caused by Coccidioides immitis, prevalent in the Southwestern United States.

Inflammation of Airways

A condition that can cause obstruction and limit airflow due to mucosal edema and bronchospasm.

Cystic Fibrosis

A genetic disorder affecting the lungs, characterized by the production of thick mucus leading to airway obstruction.

Pneumonia

ACUTE inflammation of the lungs resulting in alveolar fluid ACCUMULATION, which can vary in type and severity.

Types of Pneumonia

Lobar Pneumonia

Bronchopneumonia

Interstitial Pneumonia

Pulmonary Edema

LEAKGE of fluid from pulmonary capillaries causing the fluid to ACCUMULATE in the ACCUMULATE and then to SPILL into the alveoli.

Etiology of Pulmonary Edema

This is caused by INCREASED hydrostatic pressure (like in CHF or fluid overload), DECREASED osmotic pressure (from protein loss, blood loss, or liver/kidney disease), and altered capillary permeability (due to trauma, inhalation injury, drug overdose, or ARDS triggers like aspiration)

Pathology of Pulmonary Edema

Fluid first builds up in the interstitium, then floods the alveoli, causing restriction, atelectasis, and poor gas exchange.

Manifestations of Pulmonary Edema

• Dyspnea and SOB

• “Crackles”

• Alveoli popping open

• Fluid in the Alveoli

• Severe: audible gurgling sounds will be heard

• Hypoxia

• Patient may cough up thin, pink, frothy fluid

Treatment for Pulmonary Edema

• INCREASED Hydrostatic pressure: diuretics (Lasix)

• DECREASED Osmotic pressure: whole blood or albumin

• Altered capillary permeability: support oxygenation & ventilation (may require mechanical ventilation)

Tuberculosis (TB)

A chronic, INFECTIOUS disease that usually STARTS in the lung and SPREADS throughout the body by NECROSIS of lung tissue due to Mycobacterium tuberculosis, leaving the lungs COMPLETELY devastated by the combined inflammatory & infectious process.

Etiology of Tuberculosis (TB)

Infection with Mycobacterium tuberculosis, which is SPREAD through airborne droplets from an INFECTED individual.

Pathology of Tuberculosis (TB)

This disease starts when inhaled bacteria trigger chronic inflammation, resist destruction, replicate in macrophages, form granulomas, and may stay dormant as calcified tubercles (Ghon lesions) — but if immunity drops or reinfection occurs, it can reactivate, cause necrosis, cavitary lesions, spread beyond lungs, and scar tissue forms.

Signs & Symptoms of Tuberculosis (TB)

• NO symptoms with INITIAL infection

• Secondary/reactivated/active TB

• May experience symptoms fairly late in course of disease

• Fever

• Night sweats

• Weight Loss/Cachexia

• Fatigue

• Coughing / Hemoptysis, if severe

• Dyspnea

• Hypoxia

Diagnostic Tests for Tuberculosis (TB)

• Mantoux Skin Test

• Sputum culture

• Cytology

• Gram Stain and AFB

• CXR (Apical Lung Lesions, Calcified or Caseous)

Treatment for Tuberculosis (TB)

Combination of antibiotics over a course of 6 to 12 months, including isoniazid and rifampin, to effectively ELIMINATE the bacteria and PREVENT drug resistance.

Coccidioidomycosis

A fungal infection caused by the Coccidioides immitis, primarily AFFECTING the lungs and potentially leading to SEVRE respiratory issues.

Etiology of Coccidioidomycosis

Spore that is INHALED when dust from soil is AEROSOLIZED.

Pathology of Coccidioidomycosis

• Acute, Neutrophilic Pneumonia

• Eventually NECROTIZING and granulomas DEVELOP

• Lung tissue DESTROYED by CONTINUED inflammation, cavitary lesions, bronchiectasis, and/or fibrosis

Manifestations of Coccidioidomycosis

• Valley Fever

• Fatigue

• Achy Muscles & Joints

• Pleuritic Chest Pain

• Dry, non-productive cough

• Sputum culture

• Cytology

• Routine or fungal

• Histology

• Spherules

• Skin test

• CXR

Treatment for Coccidioidomycosis

Antifungal Drugs (Mild to Moderate)

• Fluconazole: Diflucan

• Itraconazole: Sporanox

Antifungal Drugs (Severe)

• Amphotericin B: Amphotec

Classification of Lung Cancer

• Non-small Cell Carcinoma

• Squamous Cell Carcinoma

• Adenocarcinoma

Squamous Cell Carcinoma

MOST common type of lung cancer in smokers that originates in the squamous cells LINING the airways.

Cause of Squamous Cell Carcinoma

Tumors that develop in the large, central airways (Hilar region)

Adenocarcinoma

A type of lung cancer that originates in the glandular tissue of the lungs, often associated with smoking and environmental factors.

Cause of Adenocarcinoma

Tumors that arise from glandular cells in the peripheral airways.

Invasion in Adenocarcinoma

• Pleura

• Chest wall

• Mediastinal Structures

Bronchogenic Carcinoma

A type of lung cancer originating in the bronchi, often associated with smoking and environmental factors.

Pathology of Bronchogenic Carcinoma

Tumors that spread early and easily through the lung—via lymphatic and hematogenous routes—to organs like the brain, bone, and liver, often originating from cancers like breast, prostate, or colon, sometimes BEFORE symptoms even show.

Manifestations of Bronchogenic Carcinoma

• None initially

• Dyspnea & Shortness of Breath on Exertion

• Both Symptoms LATER Occurs at Rest

• Fatigue

• Unexplained Weight Loss

• Dry, Persistent Cough that may progress to Hemoptysis

Diagnostic Tests for Bronchogenic Carcinoma

• CXR

• CT Scan

• MRI

• Sputum culture

• Expectorated

• Washings from Bronchoscopy

• Cytology

• Biopsy of Tumor

• May be done by Bronchoscopy/Needle Biopsy

Treatments for Bronchogenic Carcinoma

• Surgery (If Tumor Has NOT Metastasized)

• Palliative Surgery & Palliative Resection (If Metastasized)

• Chemotherapy and/or Radiation Therapy

Pulmonary Embolism

A potentially fatal condition where a blood clot or a fatty tissue globule BREAKS free and is CARRIED by the blood to the RIGHT heart and then gets TRAPPED in the pulmonary arteries.

Etiology of Pulmonary Embolism

This condition is usually caused by a DEEP vein THROMBOSIS in the legs or fat emboli from bone marrow RELEASED after a long bone fracture.

Manifestations of Pulmonary Embolism

• Sudden Onset

• Dyspnea

• Shortness of Breath

• Pleuritic Chest

• Pain

• Sudden Death

Diagnostic Tests for Pulmonary Embolism

• Lung Scan: Compares distribution of ventilation to perfusion (V/Q)

• Pulmonary Angiogram

Treatments for for Pulmonary Embolism

• Prevention

• Thrombolytic Drugs

• Heparin

• Warfarin

• Oxygen Therapy

Pulmonary Function Tests (PFT)

Tests used to evaluate lung function, including flow rates and lung volume measurements.

Respiratory Failure

A clinical condition where the respiratory system FAILS to MAINTAIN adequate oxygenation or carbon dioxide removal, resulting in LOW blood oxygen levels or HIGH carbon dioxide levels.

Symptoms of Respiratory Failure

• Any disease process/injury that INTERFERES with gas exchange

• Oxygen Levels DECREASED

• Carbon Dioxide Levels INCREASED

Treatment for Respiratory Failure

Mechanical Ventilation