Chapter 10: The Respiratory System— Pulmonology

Course Introduction and Respiratory Function

Professor Guido Sendowsky MHA, ATCr presents Acquiring Medical Language (ALH 111) at Orange Coast College, focusing on the respiratory system (Chapter 10). The primary function of this system is to bring oxygen ($O_2$ ) to the blood and remove carbon dioxide ($CO_2$). The upper respiratory tract is composed of the nose (nares, septum, turbinates), pharynx (nasopharynx, oropharynx, laryngopharynx), and larynx, which collectively heat, humidify, and filter incoming air. The lower tract includes the trachea, bronchi, bronchioles, and alveoli where gas exchange occurs via pneumocytes.

Medical Terminology and Word Parts

Key roots for the upper system include adenoid/o (adenoid), tonsill/o (tonsil), nas/o or rhin/o (nose), laryng/o (larynx), pharyng/o (throat), and trache/o (trachea). Anatomical structures are represented by roots such as sept/o (septum), sin/o or sinus/o (sinus), phren/o (diaphragm), thorac/o (chest), pector/o (chest), steth/o (chest), pleur/o (pleura), stern/o (sternum), and cost/o (rib). Pulmonary components are identified by pneum/o, pneumat/o, pneumon/o, pulmon/o, lob/o, bronch/o, bronchiol/o, and alveol/o. The process of breathing is denoted by spir/o or the suffix -pnea, while gases use ox/o for oxygen and capn/o or carb/o for carbon dioxide.

Subjective Symptoms and Patient History

Common complaints include productive or nonproductive coughing. Breathing rates are categorized as apnea, eupnea, tachypnea, or bradypnea, while depth variations include hypopnea or hyperpnea. Clinical abnormalities include dyspnea, orthopnea, hyperventilation, and hypoventilation. Upper tract symptoms include dysphonia, epistaxis, rhinorrhagia, and rhinorrhea. Lower tract complaints involve bronchospasm, phrenospasm, pleuralgia, and discharges such as hemoptysis, bronchorrhea, and sputum.

Clinical Observation and Diagnostic Imaging

Objective findings are gathered through auscultation (listening for pectoriloquy), palpation, and percussion. Physical signs include cyanosis, retraction, pectus carinatum, or pectus excavatum. Lab evaluations involve Arterial Blood Gas ($ABG$) analysis for levels of oxygen and carbon dioxide, capnography, and oximetry. Diagnostic imaging includes computed tomography ($CT$), pulmonary angiography, and ventilation–perfusion scans ($V/Q$ scan). Specialized assessments comprise Pulmonary Function Testing ($PFT$), spirometry, and polysomnography. Visualization is achieved via bronchoscopy, nasopharyngoscopy, and thoracoscopy.

Pathology and Surgical Treatments

Respiratory infections include laryngitis, laryngotracheobronchitis ($LTB$), pneumonia, and bronchitis. Chronic diseases include Asthma, Chronic Obstructive Pulmonary Disease ($COPD$), Cystic Fibrosis ($CF$), and Emphysema. Neoplasms include bronchiogenic carcinoma and mesothelioma. Therapies include medications like nebulizers, expectorants, mucolytics, antitussives, or bronchodilators. Surgical procedures range from reconstruction (septoplasty, laryngoplasty) and removal (adenoidectomy, lobectomy, pneumonectomy) to emergency support like endotracheal tube ($ETT$) intubation, tracheostomy, and cardiopulmonary resuscitation ($CPR$).

Clinical Case Examples

An EHR review of a $4$-month-old male showed a $4$-day history of congestion, fever of $103.4\,^{\circ}\text{F}$, and a pulse ox of $93\,\%$, resulting in an assessment of $URI$ and bronchiolitis. An emergency visit for a $22$-year-old female with $CF$ and hemoptysis recorded an $RR$ of $30$, $HR$ of $92$, and pulse ox of $89\,\%$, necessitating intubation and electrocautery. A consult for a $64$-year-old smoker who lost $5$ pounds over $2$ months revealed right upper lobe opacities and pleural effusion on $CT$, with a biopsy confirming bronchioloalveolar carcinoma requiring lobectomy and chemotherapy.