HOSA Respiratory Diseases and Conditions

Pulmonary System Function

Ventilation and respiration

Respiration

Maintains life by supplying oxygen to organs/tissues/cells and removal of CO2, a waste product

Ventilation

Bellowslike action of chest

Breathing

Controlled by CNS; nerve stimulation begins in medulla oblongata and pons

Pulmonary Circulation

Consists of pulmonary arteries carrying deoxygenated venous blood from heart to lungs; pulmonary capillaries in which gas exchange occurs; pulmonary veins, which return freshly oxygenated blood to heart for systemic criculation; lung tissue supplied w/ oxygen, nutrients in blood supply carried to bronchial arteries

Acid Base Balance

Maintain acid-base pH balance of blood; lack of oxygen w/ hypercapnia (inc CO2 in blood) results in respiratory acidosis; hyperventilation may prod hypocapnia (low CO2 in blood) causing respiratory alkalosis; kidneys work to adjust bicarbonate in blood in response to CO2

External Respiration

Oxygen inhaled from air, exchanged w/ CO2 in blood

Internal Respiration

Exchange of gases between blood and tissue cells; following respiration, CO2 is exhaled as a waste product, passing through respiratory tract (nose, pharynx, larynx, trachea)

Pulmonary Anatomy

Trachea bifurcates into bronchi; Each bronchus enters a lung, where it further divides into smaller bronchioles; At the end of each bronchiole is an alveolus sac, approx 300 mil alveoli in each lung; CO2 Oxygen exchange takes place through capillaries lying next to walls of alveolus

Diaphragm

Muscular, dome-shaped partition attached to lower ribs, separating thoracic cavity from ab cavity; on inspiration, diaphragm contracts, pulling downward, causing air to be sucked into lungs; during expiration, relaxes, pushing upward and forcing air out of lungs; expansion of chest w/ diaphragmatic contraction is an active, energy-req process; exhalation into resting state is a passive process

Visceral Pleura

Membrane that encases lungs

Parietal Pleura

Membrane lining chest of thoracic cavity

Pleural Cavity

Space between the two pleura, potentially; filled w/ 5-6 mL of pleural fluid, preventing friction and allowing pleura to slide off of each other

Mediastinum

Between lugs where heart, great vessels, trachea, esophagus, and lymph nodes are located

Dyspnea

Difficulty in breathing

Hemoptysis

Spitting up Blood

Dysphonia

Hoarseness

Common Cold

= Upper Respiratory Tract Infection (URI); affects mucus membrane lining upper respiratory tract; mainly affects nose and pharynx, but virus can spread to larynx, lungs; symptoms vary w/ bacteria responsible; nasal congestion/discharge, sneezing, watering eyes, sore throat, hoarseness, coughing; highly contagious, w/ nasal discharge OG clear/thin, becoming greenish yellow, thick w/ prog; Headache, fever, chills, malaise; screening needed for prolonged symptoms; 200 diff viruses can cause, most common Rhinoviruses, ½ time; General poor health, lack of exercise, poor nutrition predisposes; Diagnosis mainly from symptoms, sometimes culture of nasal discharge/sputum, CBC; should clear up by itself in 4-5 days, if bacterial infection no longer 10 days; no cure for a cold; resting, drinking lots of water, use of vaporizer, over the counter cold tablets, cough syrups, mild analgesics can relieve symptoms; antibiotics not suggested, aspirin not for children; benign and self-limiting; if immunocompromised, may be more vulnerable to recurrence; prevention difficult

Sinusitis

Acute/Chronic inflammation of mucus membranes of paranasal sinuses, cavities behind facial bones which space nose, cheeks, eye sockets, and normally air filled; frontal sinuses (in forehead above eyes) and maxillary sinuses (under maxillary bone)  most commonly affected; frontal sinuses → headache, esp when waking in morning, pain, tenderness above eyes and intensified when bending over; maxillary → pain in cheeks, drainage, thick greenish yellow mucopurulent discharge; lasts 3-4 weeks; any symptoms encouraged to get medical attention ASAP; cause either viral or commonly bacterial, often after common cold; mucus membranes extend into sinuses, so once something gets in there, the condition blocks sinus drainage or ventilation; can be result of swimming/diving, tooth extractions, tooth abscess, allergies; cause of chronic version may never be explained; phys exam, sinus radiographs, endoscopic sinuscopy grounds diagnosis; in radiographs, air is dark while fluid is white; specimen of nasal secretions can identify bacteria at hand; antibiotics, decongestants, antihistamines to alleviate symptoms by shrinking swollen membranes and drying nasal discharge, makin breathing easier; allergy testing and desensitization w/ immunotherapy/corticosteroids possible; if inflammation persists, sinusotomy can be advised under local anesthesia, piercing maxillary, draining and relieving pressure, instilling sterile water into sinus to remove residuals; analgesics for pain; prognosis for uncomplicated good, chronic more prolonged treatment w/ antibiotics req

Pharyngitis

Acute/chronic inflammation/infection of pharynx; often involves infla tonsils, uvula, palate; sore throat w/ dry, burning sensation, lump in throat sensation; chills, fever, dysphonia, dysphagia, cervical lymphadenopathy; mucosa of pharynx on exam found to be red/swollen w/(o) tonsillar exudate based on causative organism; persistent sore throat warrants screening, and antibiotics should not be taken beforehand; viral infection common, in children streptococcal from tonsils, adenoids, nose, sinuses; persistent infection (chronic version) when infection spreads to pharynx and remains; acute when 2ndary to systemic viral infections, e.g. chickenpox, measles; chronic when accompanying diseases, e.g. syphilis, tuberculosis; gonococcal version from oral-genital sex activity w/ infected partner; inhalation of tobacco smoke, alcohol can cause; breathing in excessive heated air or chem irritants or swallowing sharp objects can cause trauma; seasonal allergies at play; phys exam showing red/swollen mucus membranes, patient history grounds diagnosis; oftentimes CBC and sinus radiographs necessary; Lozenges, mouthwashes, salt water gargles, ice collar, aspirin can help (no aspirin for kids, Reye’s); of symptoms few days, consult physician for antibiotics, sulfonamides; if streptococcal cause, known 7-10 day antibiotics taken; chronic tonsillitis, adenoiditis, adenoid hypertrophy by surgery; bed rest, copious fluids; uncomplicated can resolve in few days, chronic must eliminate underlying cause, e.g. smoking, allergens; prevention includes maintaining good health, avoiding infections, evading known irritants, controlling allergies

Ludwig’s Angina

Cellulitis on floor of mouth; a more serious condition which may appear initially as a routine pharyngitis; charact by fever, severe sore throat, drooling and difficulty breathing; can indicate compromise to respiratory tract, and this is a medical emergency

Epiglottitis

Infection of structure overlying larynx; a more serious condition which may appear initially as a routine pharyngitis; charact by fever, severe sore throat, drooling and difficulty breathing; can indicate compromise to respiratory tract, and this is a medical emergency

Nasopharyngeal Carcinoma

arise in area of pharynx opening into nasal cavity anteriorly and oropharynx inferiorly; unique among head/neck cancers as they are NOT linked to smoking, and instead linked to diet or Epstein-Barr virus; often asymptomatic early; neck mass in 90% patients, nasal obstruction w/ epistaxis, serious otitis media; rare to find all three symptoms in single patient; hearing loss, tinnitus, pain, impaired function of cranial nerves; neck mass warrants screening; rare disease in US/West Europe, higher incidence in southern China, Mediterranean, Southeastern Asia, NA Eskimos; more males than females, often 10-25 or 50-60; risk factors consumption of salted fish, foods w/ high nitrates (processed meats), Chinese herbs, infection w/ EBV; full clinic exam of head/neck, endoscopic exam of nasopharynx, biopsy of sussy lesions, fine needle aspiration biopsy of neck mass grounds diagnosis; staged by TNM, w/ T reflecting extent of tumor invasion into adjacent structures; surgery not often, radiation therapy better; recurrent/advanced carcinomas req chemoradiotherapy; metastases to bone, lung, liver; worse prognosis for spread to cranial nerves; poorer diagnosis if EBV cause

Laryngitis

Infla of larynx, vocal cords; opening of larynx narrow, can interfere w/ breathing; symptoms vary w/ severity of infla, hoarseness, aphonia, fever, malaise, painful throat, dysphagia; any difficulty breathing med emergency; viral/bacterial infection, chronic/acute; URI’s, tonsillitis, pharyngitis, sinusitis main causes, but also bronchitis, pertussis, flu, pneumonia, measles, syphilis, tuberculosis; sometimes by irritation w/o infection; reflux version from repeated acid reflux attacks; inclement weather, tobacco smoke, alcohol, inhalation of irritants, excessive use of voice predispose, esp for chronic version; laryngoscopic exam shows infl mucosa, limited vocal cord movement grounds diagnosis; absolute voice rest, bed rest in well-humidified room, liberal fluid, no tobacco/alc, lozenges, cough syrup should see 4-5 day improvement; antibiotics good results if caused by another disease; chronic version treatment by eliminating as many causes as possible; recovery often within 1 week

Deviated Septum

Crooked nasal septum (cartilage partition btwn nostrils); narrows, obstructs air passage, makes breathing difficult; slightly inc risk sinusitis, but no other symptoms besides; can seem normal ext, but on exam w/ nasal speculum deviated; unless severe, no consequences; congenital anomaly causes, only substantial often from trauma; treatment not necessary unless air passage compromised; surgical repair possible to straighten, by removing cartilage (rhinoplasty, septoplasty), then reshaped, and repositioned in nose; good prognosis

Nasal Polyps

Benign growths from distended mucus membranes protruding into nasal cavity; not harmful, but can be large enough to obstruct nasal airway, making breathing difficult; can impair sense of smell, or obstruct 1+ sinuses; caused by overprod fluid in cells of mucus membrane, allergic rhinitis; some aspirin-sensitive persons have triad of nasal polyps, asthma, urticaria; nasal speculum exam can be seen as pearly gray lumps along nasal passage; surgical removal, injection of steroid directly into polyps repeated 5-7 day intervals until relief; surgery req anesthetic; prognosis good, but recur; no prevention known

Anosmia

Impairment or loss of smell; continues w/o obvious cause; ability to taste liquid also impaired; chronic conditions (nasal polyps, allergic rhinitis) most common cause; intranasal swelling w/ UR condition can cause temporary; sometimes a phobia for particular odor gives psych basis; can result from damage to olfactory nerves by head injury, or rarely brain tumor; removal of polyps, injections w/ offending allergen for rhinitis to desensitize patient treats; prevention unknown, no head traumas best

Epistaxis

Hemorrhage from nose, nosebleed; Common, sudden emergency, often one nostril w/o explanation; no real concern, unlikely to be related to other symptoms; if significant blood loss, vertigo, inc pulse, pallor, shortness of breath, dropped BP occur; more commonly children; if 10+ minutes after constant P applied, severe headache on onset, or commonly occur, emergency care; colds, infections (rhinitis, sinusitis) can cause crusting damaging mucus membrane, rupturing tiny vessels in anterior septum; direct trauma, picking nose, presence of foreign body common causes; can be related to systemic disorders (measles, scarlet fever, pertussis, congestive heart failure); vitamin K deficiency, hypertension, aspirin ingestion, high altitude, anticoagulant risk factors; diagnosis based on patient history of injury; applying constant P on either side of bridge of nose 5-10 minutes can treat; if persistent, local epinephrine followed by cauterization w/ silver nitrate/electric cauterization; if bleeding continues, posterior nasal packing for 1-3 days may req; mild sclerosing agent can be injected into blood vessel Rx; prognosis generally good

Larynx Tumors

Benign/Malignant; dysphonia often sole symptom; if malignant, dysphagia; in children, stridor present due to small airways; hoarseness in benign intermittent, if cancer caused cont and gradually worsens; neither type common, but malignant more so and in men more than women; unexplained, persistent hoarseness 2+ weeks warrants screening; two benign tumors (1) papillomas, multiples (2) polyps, singly; tumors from misuse/overuse of vocal cords; malignant common w/ heavy tobacco use; biopsy done on found tumor to see B/M; can always be cured if diagnosed early; benign growths excised under local anesthetic malignant if early cured w/ radiation therapy; if metastasized, laryngectomy may be req, afterwards req speech therapy; prognosis varies w/ type of tumor; avoiding smoking or any chronic irritation recommended to prevent

Laryngeal Cancer

Neoplasm of portion of respiratory tract btwn pharynx and trachea, housing vocal cords; most common site for head/neck tumors; most SCC; if involves vocal cords, hoarseness early and common initial complaint; hoarseness w/ benign cause (vocal cord polyp, nodule from chronic irritation/overuse) often intermittent, if malignant cause (neoplasm) gradually worsens; dysphagia, hemoptysis, chronic cough, referred pain to ear, stridor, sometimes airway obstruction, no flu-like symptoms; hoarseness 2+ weeks req screening; endemic risk factor where tobacco extensive, high alc consumption (Central Asia, parts of France, Central/East Europe, US); alc/smoking multiplicative risk; HPV 16/18, occupational exposure to agents (perchloroethylene, a dry cleaning agent), asbestos, relative w/ laryngeal cancer risk factors; often 50-60; often diagnosed earlier due to hoarseness; flexible fiberoptic endoscopy visualizes larynx, assesses vocal cord mobility; fine needle aspiration to biopsy cancer; staged by TNM; CT, MRI to see extent of tumor invasion, nodal metastasis; panendoscopy (laryngoscopy, esophagoscopy, bronchoscopy) done to find other areas of tumor growth due to tobacco/alc; PET scan for distant metastases; Early stage patients choose either surgery/radiation based on benefits/risks to daily life, often choosing one which preserves voice (radiation); partial laryngectomy, total laryngectomy, endoscopic laser resection possible surgeries, often for later stage cancers; chemoradiotherapy for organ-sparing approach; speech therapy post-op often req; 5-year survival 65%, w/ early stage 83%, later stage 38-50%; lowering smoking/alc can prevent

Hemoptysis

Coughing/spitting up of blood from respiratory tract; can be present w/ minor infections, or indicates serious underlying condition; bright/dark, from pulmonary or bronchial circulation; profuse bleeding for severe lung infections, a respiratory malignancy, or erosion of pulmonary vessel; trauma, erosion of vessel, calcification, tumors can cause bronchial bleeding, along w/ infla bronchitis, bronchiectasis; chronic infection → damage, irregularly shaped airways; pulmonary arterial hypertension (associated w/ right-sided heart failure), pulmonary venous hypertension (left-sided heart failure) can precipitate; fungal infections, pulmonary infarcts, tumors/ulcerations of larynx, pharynx, coagulation defects can cause; diagnosis based on source of bleeding, done w/ visual exam of mouth, nasopharynx; endoscopy to visualize larynx, trachea, bronchi, radiographs to see lungs; coagulation studies of blood to determine Y/N clotting deficiency, CT of chest, pulmonary angiogram if all else inconclusive; source of bleeding treated; if severe, ligation/surgery to remove or repair vessels involved; measures ensured to prevent asphyxiation by clotted blood, prevent obstruction of bronchial tree w/ clots, prevent exsanguination; if minor bleeding or uncertain cause, antibiotics, cough suppressants Rx; 75% of time no serious disease

Atelectasis

Airless or collapsed state of pulmonary tissue; follows incomplete expansion of lobules/segments of lung, w/ partial/complete collapse of lung; hypoxia, dyspnea; if small segment of lung, dyspnea only; if large area, are for gas exch dec, dyspnea severe; substernal retraction, cyanosis on phys exam, diminished breath sounds over affected area on auscultation; radiographs show mediastinal shift towards side of collapse; diaphoresis, tachycardia, fever as disorder makes prone to infection; severe dyspnea is med emergency; caused by obstruction in bronchial tree, e.g. mucus plug, foreign body, bronchogenic cancer; compression version when tumor exerts P on lung, not allowing air in; infla version from accumulation of fluid in pleural cavity; conditions making breathing difficult induces; failure to breath deeply postoperatively, or prolonged inactivity can cause; in newborns, prematurity, hyaline membrane disease, dec stimulus to breath, narcotics crossing placental barrier, can cause; any condition lowering amount of surfactant (lubricating fluid) can collapse air sacs; radiographs, phys exam, CT scan of chest, bronchoscopy grounds diagnosis; encouraged to ambulate, deep breathe, cough; suctioning of airway to remove obstruction, spirometry, antibiotics for accompanying infection; suctioning of trachea in newborns to remove mucus followed by O2 administration; prognosis varies w/ cause, mild may resolve spontaneously, severe cases prone to complications; higher risk in obese, post ab/chest surgery, neuromuscular weakness, pulmonary disease; early ambulation, good ventilation post-op can prevent

Pulmonary Embolism

Blood clot, foreign body, or tumor lodges in artery in pulmonary circulation; consequences based on size/location, phys condition of patient; no symptoms until blood flow stops; apprehension; if small, cough, chest pain, low fever; more severe dyspnea, tachypnea ( < 20 breaths/min), chest pain, occasional hemoptysis; massive embolisms have sudden cyanosis, shock, death; symptoms mimic heart attack, so calling ambulance for medical emergency w/ symptoms; most thrombi broken loose from deep vein in legs/pelvis; can be composed of air, fat globules, small piece of tissue, cluster of bacteria; mass moves thru venous circulation, pumped by right side of heart to pulmonary circulation where it lodges in a vessel; risk factors from stasis of blood flow from immobility, vessel injury, predisposition to blood clot, thrombophlebitis, cardiovascular disease; pregnancy can predispose, as can oral contraceptives high in estrogen, diabetes mellitus, myocardial infarction; clinical picture, history of phys immobility, lung scans, CT angiography to show pulmonary blood flow grounds diagnosis; Auscultation reveals rales in pleural rub in area of embolism; arterial blood gas can show reduced pressure of O2 and CO2; residual thrombi in veins of lower extremities can help since most originate there; O2 therapy, anticoagulant administration, Heparin or analogues, Warfarin, thrombolytic drugs sometimes esp when low BP; early ambulation, TED stocking, helps prevent; mild cases good prognosis w/ treatment, but inc mortality w/ size; avoiding long-term mobility can prevent

Pneumonia

Infective infla of lungs; uni/bilateral, some/all of infected lung; cough, fever, shortness of breath even at rest, chills, sweating, chest pains, cyanosis, blood in sputum; infants tachypnea; more lung affected, more severe symptoms; aspiration version from aspiration of liquids/other into tracheobronchial tree, common in patients w/ difficulty swallowing, esp elderly, those weakened by cancer, stroke, Parkinson’s, other neurologic problems; viral/bacterial infection cause, often pneumococci, staphylococci, group A, hemolytic streptococci, Haemophilus influenza type B, Klebsiella penumoniae types 1/2, other gram-negative organisms; atypical/walking version often demonstrates marked abnormalities on chest x-ray but patient does not feel ill, most commonly legionella, mycoplasma, chlamydia agents; adenoviruses, influenza viruses, respiratory syncytial viruses can also cause; damage to lungs from inhalation of poisonous gas (Cl) or other foreign matter; can be complication of URI or life-threatening illnesses; can be acquired nosocomial; phys exam, patient history, chest radiographs, arterial blood gases, bronchoscopy, blood/sputum cultures grounds diagnosis; treatment varies w/ underlying cause; organism-specific antibiotics for bacterial cause, penicillin for pneumococcal; tetracycline drugs, erythromycin, sulfonamides sometimes administered; analgesics, aspirin for pain, oxygen therapy for shortness of breath; bed rest, inc fluid intake, high calorie diet beneficial; prognosis good unless severe, chronically ill; 5th leading cause of death in US; antibiotics for URIs can prevent

Severe Acute Respiratory Syndrome (SARS)

Outbreak starting in 2003 China; threat of international epidemic, w/ Toronto hit hardest; from a mutation of Corona Virus; highly contagious, onset of fever, mild sore throat, muscle aches, dry unproductive cough; chest radiographs OG normal; transmission airborne thru env contamination, esp around wildlife markets; lymphopenia, mild thrombocytopenia, elevated liver enzymes; no effective treatment now, and new cases of SARS have vanished; researchers still seeking agnostic test to seek out newly discovered viruses, or future vaccines; research of how virus causes disease on cellular level being done

Pulmonary Abscess

Area of contained infectious material in lungs; more common in lower portions of lungs and right lung due to more vertical bronchus; alternating chills/fever, chest pain, productive cough w/ purulent, bloody, foul-smelling sputum and breath; req immediate medical care; complication of pneumonia due to bacteria; aspiration of food foreign object, bronchial stenosis, neoplasms can cause; septic embolism carried to lung from pulmonary circulation can develop abscess; dec breath sounds on chest auscultation, patient history of recent aspiration, radiograph of chest necessary to find site, blood/sputum cultures to identify bacteria ground diagnosis; antibiotics for long duration or until abscess gone; surgical resection of abscess and portion of affected lung may be req if antibiotics no work; prognosis mainly good, but guarded for very young, elderly, immunocompetent, chronically ill; influenza vaccine can prevent for some

Legionellosis

Pneumonia caused by Legionella pneumophila; severe (Legionnaires’ Disease)/mild (Pontiac Fever) forms; acute respiratory tract infection prod pneumonia-like symptoms, possibly fatal; named for epidemic outbreak at Legion Convention Philly 1976, 34 deaths; general malaise, headache, cough w/ rapid onset of chills, fever, chest pain, dyspnea, myalgia, vomiting, diarrhea, anorexia; 2-10 day incubation for Legionnaires, Pontiac shorter, few hours-2 days; hospitalization may be req; L. pneumophila thrives in warm, aquatic env, inhaled from contaminated aerosolized water droplets; air conditioning systems, cooling towers, whirlpool spas, showers, hot water plumbing of buildings w/ water 95-115 degrees F permits reproduction of bacterium; smoking, phys debilitation, COPD, immunosuppression, alcoholism predisposes; pontiac fever usually occurs in otherwise healthy ind; complete phys exam, patient history, radiograph chest studies, blood tests for elevated WBC, liver enzyme level, ESR, culture of sputum to isolate Legionella necessary to ground diagnosis; antibiotic therapy before confirmation since response to treatment is often slow, e.g. erythromycin; rifampin sometimes when antibiotics are not adequate; oxygen for dyspnea, antipyretics antiemetics analgesics helpful; pontiac fever often resolves in a few days w/o treatment; legionellosis occurs worldwide; prognosis guarded due to variety; appropriate design of facilities preventing stagnant water, ensuring water is either <95 F or >115 w/ adequate chlorination

Respiratory Syncytial Virus Pneumonia (RSV)

infla infectious condition of lungs, common in very young/old; coldlike symptoms, e.g. congestion, in mild upper respiratory tract form of infection; w/ progression downards, fever, malaise, lethargy, more freq coughing, wheezing, dyspnea; req prompt medical attention; caused by Respiratory syncytial virus, w/ annual epidemic infection during winter (Dec-Mar), premature infants w/ genital cardiac defect or preexisting pulmonary disorders; RSV spread by contact w/ secretions infected persons, e.g. nasal secretions; phys exam, lavage of nasal pharynx aid to determine RSV in tissue culture; antipyretics for fever, antibiotics for otitis media, inhalation therapy if invading lower respiratory tract; hospitalization may be req for O2 therapy, hydration; prognosis good, but infants prone to otitis media complication; strict hand washing to prevent is necessary

Histoplasmosis

Fungal disease originating in lungs caused by inhalation of dust containing Histoplasma capsulatum; can cause pneumonia, can become systemic; most asymptomatic; not contagious; as fungus disseminates thru pulmonary tissue, dyspnea, loss of energy to pint of incapacitation, becomes febrile, spleen/lymph nodes enlarge; when having AIDS, may occur as opportunistic infection; most in Mid-West US, often found in soil contaminated w/ bird/bat droppings; positive skin test, blood serologic findings for fungus, and identification of fungus by pus, sputum, tissue specimens, radiographs of chest ground diagnosis; if self-limiting, no treatment; otherwise, antifungal drugs (itraconazole, fluconazole, amphotericin B) can treat severe; spontaneous recovery usual, 2ndary infection possible, small calcifications remain in lungs after infection; can be fatal if progressive

Blastomycosis

= Gilchrist disease, fungal infection caused by inhaling Blastomyces dermatitidis, which grows in mold in moist soil, wood, endemic to North America w/ greatest prevalence in Midwest, southward along Mississippi/Ohio riverbeds

Coccidiomycosis

Coccidioides innitis is causative fungus, causing disease San Joaquin Valley Fever

Influenza

Generalized, highly contagious, acute disease occurring in annual outbreaks; charact by infla of upper/lower respiratory tract mucus membranes, severe protracted cough, fever, headache, sore throat, generalized malaise; fever 101-102 F for 2-3 days, or 103-104 severe cases for 4-5 days; weakness, sweating, fatigue may persist from days to weeks; if longer 5 days, may indicate secondary bacterial pneumonia, complications of bronchitis, sinusitis, otitis media, cervical lymphadenitis; Known causative viruses are orthomyxovirus types A/B/C, mutant strains reproducing in humans/animals which often recover commonly and uncomplicated; secondary bacterial pneumonia after influenza mainly from hemolytic streptococcus, staphylococcus, pneumococcus; outbreaks of influenza can be sporadic or epidemic, often every 1-4 years; incubation period 1-3 days; transmission by inhalation of virus in airborne mucus discharge, fatalities as short as 48 hours after onset occur; may be indistinguishable from the common cold; considerations to amount of time passed since onset, presence of epidemic in community, severity of patient’s symptoms to differentiate from other diseases; freq recurrence of syndromes may make diagnosis tuberculosis; complicating pneumonia may be present w/ dyspnea, cyanosis, hemoptysis, rales in lungs; WBC count may indicate leukopenia w/ relative lymphocytosis; confirmation of diagnosis from isolation of virus w/ throat culture, sputum culture isolating bacteria; treatment symptomatic, w/ vaccines useless after disease is established; bed rest, inc fluids, light diet, use of antipyretics analgesics helpful; amantadine antiviral agent helps A version, oseltamivir for A/B version; all agents only effective within first 48 hours; when not severe, treatment not necessary, w/ warm salt water gargles, steam inhalation, cough syrups comforting; antibiotics help w/ bacterial cause; recovery often fully complete, but complications (pneumonia) can occur; young, elderly, chronically ill esp can see morbidity;  vaccines can reduce occurrence taken annually; immunity takes 2-4 weeks to develop

Avian Flu

Influenza type A H5N1, called bird flu, when transmitted to humans high mortality; fever, respiratory illness; low pathogenic form can go undetected, a highly pathogenic form affects multiple internal organ; ordinarily does not infect humans; mainly in aquatic birds (wild ducks); first occurred from chickens to humans; cannot spread human to human, but concern of mutation can cause deadly pandemic; bird flu vaccine exists, but only half of ppl who receive prod infection-fighting antibodies; if it becomes highly infectious, infective persons must be isolated quickly, hands must be washed, strict infection control; aggressive treatment of symptoms for comfort hydration; death often ensues despite interventions

COPD

Encompasses several obstructive lung diseases; mechanisms can vary, but the consequences are the same: inability to ventilate lungs freely, causing ineffective exchange of respiratory gases; normal respiratory response to elevated CO2 levels becomes diminished; includes bronchitis, bronchiectasis, asthma, emphysema, cystic fibrosis, pneumoconiosis

Bronchitis

Acute/Chronic Infla of mucus membranes lining the bronchi; deep persistent productive cough is main symptom;; thick yellow to gray sputum, shortness of breath, wheezing, slightly elevated temp, pain in upper chest aggravated by cough; acute symptoms subside in a week, but cough may continue for 2-3 weeks; chronic version has infla persist, worsens; mild forms may exists for years as a slight cough which then aggravates as patient contracts URI, causing obstructive asthmatic symptoms, dyspnea, diminished chest expansions, scattered rales and wheezing; in beginning stages, flare-ups of chronic bronchitis likely in patients experienced to colds/flu; later stages see minor head cols becoming severe attacks; final stages see coughing, shortness of breath, wheezing continuously, prolonged recurrent attacks gradual deterioration; all symptoms more troublesome during winter, damp env, polluted atmosphere; if cough w/ no improvement, chronic, w/ purulent sputum, fever, advised to seek medical care; acute version general URI, beginning as common cold or other viral infection of (naso)pharynx as complication of other bacterial infections; recurring attacks from infection, e.g. sinusitis, other COPD; in children, hypertrophied tonsils, adenoids can be source; allergens predispose; chronic caused by same viruses as pneumonia; can be caused by irreversible changes to bronchi from constant irritation, smoking, exposure to industrial pollution; patient symptoms and history can ground diagnosis; radiographs of chest, pulmonary function tests, arterial blood gases, other blood/sputum analyses can help; no specific treatment prescribed; aspirin for fever control, inc fluid intake, vaporizer humidifier usage; bronchodilator aerosol inhaler for wheezing shortness of breath, cough suppressant if chest is sore from coughing; treatment of chronic based on stage of disease; low-flow O2 therapy for hypoxemia, postural drainage, percussion to loosen thick mucus; aerosolized corticosteroids for infla; avoiding smoking, smoke-filled rooms, other affected ppls; acute complete recovery in few days w/ residual cough; chronic guarded prognosis due to debilitation of blocking airways

Bronchiectasis

Permanent, irreversible dilation/distortion 1+ bronchi from destruction of muscular/elastic portions of bronchial walls; takes many years to develop, often bilateral, involving lower lobes of lungs; chronic cough w/ purulent foul-smelling sputum main symptom, warranting screening; caused by repeated damage to bronchial walls, often by recurrent airway infections; phys exam, history of symptoms, radiographs of chest, CT of chest, bronchoscopy, sputum culture, pulmonary function tests ground diagnosis; antibiotics, bronchodilators prescribed, postural drainage encouraged; avoiding env irritants (smoke, fumes, dust) important; if large hemoptysis, surgery to remove afflicted lung suggested; prognosis varies w/ cause; respiratory, cardiac complications common; childhood immunizations recommended, preclusion of smoking/exposure to respiratory irritants best

Asthma

Wheezing, difficulty breathing, productive cough; intrinsic/extrinsic causes; pharmacological therapy w/ inflammatory drugs, bronchodilators; to prevent attacks, quick relief and long-term meds given; adult onset asthma occurs for the first time in someone middle age or older w/ moderate to severe symptoms

Pulmonary Emphysema

COPD charact by destructive changes to alveolar walls or irreversible enlargement of alveolar air sacs; interfered w/ breathing, gas exch; alveoli become large, destroying alveolar walls and adjacent capillaries; dyspnea from trapped air; insidious onset of symptoms, gradual difficulty breathing, tachypnea, wheezing, minor cough; barrel chest due to further effort to exhale CO2; shortness of breath, dyspnea inc during exhaling; w/ progression, circumoral cyanosis noting right ventricular heart failure, digital clubbing; long-term smoking contributes; repeated respiratory tract infections in childhood contributes; ozone, SO2, nitrogen oxides thought to play a role; familial tendency possible, esp w/ alpha1-antitrypsin enzyme deficiency; full etiology not understood; diagnosis based on clinical exam, patient history to show long exposure to irritants (smoking); pulmonary function studies show inc tidal/residual volumes, dec vital capacity and expiratory maneuver volumes; chest radiographs show translucent lungs, depressed/flat diaphragm; distended neck veins, hepatomegaly, peripheral edema, clubbed fingers, cyanosis in those w/ extensive progress of disease; avoiding irritating substances (smoke), infections of respiratory tract, and annual influenza vaccine can treat; drug therapy w/ beta2-andrenergic sympathomimetic drugs (Ventolin, Proventil) for bronchodilation, exercise training can improve quality of life; prognosis for long-term is poor; surgery is a potential option for serious air trapping; in US, most common death respiratory disease; education can prevent

Pneumoconiosis

Any disease of lung caused by long-term dust inhalation; causes progressive, chronic infla/infection of lungs; symptom onset can be insidious, dyspnea often first; dry cough akin to chronic bronchitis; inc effort for inspiration, pulmonary hypertension, tachypnea, general malaise, recurrent respiratory tract infections, tuberculosis symptoms; persistent cough for months req clinical evaluation; takes 10+ years continual daily exposure to develop; patient history, complete phys exam, radiographs of chest, pulmonary function tests, arterial blood gas for diagnosis;treatment symptom-focus, includes bronchodilators, oxygen therapy, chest phys therapy to remove secretions, corticosteroids; damage to lungs is irreversible; no smoking, dust reduction of workplace best prevents

Asbestosis

Form of dust disease from exposure to asbestos fibers; charact by slow, progressively diffuse fibrosis of lungs; common type of pneumoconiosis

Anthracosis

Form of pneumonoconiosis; = black lung = Coal miner’s lung; caused by accumulation of carbon deposits in lung from smoke or coal dust inhalation

Silicosis

Dust disease affecting stone masons or metal grinders working in quarries; develops from inhaling silica (quartz) dust; causes dense fibrosis of lungs and emphysema w/ respiratory impairment

Pleurisy (Pleuritis)

Infla of membranes surrounding lungs, lining pleural cavity; sharp, needlelike pain inc w/ inspiration, coughing; cough, fever, chills, shallow rapid inspirations; often secondary to other diseases/infections, may result in presence of tumor; wet version when pleural fluid present, inc volume causes compression of pulmonary tissue, dyspnea; dry version when pleural liquid dec in volume, resulting in dryness btwn pleura, causing layers to rub together and become congested, edematous; diagnosis from symptoms, history, phys exam; pleural rub can be heard by auscultation of lungs; antibiotics, analgesics, splinting of chest, deep breathing exercises treats and promotes good ventilation; recovery often complete; prevention unknown

Pneumothorax

Collection of air/gas in pleural cavity from a collapsed lung; severe shortness of breath, sudden sharp chest pain, falling BP, rapid weak pulse, shallow/weak respirations; may be cyanotic, appear anxious, can cause mediastinal shift to unaffected side from inc air pressure; req urgent care; can be spontaneous/traumatic; spontaneous version when opening present on surface of lung from erosion of alveoli from tumor/disease, inc P in respiratory system; Traumatic version when integrity of pleural cavity breached from trauma, e.g. gunshot, stab, crush to chest; history, clinical findings, radiographs of pleural cavity grounds diagnosis; put patient in Fowler’s or semi-Fowler’s position, may req O2; occlusive dressing is placed over any sucking wound to seal entry of air into chest; thoracostomy performed to withdraw air from cavity, a closed drainage system established if air continues to leak, allowing expansion/healing of lung; prevention unknown

Hemothorax

Accumulation of blood in pleural cavity; symptoms akin to pneumothorax; signs of hemorrhage including pale, clammy skin, weak thready pulse, falling BP; life threatening emergency; results from trauma or erosion of pulmonary vessel, causing lung to collapse; diminished breath sounds on affected side; radiographs show blood in pleural space; blood tests show hemorrhage, arterial blood gas reflects respiratory failure all ground diagnosis; lung must be reexpanded, often thoracostomy w/ closed drainage to remove blood; surgery to repair wound often req, blood repaired afterwards; prognosis guarded, prevention unknown

Flail Chest

Instability of chest wall from multiple rib/sternum fractures; 3+ ribs fractured, severe pain, dyspnea, appears cyanotic and anxious; paradoxical breathing when chest moves inward during inspiration, out expiration; medical emergency, life threatening; may be from direct compression of heavy object, car accident (esp behind wheel), hard fall, industrial accident; chest trauma, paradoxical movement, radiographs grounds diagnosis; mechanical ventilation/sedation w/ endotracheal tube in place, pain meds (morphine, meperidine hydrochloride) to keep patient comfortable; hospital ASAP req, inc time worsens chance to recover; wearing seat belts in car can prevent from car accident

Pulmonary Tuberculosis

Chronic/(sub)acute infection of lungs by Mycobacterium tuberculosis; infectious, infla disease of lungs from inhaling dried droplet nucleus of bacteria; droplet nuclei can remain in air for hours; asymptomatic OG; when infection 2ndary, weight loss, reduced appetite, listlessness, vague chest pain, dry cough, loss of energy, fever; w/ progression, productive cough w/ purulent sputum, blood streaking, hemoptysis, fever, night sweats; bacteria can survive in dried form for months if not exposed to sunlight; any tissue can be affected, lungs primarily; infection begins as primary lesion in lower lung; as body’s defense attacks bacteria, antigens prod, causing necrosis, fibrosis, calcification of affected tissue; infection then may be arrested and inactive for years, and if not arrested, patient experiences primary version; resistance to 2ndary version depends on env and general health; malnutrition, poor health, unsanitary/crowded living env, presence of other illness lowers resistance to disease; can be exacerbated by other infection; inc immigration btwn Asia, South/Central America, and AIDS epidemic inc prevalence in US; Mantoux Test standard intradermal test to find tuberculin antibodies; takes 48-72 hours to interpret, where induration of 8-10 mm indicates sensitivity to bacillus if positive; positive test result w radiographs of chest, exam of gastric washings, fiberoptic bronchoscopy, sputum culture grounds diagnosis; tubercles are lesions seen in chest radiographs; LTBI is latent tuberculosis w/ no symptoms but positive test result, are not infectious; if communicable must be quarantined w/ cases reported to local health department; new prevalence of drug-resistant version and complications raises concern; uncomplicated treatment uses drug therapy and antituberculosis agents, e.g. Isoniazid w/ rifampin, ethambutol, aminosalicylic acid, streptomycin, cycloserine; early treatment excellent prognosis, but not as good for drug resistant strains, risk factors; Testing if in contact advised

Infectious Mononucleosis (Glandular Fever)

acute, herpesvirus infection; lymphadenopathy and fever mainly in afternoon two key symptoms; malaise, anorexia chills; w/ progression, sore throat, fever, headache, fatigue, tonsils appear coated w/ debris; hepatitis, atypical lymphocytosis; incubation 5-15 days, mainly young adults, rare after 35; caused by Epstein-Barr Virus (EBV), a herpesvirus, carried in saliva of previously infected, transmitted in oral pharyngeal route (e.g. kissing) or blood transfusions; infects WBC in lymph, blood, connective tissue; patient history, phys exam to rule out hepatitis, other lymphomatous disorders; blood smear and immunologic study of blood serum grounds diagnosis; blood screening tests, antinuclear antibody, total serum bilirubin, liver function tests, EBV serology; treatment based on symptoms; in acute phase of fever/malaise bed rest, fluid intake orally or intravenously for high fever; antipyretics (acetaminophen) when high temp fever; prevention hard; barring complications, recovery completes within 3-4 months

Adult Respiratory Distress Syndrome (ARDS)

severe pulmonary congestion charact by acute respiratory distress, hypoxemia; sudden onset of severe hypoxemia, progressive hypercapnia, acidemia in patients recently undergone septicemia, shock, insult to lungs and rest of body; = shock lung; lungs hemorrhagic, wet, boggy, congested, unable to diffuse oxygen; atelectasis results; onset 24-48 hours after medical/surgical insult to body; sudden/severe dyspnea w/ tachypnea, inspiratory intercostal and suprasternal retractions noted, cyanosis, mottled skin; during Vietnam War was called Da Nang lung; supplemental O2 does not help; rales, rhonchi, wheezes may be present; medical emergency, req ambulance; severe trauma or some agent of insult precipitates inc capillary permeability in lungs, pulmonary edema, and resulting respiratory failure; leukocytes and platelets in capillaries release products causing additional injury; alveoli fill w/ exudate 12-48 hours after insult, collapsing at end of expiration, leaving less tissue for gas exch; low pulmonary compliance, pulmonary hypertension, dec functional residual capacity, hypoxemia results; ARDS must have underlying cause, e.g. severe trauma, pneumonia, hypovolemic shock; arterial blood gas determinations indicate reduced perfusion, inc pH, radiograph chest shows bilateral alveolar infiltration; no cure known; Oxygenation by establishing airway, administering humified O2, suctioning air passage Rx; if ventilation poor, mechanical attempted w/ PEEP; nutritional status and cautious hydration maintained intravenously; renal failure or superinfection req intervention; prognosis guarded, w/ many recovering w/o permanent lung damage; onset unpreventable

Sarcoidosis

Multisystem granulomatous (small lesions of infla cells) disorder most commonly in lungs; often no complaints based on size of lesion; in pulmonary version, dry cough, shortness of breath, mild chest pain from loss of lung volume, lung stiffness; fatigue, fever, weight loss, swollen ankles, joint pain; typical epithelioid lesions can also affect skin, eyes, musculoskeletal system, other int organs; often insidious; exact cause uncertain, thought to be malfunction of immune system or some virus; toxins in env can trigger; US more common, 20-40 yo, more in African Americans; genetic factors suspected; difficult to detect, oftentimes uncovered by complete med evaluation (history, phys exam, chest x-ray), lab tests, pulmonary function studies help ground diagnosis; often abates spontaneously, no treatment if asymptomatic; corticosteroids (prednisone) helps lessen symptoms; methotrexate can treat widespread disease, e.g. disfiguring skin lesions, cardiac, or CNS involvement; most affected live normally; if lungs fibrotic or other organ damage poorer prognosis; rarely fatal; prevention unknown

Lung Cancer

Most common cancer death for M/F, 30% of them; repeated carcinogenic irritation to bronchial epithelium leads to inc cell division; cough w/((o) sputum prod most common; most affected is coupled w/ COPD and chronic cough; dyspnea, hemoptysis, chest pain (usually dull, intermittent on side of tumor), weight loss; brain common metastasis site, inducing headache, weakness, change in mental, seizures; liver, bone, skin metastasis sites; oftentimes asymptomatic; SCC 30%, adenocarcinoma 40%, large cell carcinoma 20%, small cell carcinoma 20%, first three considered NSCLC due to similar treatments, w/ small cell lung cancer exclusively to smoking w/ quick metastasis; cigarette smoke main risk factor, responsible for 87% of cases, based on duration of total lifetime smoking; can dec w/ cessation to smoke but best never to start; 2nd hand smoke, asbestos, radon, arsenic, air pollution, radiation, diet/genetic factors can play a role; most found incidentally in chest radiographs; advanced lesions seen in radiographs; sputum cytologic analysis positive for malignant cells useful for diagnosis; to be definitive, tissue biopsy req from bronchoscopy, mediastinoscopy, or CT-guided fine needle asplirate; CT scan of chest, abdomen, head for metastases; NSCLC staged by TNM, where small cell lung cancer staged in two-staage system distinguishing disease from one side of chest (limited) to encompassing both sides (extensive) versions; NSCLC early use surgical resection w/(o) radiation/chemo for best chance survival; surgery often lobectomy, removing tumor affected part of lung; later stage NSCLC not treated by surgery alone, req chemo, radiation, surgery, palliative symptom control; since SCLC metastasizes early, systemic chemo (w/ cisplatin, etoposide, or irinotecan) w/ radiation therapy rather than surgery; SCLC often relapses after 2 years, w/ recurrence dealt w/ by different chemo, poor prognosis; 15% 5-year suvival rate; early detection not proven to improve survival; stopping smoking is key to prevention