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Lecture 4: Respiratory System

Biomedicine: Human Sciences

Lecture 4:

Respiratory System

Learning Outcomes

In today’s topic you will learn:

⮚ The parts of the respiratory

system including its structure

and function in the human body.

⮚ The signs, symptoms,

investigation procedures and

some mainstream treatments of

common respiratory diseases.

Functions

1. Gas exchange: Oxygen (O₂) and carbon dioxide

(CO₂).

⮚ O₂is required for cell respiration.

⮚ CO₂is a waste product of cell respiration.

⮚ By breathing, we inhale O₂and exhale CO_2.

2. Warming or cooling and moistening of air.

3. Removal of inhaled particles (immunity):

⮚ Removal of larger substances in nose. ⮚ Smaller substances by mucociliary escalator. ⮚ Alveolar macrophages in alveoli.

4. Voice production and olfaction (smell).

alveoli = air sacs in lungs macrophages = white blood cells

mucociliary escalator = goblet cells and ‘hairs’ in the respiratory tract that help remove particles

Respiratory System Structures

Air flows through the following structures in the respiratory system: - Nose.

- Paranasal sinuses.

- Pharynx (throat).

- Larynx (voice box).

- Trachea (windpipe).

- Bronchi (left and right).

- Bronchioles.

- Alveoli (air sacs).

Nose

Pharynx

Larynx

Trachea

Bronchi

Bronchioles

Types of Respiration

1. External respiration:

• Exchange of gases between the

blood and lungs (air). Pulmonary

capillaries carry blood around alveoli.

• Air is inhaled and exhaled — this is

called ventilation.

2. Internal respiration:

• Exchange of gases between blood and cells.

3. Cellular respiration:

• Metabolic process whereby energy

(ATP) is obtained by metabolising

carbohydrates, fats and proteins.

Respiratory Tract Mucous Membrane

The respiratory tract is lined with a mucous membrane. This is a ciliated epithelial membrane that contains mucus-secreting goblet cells.

• Mucus traps inhaled particles and acts as a surfactant (lowers the surface tension of a liquid, allowing easier spreading).

It also has antimicrobial properties.

• Cilia move the particle-laden mucus towards the oesophagus where it can be coughed up or swallowed, thus protecting the lungs from inhaled pathogens. This mechanism is

called the mucociliary escalator.

cilia = fine hairs

Nose and Nasal Cavity

The nasal cavity is the first contact organ in the respiratory system and it conditions air.

• It is an irregular cavity, divided by a septum (cartilage). Bordered posteriorly by skull bones.

• The nasal cavity contains hairs that trap larger particles.

• Internally has three nasal concha (turbinates) — shelves that increase surface area and trap water during exhalation.

• Contains olfactory receptors (interpret smell).

• Internal nose lined by mucous membrane and capillaries.

conche = Greek for ‘shell’ olfactory = ‘smell’

septum = Latin for ‘enclosure’

Nasal Cavity Functions

1. Filtering air:

• Hairs (larger particles) and cilia / mucus (trap smaller particles, protect

epithelium; cilia beat towards mouth).

• Nasal concha (turbinates) spin air within the nasal cavity; this filters air and encourages particles to become trapped in the mucus.

2. Warming air — strong vascularity of mucosa .

Nose bleeds

demonstrate how vascular the

nasal cavity is. Nasal cilia:

3. Humidification — air travels over moist mucosa.

4. Sneezing reflex — in case of mucosal irritation.

5. Olfactory function — olfactory receptors.

Paranasal Sinuses

para- = ‘beside’ nasal = ‘nose’

The paranasal sinuses are air-filled cavities within certain facial and cranial bones.

• They are lined with mucous membranes that are continuous with the nasal mucosa lining. Secretions drain into nasal cavity.

• Include: Frontal, ethmoid, sphenoid, maxillary.

• The sinuses perform the following functions:

1.Resonance in speech.

2.Lightening of cranial mass.

3.Nasolacrimal ducts drain tears from the eyes.

4.Moistening / humidifying of the air.

Pharynx

The pharynx is a straight muscular

tube that connects the nose and throat.

• The pharynx is roughly 13cm long

and sits anterior to the cervical

spine, terminating at the larynx.

• Consists of the nasopharynx,

oropharynx and laryngopharynx.

• The pharynx contains the eustachian

tubes, which connect the nasopharynx

to the middle ear and allow equalisation

of pressure in the middle ear.

• Contains adenoids (nasopharyngeal tonsils).

Pharynx

FUNCTIONS:

1. Passageway for air and food.

2. Warming and humidifying.

3. Taste.

4. Hearing.

5. Equalisation of pressure in

middle ear (eustachian

tubes).

6. Immune protection: Tonsils.

7. Speech: Resonating

chamber.

Nasopharyngeal tonsils

Larynx

The larynx is also known as the voice box and

connects the laryngopharynx with the trachea.

• Consists of nine pieces of cartilage (including

the thyroid cartilage and epiglottis) and vocal

cords.

• The vocal cords are composed of mucous

membrane foldings stretched horizontally.

• Laryngeal muscles attach to the vocal cords

and when contracted stretch them:

• Relaxed muscles = loose cords = low tone • Contract muscles = tight cords = high tone (vibrate rapidly).

Testosterone

thickens and

lengthens the

vocal cords.

Larynx

FUNCTIONS:

• Production of sound (vocal cords) and

speech (tongue, lips and cheeks).

• Protection — the epiglottis closes off

the trachea during swallowing and

hence prevents food entering the

lungs.

• Air passageway.

• Warming and humidifying.

Trachea

The trachea (or windpipe) is roughly

12cm long and is made of incomplete

C-shaped rings of hyaline cartilage.

• The incomplete rings of cartilage are

connected by smooth muscle, which is

called trachealis.

• Sympathetic (fight or flight) response 🡪

tracheal dilation.

• Parasympathetic (rest and digest)

response 🡪 tracheal constriction.

Trachea

FUNCTIONS:

1. Air flow: Rings keep trachea

open and unobstructed.

2. Mucociliary escalator:

Trapping inhaled particles and

removing them from the

respiratory tract.

3. Cough reflex.

4. Warming, humidifying, filtering

(it is usually warm and humid

by this point).

Coughing Reflex

1. Epithelial receptors in the respiratory tract are

highly sensitive to mechanical and chemical stimuli. The coughing reflex starts when irritation of the mucous membrane occurs.

2. Stimulates sensitive nerve endings in the larynx, trachea, bronchi.

3. A nerve impulse is sent via the vagus nerve to the respiratory centre in the brain stem. 4. This causes deep inhalation and closure of the glottis (and vocal cords).

5. Contraction of the abdominal / respiratory muscles to increase pressure.

6. Forced removal of irritation.

Coughing is a reflex that can reach speeds of up to 60 miles/hr...

Bronchi

The trachea divides into left and right bronchi at the vertebral level of T5. • The bronchi deliver air into the lungs. • Bronchi contain cartilage rings that

maintain an open airway. Bronchi are lined with ciliated epithelium.

• The right bronchus is more vertical, shorter and wider. Hence an aspirated object is more likely to enter the right lung.

• Where the trachea divides into the two bronchi, an internal ridge called the carina is formed (this is the most sensitive structure in the system and it triggers the cough

carina means ‘ridge’

reflex). ¹⁷ © CNM: Human Sciences – Respiratory System. BQ/MC

Bronchioles

The bronchioles are continuations of the bronchi.

• Bronchioles have no cartilage in their structure and

instead contain more smooth muscle.

• The bronchioles lead directly into the

alveoli, where gas exchange occurs.

Control of air-entry via:

• Sympathetic nervous system

(SNS: Fight or flight) = bronchodilation.

• Parasympathetic nervous system

(PSNS: Rest and digest) = bronchoconstriction.

Alveoli

Alveoli are small hollow cavities that make up most of the lung volume. They act as the sites of gas exchange in the lungs.

• The bronchioles terminate into alveolar sacs.

• Alveolar gas exchange is maximised by the following:

- A large surface area (approximately 80m²) created by 250 million alveoli in each lung. - Alveolar walls are very thin

(single-layered).

- Surrounded by many blood capillaries. - Alveolar surfaces are moist (gases

exchange more easily when in water).

Alveolus = Latin for ‘hollow cavity’

Alveolar Gas Exchange

In alveoli, oxygen and carbon dioxide are

exchanged between air and blood

• Gas exchange occurs between alveoli

and capillaries.

• Oxygen moves from the alveoli (after

breathing in), into the blood. This causes

the blood to become oxygenated.

• Carbon dioxide moves from the blood

(having been delivered via the pulmonary

artery), into the alveoli, to be exhaled.

• The movement of both gases occurs via

diffusion (down the concentration gradient).

Alveolar Cells

Type I alveolar cells:

• These are simple epithelial cells, covering

90% of the alveolar surface and are

very thin to support gas exchange.

Type II alveolar cells:

• Secrete alveolar fluid that contains

pulmonary surfactant.

• Pulmonary surfactant reduces alveoli

surface tension, preventing alveolar collapse.

• The fluid allows gases to diffuse through it.

Alveolar macrophages:

• These are strategically located white blood cells (leukocytes) that engulf and destroy microbes entering the alveoli.

surfactant = 'surface' and 'active substance'

gestation = time when foetus develops

Pulmonary Surfactant

Surfactant is a mixture of lipids and proteins that forms a surface film in alveoli.

• The protein part is hydrophilic and resides in the alveolar fluid, whilst the lipid component is hydrophobic and faces the air. • Through this structure, surfactant

reduces the surface tension within

the alveoli, preventing them from

collapsing and reducing the pressure

required to re-inflate them.

• Surfactant is not produced until 24-28

weeks’ gestation, so consider lung

development in a premature baby.

• Two-thirds of the work of breathing is to overcome surface tension. 22

Lung Anatomy

Two cone-shaped lungs, separated by the heart.

Surfaces:

• Apex (extends above clavicle).

• Base (over diaphragm).

• Costal (rib) surface.

• Medial surface.

Lobes:

• Right lung: Three lobes.

• Left lung: Two lobes (due to the heart). Blood supply:

• From the pulmonary artery (left and right).

apex = Latin for tip / peak

Pleura and Pleural Cavity

The pleura are serous membranes that

surround the lungs.

• The pleura contain a visceral and a parietal

layer, with a pleural cavity in between.

• The visceral and parietal pleura form a

double layer separated by 5 - 10ml of

serous fluid that prevents friction.

• The pleura adhere to the lungs so that the

lungs are sucked to the pleura (‘passive

dilation’) — helps expansion of the lungs.

• A pneumothorax occurs when damage to the pleura allows air into the pleural cavity.

visceral = pertaining to organs parietal = walls of a cavity

Ventilation

ventus = Latin for ‘wind’

Ventilation is the process through which O₂and

CO₂are transported to and from the lungs.

• A normal cycle of ventilation during quiet

breathing involves 12 - 15 breaths per minute.

• Ventilation involves two main phases:

1. Inhalation (approx. two seconds).

2. Exhalation (approx. three seconds)

(followed by a brief pause).

• Breathing can come from two areas:

- Abdominal (diaphragmatic) breathing —

where most breathing should come from.

- Upper rib breathing.

Muscles of Ventilation

Two types of ventilation muscles: primary

and secondary.

Primary muscles:

• Intercostal muscles (internal and external):

• Attached between ribs at right angles.

• Contraction pulls ribs upwards (inhalation)

expanding outward and increasing size of rib cage.

• Diaphragm:

• Attached to the lower ribs, sternum and

lumbar spine. A domed muscle that

separates the thoracic and abdominal cavity.

• Contraction moves the diaphragm into the

abdomen and draws air into the lungs.

Muscles of Ventilation

The secondary muscles of ventilation

(also called accessory muscles) assist in breathing.

• These muscles are often over-recruited in patients suffering with breathlessness (e.g. asthmatics). They can become shortened and fatigued.

• Most accessory muscles are located around the neck and chest.

The scalenes:

• Examples of secondary muscles of ventilation include the trapezius, sternocleidomastoid, and the scalenes.

Ventilation

Inhalation:

• Inhalation is an active process requiring muscles.

• Negative pressure in the thoracic cavity causes air

to enter lungs down a pressure gradient.

Exhalation:

• Exhalation is typically a passive process —

muscles relax.

• This occurs through the elastic recoil of the lungs.

• Should only be active during forceful breathing.

• If elasticity is lost, for example, in pulmonary

fibrosis, exhalation can become active with the

recruitment of internal intercostal and abdominal

muscles.

Lung Volumes

The average pair of human lungs

can hold about six litres of air.

• However, only a small amount of this

capacity is used during normal

breathing (as highlighted in the image).

• The tidal volume represents the normal

volume of air that enters the lungs during

inspiration when no extra effort is applied.

• A normal tidal volume is about 500ml.

• Men generally have larger lung volumes, as

do taller individuals, non-smokers,

athletes and those living at higher altitudes.

Gases

Inspired air contains a large quantity of nitrogen and oxygen. • As oxygen has a strong affinity

(attraction) for haemoglobin, oxygen will readily enter the blood and bind with haemoblogin molecules.

• Haemoglobin is the key component of red blood cells and transports oxygen in the blood.

Atmospheric Gases:

Gas:	Inspired air:	Expired air:
Oxygen:	21%	16%
Carbon dioxide:	0.04%	4%
Nitrogen and rare gases:	78%	78%

• Nitrogen doesn’t bind to haemoglobin. _{Furthermore, nitrogen is not used or}

created in the body, so any nitrogen

that has dissolved in the blood will

remain at the same concentration.

Gases in Blood: Oxygen

98.5% of oxygen in the blood is transported by haemoglobin (Hb) in red blood cells. • 1.5% of oxygen is dissolved in plasma (oxygen dissolves poorly in water).

• Haemoglobin changes colour depending on how much oxygen is bound to the molecule. • Oxyhaemoglobin is when plenty of oxygen is bound to Hb. Deoxyhaemoglobin is Hb that lacks oxygen.

• Oxygen is an essential gas in the body. Cells use oxygen to create the energy that is required for various processes.

oxy- = oxygen

haem- = blood

globus = a spherical protein

Gases in Blood: Carbon Dioxide

Carbon dioxide diffuses into the

blood from respiring cells easily. It

is transported in the following

ways:

• 70% found in plasma as HCO^3- (bicarbonate).

• 23% carried in RBCs (bound to haemoglobin).

• 7% dissolved in plasma (the water component of blood).

Bicarbonate

CO₂+ H₂O ↔ H₂CO₃↔ H⁺+ HCO₃- Carbonic acid

Gases in Blood: Carbon Dioxide

Bicarbonate buffer reaction (to control blood pH):

• CO₂diffuses down its concentration

gradient from tissues into the blood.

• Because of the high-water content

of blood, CO₂combines with water

to produce carbonic acid (H₂CO₃).

• As carbonic acid is unstable, it decomposes

immediately into bicarbonate and H⁺.

• Hydrogen is exhaled and excreted in

urine to reduce the acidity. In addition,

the bicarbonate formed is alkaline, which

buffers the acidity of blood to keep pH stable.

Respiratory System: Blood pH

pH is the measure of acidity, alkalinity and neutrality. • Blood pH needs to be controlled within very narrow limits. • Low pH = elevated H⁺ion concentration (more acidic).

• High pH = more alkaline.

What causes a low pH (acidity) in the blood?

• 🡹 CO₂: When CO₂dissolves in the blood, it

causes an increase in H⁺ions and thus an increase

in acidity. This leads to respiratory acidosis.

• It is not just CO₂that causes acidosis; exercise

produces lactic acid, and fasting produces ketoacids

which enter the blood. This is called metabolic acidosis.

• Ventilation helps to lower the acidity of body fluids via

exhalation of CO_{2. 34} © CNM: Human Sciences – Respiratory System. BQ/MC

Regulating Blood pH

Increase in acidity is managed in three ways:

1. Buffer systems

• Temporarily bind to H⁺removing

them from solution (i.e. proteins,

bicarbonate).

2. Increased exhalation of CO₂

3. Kidney excretion of H⁺

• Slow mechanism.

• Kidneys can also synthesise new

bicarbonate and reabsorb

bicarbonate, thus influencing pH.

buffer = to lessen or moderate the impact of something

Cell Respiration

Cell respiration describes the process of energy production (ATP) within cells. • Glucose is the primary organic molecule

metabolised for ATP production although fats and proteins are also used.

Energy is produced by either:

1. Aerobic respiration (with oxygen) 38 ATP (total yield) + water + CO_2. 2. Anaerobic respiration (no oxygen) 2 ATP (total yield) + lactic acid.

Remember: ATP is

adenosine triphosphate, the energy currency in the body.

The oxygen availability of cells depends on the functioning of the respiratory system (breathing and gas exchange), as well as circulation to deliver oxygen.

Ventilation Control

The control of ventilation is primarily involuntary.

• The respiratory centre is in the brainstem (medulla

oblongata and pons). This receives

inputs from different parts of the body.

• Chemical receptors found in the brainstem

measure CO₂and acidity (H⁺concentration).

• Chemical receptors in the aorta and carotid

artery measure CO₂, O₂and acidity levels.

• Stretch receptors in the walls of the bronchi

and bronchioles detect over-inflation.

• If receptors detect high arterial CO₂, this triggers

hyperventilation (to excrete / exhale excess CO₂).

Summary Quiz:

1) Name the TWO gases that are exchanged in alveoli.

2) Where does internal respiration take place?

3) How many lobes does the left lung have?

4) Name the artery that supplies the lungs.

5) Indicate the location of the respiratory centre in the brain. 6) List THREE functions of the nasal cavity.

7) Is exhalation generally an active or passive process?

8) Name TWO primary muscles of ventilation.

9) Describe the function of the mucociliary escalator.

10) Explain the effect of high blood concentrations of carbon dioxide on blood pH.

Smoking and the Respiratory System

Smoking cigarettes significantly increases

the risk of lung diseases.

• Cigarettes contain substances known as

carcinogens. Carcinogens are substances

that can cause cancer.

• Smoking also damages the delicate cilia that

line the respiratory tract. Normally these cilia

would sweep trapped particles out of the lungs.

• Following cilia damage, mucus and trapped

particles build up in the lungs, causing a

smoker’s cough, whilst also increasing the risk

of pulmonary infections, bronchitis and emphysema.

Research has shown that 15 cigarettes smoked = one genetic mutation 39

Respiratory Investigations:

Common Signs and Symptoms

• Congestion. • Runny nose. • Sneezing.

• Cough.

• Sputum.

• Wheezing. • Chest pain. • Breathlessness.

ortho = straight/upright dys- = difficulty

-pnoea = breathing

Cyanosis:

Inadequate oxygenated blood in an area. Due to:

• Dyspnoea (difficulty breathing). • Orthopnoea (breathless when lying down).

• Hyperventilation (over-breathing). • Cyanosis.

1. A peripheral arterial disease (i.e. blockage).

2. Lung disease (poor gas exchange). 3. Heart failure (inability to deliver oxygenated blood).

Sputum Differential Diagnosis

The following table describes the key appearances of sputum and what each appearance might indicate:

Sputum type:	Sputum characteristics:	Possible causes:
Mucoid	Clear, grey / white.	Asthma and bronchitis.
Purulent	Thick, yellow / green.	Infections (bronchitis, pneumonia).
Serous	Clear, frothy, pink.	Pulmonary oedema.
Blood	Blood.	Lung cancer, TB, pulmonary embolism, clotting disorders.

purulent = containing pus

Investigations

^{Medical investigations:}• Blood test (i.e. white blood cell count,

inflammatory markers).

^{• Biochemistry tests. • Sputum analysis and microbiology.}• Imaging — chest x-ray, MRI, CT.

Physical examination:

• Percussion (tapping to the thoracic

cage) and auscultation.

• Respiratory function tests — measure

inspiration / expiration of lungs and

gaseous exchange in the lungs / circulation.

Naturopathic investigations (later in the course).

Respiratory Examination

Finger clubbing:

Lung cancer, COPD or cystic fibrosis

^Percussion:Chest deformity:

‘Barrel chest’

(seen in COPD)

_{Auscultation:}X-Ray – lung tumour:

Respiratory Pathologies: _rhin-_{= nose}

Rhinitis

Rhinitis is inflammation of the nasal mucosa.

• The inflammation leads to mucosal swelling and an increase in the volume and viscosity of nasal secretions (mucus).

CAUSES:

• Immune compromise (leading to viral, bacterial or fungal infections); i.e. related to emotional stress, medications, diet etc.

• Allergic rhinitis (e.g., due to pollen, spores, mites) — IgE stimulates mast cells to release histamine.

-itis = inflammation

Rhinitis can be acute or

chronic...

• Non-allergic rhinitis (associated with environmental and lifestyle changes; e.g. pollution, diet, drugs

such as NSAIDs, stress, etc).

Rhinitis

SIGNS AND SYMPTOMS:

• Itchy runny nose, sneezing, stuffy nose, ↓ smell.

COMPLICATIONS:

• Nasal polyps, ear infections, loss of smell.

TREATMENT:

• Allopathic: Anti-histamines, decongestants, steroid nasal sprays.

• Natural: Nutritional (immune modulation and anti-inflammatory) — raw honey, apple cider vinegar, quercetin, probiotics.

Herbs (e.g. echinacea, nettle), homeopathy,

Echinacea

acupuncture. ₄₅ © CNM: Human Sciences – Respiratory System. BQ/MC

Common Cold

Infection of the upper respiratory tract.

• Those with lower immunity become infected with virus.

SIGNS AND SYMPTOMS: gradual onset, lasting two to seven days: • Rhinorrhoea (runny nose), sneezing, sore throat and mild fever.

ALLOPATHIC DRUG TREATMENT:

• Symptomatic: Painkillers, decongestants.

NATURAL TREATMENT:

• Nutritional (immune support) — vitamin C in high

doses, zinc, vitamin D, steam inhalations with mint, thyme, eucalyptus, colloidal silver, rest. Acupuncture and homeopathy. • Herbal medicine, e.g., echinacea, elderberry.

Influenza (Flu)

Influenza is an acute respiratory disease,

associated with various strains of the flu virus.

• Incubation period: One to four days (time

between microbial exposure and first symptoms).

• Symptoms tend to be systemic, more severe

and last longer.

• Flu vaccinations often don’t provide effective

immunity as the virus mutates (the vaccine

also produces significant adverse effects).

SIGNS AND SYMPTOMS:

• Sudden onset: Fever and shivering, malaise,

muscle and joint pain, rhinitis, sore throat.

⁴⁷© CNM: Human Sciences – Respiratory System. BQ/MC

Influenza (Flu)

ALLOPATHIC TREATMENT:

• Antiviral drugs — reduces viral shedding. To be taken within 48hrs, but very poor effectiveness and adverse effects.

• Antibiotics to prevent secondary bacterial

infection (adverse effects: Lowered immunity,

diarrhoea, poor digestion and thrush).

• Flu vaccine in vulnerable populations.

NATURAL TREATMENT:

• Herbal medicine (immune system support and anti-viral herbs). • Homeopathy, nutritional (immune support) — garlic,

vitamin C in high doses, zinc, vitamin D, quercetin,

steam inhalations with mint, thyme, eucalyptus, rest.

Flu Complications

• Secondary infections while the immune system

is depleted due to primary flu infection.

• Post-viral syndrome (chronic fatigue syndrome)

following compromised immune system.

• Morbidity / mortality — influenza pandemics such

as the pandemic of 1918 which is estimated to have

killed between 50-100 million people (2.7-5.4% of the

world population - consider that this pandemic followed

the huge loss and distress of World War 1.

• Pigs are known as mixing reservoirs as they can

host both human and non-human viruses, potentially

allowing the mixing of viral genes creating a new virus.

Cold v. Flu

	Common Cold:	Influenza:
Onset:	• Gradual.	• Rapid.
Symptom distribution:	• Localised (upper respiratory tract).	• Systemic (body aches, joint pains etc.)
Duration:	• Two‒seven days.	• Seven‒14 days.
Cause:	• Rhinovirus.	• Influenza virus.
Headache:	• Rare.	• Common.
Runny nose:	• Common.	• Sometimes.
Complications:	• Less likely.	• More serious.

Sinusitis

Inflammation of the membranous lining of one or more of the sinuses (rhinosinusitis).

sinus = sinuses -itis = inflammation

• Sinusitis can be acute or chronic (> three months).

• Often associated with immune compromise. - - - Frequently follows a respiratory infection.

An infected tooth may cause

the sinuses to become infected also.

SIGNS AND SYMPTOMS:

• Pain over affected sinus and congestion.

• Sinus headaches.

• Fever, nasal drip, change in tone of voice, reduced sense of smell.

Sinusitis

ALLOPATHIC DRUG TREATMENT:

• Painkillers, decongestants.

NATURAL TREATMENT:

• Nutritional (vitamin C in high doses,

zinc, vitamin D, steam inhalations

with mint, thyme, eucalyptus).

• Herbal medicine (immune system

support, antiviral and decongestant

herbs; e.g. eyebright, echinacea).

• Homeopathy, acupuncture. Netty pot drainage.

Nasal Polyps

Nasal polyps are soft, non-cancerous (benign) masses of oedematous nasal mucosa.

CAUSES / RISKS:

• The end-product of chronic inflammation, due to: • Viral, bacterial or fungal.

• Allergies - chronic rhinitis.

PATHOPHYSIOLOGY:

• Chronic inflammation causes the blood vessels in the lining of the nose and

sinuses to become more permeable,

allowing water to accumulate in the cells. • Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps.

oedema = fluid swelling 53

Nasal Polyps

SIGNS AND SYMPTOMS:

• Difficulty breathing, runny nose, persistent

stuffiness.

• Chronic sinus infections, reduced sense of smell.

^{• Dull headaches, snoring, mouth breathing.}• Can cause sleep apnoea.

ALLOPATHIC TREATMENT:

• Intranasal steroids (adverse effects).

• Anti-histamines, anti-fungals, surgery.

NATURAL TREATMENT:

• Treat the cause. Nutrition and herbal

medicine for immune modulation / support.

• Homeopathy and acupuncture (relieve blockage).

^tonsill^{= tonsils}Tonsillitis -itis = inflammation

Tonsillitis describes inflammation of the tonsils.

• Common type of infection in children

5–10 years and 15–25 years.

• Viral (common cold or flu virus) or

bacterial (streptococci).

• Short incubation period.

SIGNS AND SYMPTOMS:

• Sore throat that becomes worse when swallowing. • Fever over 38^oC.

• Coughing, headache and red / inflamed tonsils. © CNM: Human Sciences – Respiratory System. BQ/MC

Tonsils are

immune /

lymphoid tissue positioned in the oral and nasal passageway as a first line of

defence.

Tonsillitis

COMPLICATIONS:

• Middle ear infection, quinsy (abscess).

ALLOPATHIC TREATMENT:

• Painkillers, antibiotics (adverse effects: Lowered

immunity, disturbed gut function (diarrhoea, bloody

stools, poor digestion and absorption, candida).

• Surgery (tonsillectomy) — loss of immune tissue.

NATURAL TREATMENT:

• Nutritional (support immune system and reduce

inflammation), lozenges, gargles, colloidal silver.

• Herbal medicine — anti-microbial, immune

support; i.e. echinacea, calendula, sage.

• Homeopathy and acupuncture.

Quinsy (peritonsillar abscess)

An abscess that has formed around the tonsils, occurring as a result of tonsillitis.

• Mostly affecting adolescents and young adults.

SIGNS AND SYMPTOMS:

• Severe unilateral throat pain, dysphagia, unilateral earache, trismus (limited mouth opening), fever, swollen lymph nodes.

TREATMENT:

• Allopathic: Antibiotics, pus drainage, surgery. • Alternative: Herbal medicine, nutritional support, lozenges, gargles, colloidal silver. Homeopathy and acupuncture.

peri- = Greek for around tonsillar = of the tonsils abscess = collection of pus

dys- = difficulty

-phagia = swallowing

Pharyngitis

An acute inflammation of the mucous membrane of the pharynx.

• Usually accompanies colds and tonsillitis and is often accompanied by swollen lymph nodes.

ALLOPATHIC TREATMENT:

• Painkillers for virus (adverse effects). • Antibiotics — adverse effects.

NATURAL TREATMENT:

pharyng- = pharynx -itis = inflammation.

• Herbal medicine (anti-microbial, immune support), nutritional (support immune system and reduce

inflammation), lozenges, gargles, acupuncture. Homeopathy.

Laryngitis

Laryngitis describes inflammation of the larynx.

• Can be acute or chronic:

• Acute: Viral, bacterial.

• Chronic: Overuse — repeated strain, irritants (smoke, fumes), acid reflux.

SIGNS AND SYMPTOMS:

• Hoarseness, weak voice or voice loss. • Sore / dry / tickly throat.

• Dry cough.

• Difficulty breathing (in children).

laryng- = relating to larynx -itis = inflammation.

Again, you must

consider why the

host immune system is failing to prevent

disease…

Laryngitis

ALLOPATHIC TREATMENT:

• Antibiotics (consider adverse effects).

• Avoid smoking and smoke,

maintain oral hygiene.

NATURAL TREATMENT:

• Herbal medicine (anti-microbial, immune support); i.e., echinacea, boswellia, turmeric, ginger, red sage.

• Nutritional (support immune system and reduce inflammation) — garlic, onions, steam inhalations. Homeopathy and acupuncture.

Boswellia

Asthma

Asthma is a chronic airway disease with

reversible narrowing of the bronchi and

bronchioles.

• An inflammatory condition combined with

bronchial hyper-responsiveness with

varying degrees of immune cell infiltration.

• Airflow obstruction due to oedema, mucus buildup and smooth muscle proliferation (= problems exhaling).

• Asthma can develop at any age, but most

commonly affects children under 10 years of age,

with another peak in the elderly.

• Leukotrienes are key chemical inflammatory

mediators in asthma. They are bronchoconstrictors.

Asthma

The prevalence of asthma is increasing.

Possible reasons for this include:

• Earlier weaning.

• Inadequate exposure to pathogens in

childhood.

• Inherited dysbiosis (imbalance of gut flora)

and antibiotic use in children.

• Food additives.

• Leaky gut syndrome.

• Nutritional deficiencies’ i.e., C, D, E, magnesium.

Asthma

ASTHMA CLASSIFICATION:

• Extrinsic (or atopic) asthma:

• Affecting children typically, immunologically

mediated with an increase in IgE antibodies. Brought on by exposure to allergens e.g., pollen, dust, animal dander.

• Intrinsic asthma:

• A bronchial reaction that is not due to

antigen-antibody stimulation. Adult onset typically.

• Common triggers include anxiety, chemicals, exercise, cold air, drugs (NSAIDs, beta blockers), stress, dust, etc. 63

Asthma

This image highlights the pathological

changes that occur in the bronchioles of

an asthmatic patient.

• Smooth muscle contracts and immune

cells infiltrate the bronchioles as part of

the inflammatory process, which

obstructs the airways.

Asthma

SIGNS AND SYMPTOMS:

• Recurrent episodes of breathlessness

and chest tightness.

• Wheezing when exhaling.

• Nocturnal coughing, occasionally with

thick clear or yellow sputum.

• Accessory muscles of ventilation are

overused and can cause aching in

the neck and upper back.

DIAGNOSIS:

• Based on signs / symptoms and history.

• Spirometry.

Asthma

ALLOPATHIC TREATMENT:

• Bronchodilators (blue inhaler).

• Corticosteroids (brown inhaler) — many adverse

effects.

NATURAL TREATMENT:

• Nutritional — fruit and vegetables, antioxidants (e.g.,

vitamin C and E, quercetin), onions and garlic, omega-3s, magnesium (bronchodilator), eliminate food allergens.

• Herbal medicine; e.g., boswellia, turmeric, astragalus,

gingko, liquorice.

• Homeopathy and acupuncture.

• Avoid irritants (dust, smoke etc.) and allergens, allergy treatment, breathing exercises, manual therapy.

Asthma Attack

• An asthma attack can be life-threatening.

• Do not hesitate to call for help. It is severe if the patient cannot speak in sentences and has more than 25 breaths per minute (tachypnoea).

• Encourage the patient to sit down (not lie down) and take slow, steady breaths. Try to keep the patient calm.

• Use inhaler (usually blue bronchodilator) every 30‒60 seconds, up to a maximum of 10 puffs.

• CALL AN AMBULANCE IF YOU CANNOT GET THE PATIENT’S SYMPTOMS UNDER CONTROL.

tachy- = rapid

-pnoea = breath 67

Bronchitis

Bronchitis describes inflammation of the bronchial tubes. Inflammation can be acute or chronic.

• Viral or bacterial infections can result from compromised immunity (considered a lower respiratory tract infection). Can be associated with environmental irritants.

• When an irritant enters the airways, goblet cells secrete mucus to flush it out. If mucus is overproduced, the respiratory system attempts but struggles to clear it.

• This can increase airway resistance and cause breathing difficulties.

bronch- = bronchi -itis = inflammation.

Bronchitis

SIGNS AND SYMPTOMS:

• Hacking unproductive cough, becoming

productive within days (thick yellowy mucus).

• Fever, sore throat, shortness of breath,

headache, runny or blocked nose, muscle pain.

• Signs: Crackles on auscultation, tachypnoea,

tachycardia, cyanosis.

TREATMENT APPROACHES:

• Allopathic: Antibiotics (adverse effects).

• Alternative: Herbal medicine (anti-microbial,

immune support), nutritional (support immune

system and reduce inflammation), avoid irritants.

Homeopathy, acupuncture.

Chronic Obstructive Pulmonary Disease (COPD)

COPD causes airflow limitation that is progressive and not fully reversible. The airflow limitation is due to airway and functional lung tissue damage.

• A chronic inflammatory response of the

lungs (usually to inhaled toxins).

• COPD refers to a combination of two

main pathologies (of varying proportions):

- Emphysema 🡪 walls of the alveoli

damaged and destroyed, leading to

reduced gas exchange.

- Chronic bronchitis 🡪 the bronchial lining is

constantly irritated and inflamed 🡪 thick mucus.

COPD

Chronic Bronchitis:

Emphysema:

Pathology:

• Inflammation and

thickening of bronchial lining with mucus

hyper-secretion.

• Dilation of alveolar sacs by destruction of alveolar wall, leading to collapse of alveoli during expiration

Key symptoms:

• Cough and wheezing.

• Breathlessness.

CAUSES:

• Smoking (accounts for 90% of COPD in Western countries). • Exposure to lung irritants (air pollution, industrial chemicals, dusts, etc.), genetic susceptibility.

COPD

• Smoking cigarettes and inhaling

other irritants leads to high levels

of oxidative stress in the

respiratory tract.

• Oxidative stress damages the

delicate cilia and promotes

chronic inflammation throughout

the respiratory tract.

• Cells are damaged and scar.

This, as well as excess mucus

production, leads to airflow obstruction.

COPD

SIGNS AND SYMPTOMS:

• Chronic cough with sputum, dyspnoea.

• Prolonged expiration and wheeze.

• Frequent infections.

• Signs: Tachypnoea, breathlessness on

exertion, pursed lips breathing, patients

may lean forward and rest arms on the table,

flapping tremor, cyanosis, hyperinflation of

chest (barrel chest), clubbed nails.

COMPLICATIONS:

• Chronic hypoxaemia 🡪 pulmonary hypertension. • Recurrent respiratory infections.

• Respiratory failure.

hypo = below normal -ox = oxygen

-aemia = blood

tachy = fast / rapid -pnoea = breathing

COPD

ALLOPATHIC TREATMENT:

• Smoking cessation. Bronchodilators,

corticosteroids, oxygen therapy.

NATURAL TREATMENT:

• Herbal medicine:

- Anti-inflammatory and immune enhancing

(i.e., echinacea, andrographis, cat’s claw).

- Mucous membrane support (i.e., goldenseal, eyebright). • Nutritional (support immune system and reduce

inflammation), i.e., vitamin C, zinc, quercetin, ginger.

• Avoid irritants (dust, smoke, etc.) and allergens;

allergy treatment, acupuncture and homeopathy.

COPD

Emphysema chest

NORMAL EMPHYSEMA

CT scan:

Dilation of alveolar sacs by

destruction of alveolar wall

Pneumonia

Pneumonia is an infection of the alveoli

and terminal bronchioles, mostly bacterial.

• Associated with an infiltration of neutrophils

with inflammation and oedema.

• Most common in infants, children and the elderly. Higher risk if the patient is immune suppressed.

SYMPTOMS AND SIGNS:

^{• Cough and purulent sputum which may be blood}stained.

• Breathlessness, fever, malaise.

bronchiole

fluid in bronchiole

• Signs: Tachypnoea, crepitations on auscultation.

pulmonary = of the lungs

^fibrosis^{= scarring}Pulmonary Fibrosis _idiopathic_{= unknown cause}

Gradual replacement of the one-layer-thick epithelial cell lining in alveoli with fibrotic tissue.

• Fibrotic (scar) tissues are less able to

exchange oxygen and CO_2.

CAUSES:

• Idiopathic (IPF): Unknown, may be

genetic, presents around 70 years.

• Smoking, asbestos, some drugs, radiation

therapy, accompanies some diseases (autoimmune, e.g. RA).

SIGNS AND SYMPTOMS:

• Progressive dyspnoea, chronic cough, fatigue,

discomfort in the chest, loss of appetite, weight loss.

Pulmonary Fibrosis

Currently no effective allopathic treatments.

NATURAL TREATMENT:

• Herbal medicine (anti

inflammatory, bronchodilators, immune modulation).

• Nutritional (support immune system and reduce

inflammation).

• Avoid irritants (dust, smoke, etc.) and allergens, allergy treatment. • Acupuncture and homeopathy.

Normal lung

histology:

Pulmonary fibrosis histology:

Normal chest

CT scan:

Pulmonary fibrosis CT:

Obstructive Sleep Apnoea

a- = absence

-pnoea = breathing

Intermittent and repeated upper airway collapse during sleep leading to interrupted breathing.

• Causes / risks: Include obesity, male gender, middle-aged, smokers, alcohol, sedatives, nasal obstruction (rhinitis, polyps).

• Treatment with nasal continuous positive

airway pressure (CPAP), lifestyle modification.

It is essential to treat the cause.

SIGNS AND SYMPTOMS:

• Loud snoring, daytime sleepiness, morning headache, morning drowsiness, nocturnal choking, reduced libido. Diagnosis by polysomnography.₇₉ © CNM: Human Sciences – Respiratory System. BQ/MC

Pneumothorax

A pneumothorax describes air

accumulation within the pleural cavity, causing part, or all, of a lung to collapse.

• Air enters via defect in visceral or parietal pleura (e.g. rib fracture).

• Can be simple (i.e. heart remains central) or tension (unstable — progressive buildup of air shifting the heart away).

CAUSES:

pneumo = lungs or air thorax = cavity under ribs

• Spontaneous — rupture of cyst / pocket of air,

tuberculosis, cystic fibrosis, emphysema.

• Traumatic (damage to pleura) — fracture, surgical complication.

Lecture 4: Respiratory System

Biomedicine: Human Sciences

Lecture 4:

Respiratory System

Learning Outcomes

In today’s topic you will learn:

⮚ The parts of the respiratory

system including its structure

and function in the human body.

⮚ The signs, symptoms,

investigation procedures and

some mainstream treatments of

common respiratory diseases.

Functions

1. Gas exchange: Oxygen (O₂) and carbon dioxide

(CO₂).

⮚ O₂is required for cell respiration.

⮚ CO₂is a waste product of cell respiration.

⮚ By breathing, we inhale O₂and exhale CO_2.

2. Warming or cooling and moistening of air.

3. Removal of inhaled particles (immunity):

⮚ Removal of larger substances in nose. ⮚ Smaller substances by mucociliary escalator. ⮚ Alveolar macrophages in alveoli.

4. Voice production and olfaction (smell).

alveoli = air sacs in lungs macrophages = white blood cells

mucociliary escalator = goblet cells and ‘hairs’ in the respiratory tract that help remove particles

Respiratory System Structures

Air flows through the following structures in the respiratory system: - Nose.

- Paranasal sinuses.

- Pharynx (throat).

- Larynx (voice box).

- Trachea (windpipe).

- Bronchi (left and right).

- Bronchioles.

- Alveoli (air sacs).

Nose

Pharynx

Larynx

Trachea

Bronchi

Bronchioles

Types of Respiration

1. External respiration:

• Exchange of gases between the

blood and lungs (air). Pulmonary

capillaries carry blood around alveoli.

• Air is inhaled and exhaled — this is

called ventilation.

2. Internal respiration:

• Exchange of gases between blood and cells.

3. Cellular respiration:

• Metabolic process whereby energy

(ATP) is obtained by metabolising

carbohydrates, fats and proteins.

Respiratory Tract Mucous Membrane

The respiratory tract is lined with a mucous membrane. This is a ciliated epithelial membrane that contains mucus-secreting goblet cells.

• Mucus traps inhaled particles and acts as a surfactant (lowers the surface tension of a liquid, allowing easier spreading).

It also has antimicrobial properties.

• Cilia move the particle-laden mucus towards the oesophagus where it can be coughed up or swallowed, thus protecting the lungs from inhaled pathogens. This mechanism is

called the mucociliary escalator.

cilia = fine hairs

Nose and Nasal Cavity

The nasal cavity is the first contact organ in the respiratory system and it conditions air.

• It is an irregular cavity, divided by a septum (cartilage). Bordered posteriorly by skull bones.

• The nasal cavity contains hairs that trap larger particles.

• Internally has three nasal concha (turbinates) — shelves that increase surface area and trap water during exhalation.

• Contains olfactory receptors (interpret smell).

• Internal nose lined by mucous membrane and capillaries.

conche = Greek for ‘shell’ olfactory = ‘smell’

septum = Latin for ‘enclosure’

Nasal Cavity Functions

1. Filtering air:

• Hairs (larger particles) and cilia / mucus (trap smaller particles, protect

epithelium; cilia beat towards mouth).

• Nasal concha (turbinates) spin air within the nasal cavity; this filters air and encourages particles to become trapped in the mucus.

2. Warming air — strong vascularity of mucosa .

Nose bleeds

demonstrate how vascular the

nasal cavity is. Nasal cilia:

3. Humidification — air travels over moist mucosa.

4. Sneezing reflex — in case of mucosal irritation.

5. Olfactory function — olfactory receptors.

Paranasal Sinuses

para- = ‘beside’ nasal = ‘nose’

The paranasal sinuses are air-filled cavities within certain facial and cranial bones.

• They are lined with mucous membranes that are continuous with the nasal mucosa lining. Secretions drain into nasal cavity.

• Include: Frontal, ethmoid, sphenoid, maxillary.

• The sinuses perform the following functions:

1.Resonance in speech.

2.Lightening of cranial mass.

3.Nasolacrimal ducts drain tears from the eyes.

4.Moistening / humidifying of the air.

Pharynx

The pharynx is a straight muscular

tube that connects the nose and throat.

• The pharynx is roughly 13cm long

and sits anterior to the cervical

spine, terminating at the larynx.

• Consists of the nasopharynx,

oropharynx and laryngopharynx.

• The pharynx contains the eustachian

tubes, which connect the nasopharynx

to the middle ear and allow equalisation

of pressure in the middle ear.

• Contains adenoids (nasopharyngeal tonsils).

Pharynx

FUNCTIONS:

1. Passageway for air and food.

2. Warming and humidifying.

3. Taste.

4. Hearing.

5. Equalisation of pressure in

middle ear (eustachian

tubes).

6. Immune protection: Tonsils.

7. Speech: Resonating

chamber.

Nasopharyngeal tonsils

Larynx

The larynx is also known as the voice box and

connects the laryngopharynx with the trachea.

• Consists of nine pieces of cartilage (including

the thyroid cartilage and epiglottis) and vocal

cords.

• The vocal cords are composed of mucous

membrane foldings stretched horizontally.

• Laryngeal muscles attach to the vocal cords

and when contracted stretch them:

• Relaxed muscles = loose cords = low tone • Contract muscles = tight cords = high tone (vibrate rapidly).

Testosterone

thickens and

lengthens the

vocal cords.

Larynx

FUNCTIONS:

• Production of sound (vocal cords) and

speech (tongue, lips and cheeks).

• Protection — the epiglottis closes off

the trachea during swallowing and

hence prevents food entering the

lungs.

• Air passageway.

• Warming and humidifying.

Trachea

The trachea (or windpipe) is roughly

12cm long and is made of incomplete

C-shaped rings of hyaline cartilage.

• The incomplete rings of cartilage are

connected by smooth muscle, which is

called trachealis.

• Sympathetic (fight or flight) response 🡪

tracheal dilation.

• Parasympathetic (rest and digest)

response 🡪 tracheal constriction.

Trachea

FUNCTIONS:

1. Air flow: Rings keep trachea

open and unobstructed.

2. Mucociliary escalator:

Trapping inhaled particles and

removing them from the

respiratory tract.

3. Cough reflex.

4. Warming, humidifying, filtering

(it is usually warm and humid

by this point).

Coughing Reflex

1. Epithelial receptors in the respiratory tract are

highly sensitive to mechanical and chemical stimuli. The coughing reflex starts when irritation of the mucous membrane occurs.

2. Stimulates sensitive nerve endings in the larynx, trachea, bronchi.

3. A nerve impulse is sent via the vagus nerve to the respiratory centre in the brain stem. 4. This causes deep inhalation and closure of the glottis (and vocal cords).

5. Contraction of the abdominal / respiratory muscles to increase pressure.

6. Forced removal of irritation.

Coughing is a reflex that can reach speeds of up to 60 miles/hr...

Bronchi

The trachea divides into left and right bronchi at the vertebral level of T5. • The bronchi deliver air into the lungs. • Bronchi contain cartilage rings that

maintain an open airway. Bronchi are lined with ciliated epithelium.

• The right bronchus is more vertical, shorter and wider. Hence an aspirated object is more likely to enter the right lung.

• Where the trachea divides into the two bronchi, an internal ridge called the carina is formed (this is the most sensitive structure in the system and it triggers the cough

carina means ‘ridge’

reflex). ¹⁷ © CNM: Human Sciences – Respiratory System. BQ/MC

Bronchioles

The bronchioles are continuations of the bronchi.

• Bronchioles have no cartilage in their structure and

instead contain more smooth muscle.

• The bronchioles lead directly into the

alveoli, where gas exchange occurs.

Control of air-entry via:

• Sympathetic nervous system

(SNS: Fight or flight) = bronchodilation.

• Parasympathetic nervous system

(PSNS: Rest and digest) = bronchoconstriction.

Alveoli

Alveoli are small hollow cavities that make up most of the lung volume. They act as the sites of gas exchange in the lungs.

• The bronchioles terminate into alveolar sacs.

• Alveolar gas exchange is maximised by the following:

- A large surface area (approximately 80m²) created by 250 million alveoli in each lung. - Alveolar walls are very thin

(single-layered).

- Surrounded by many blood capillaries. - Alveolar surfaces are moist (gases

exchange more easily when in water).

Alveolus = Latin for ‘hollow cavity’

Alveolar Gas Exchange

In alveoli, oxygen and carbon dioxide are

exchanged between air and blood

• Gas exchange occurs between alveoli

and capillaries.

• Oxygen moves from the alveoli (after

breathing in), into the blood. This causes

the blood to become oxygenated.

• Carbon dioxide moves from the blood

(having been delivered via the pulmonary

artery), into the alveoli, to be exhaled.

• The movement of both gases occurs via

diffusion (down the concentration gradient).

Alveolar Cells

Type I alveolar cells:

• These are simple epithelial cells, covering

90% of the alveolar surface and are

very thin to support gas exchange.

Type II alveolar cells:

• Secrete alveolar fluid that contains

pulmonary surfactant.

• Pulmonary surfactant reduces alveoli

surface tension, preventing alveolar collapse.

• The fluid allows gases to diffuse through it.

Alveolar macrophages:

• These are strategically located white blood cells (leukocytes) that engulf and destroy microbes entering the alveoli.

surfactant = 'surface' and 'active substance'

gestation = time when foetus develops

Pulmonary Surfactant

Surfactant is a mixture of lipids and proteins that forms a surface film in alveoli.

• The protein part is hydrophilic and resides in the alveolar fluid, whilst the lipid component is hydrophobic and faces the air. • Through this structure, surfactant

reduces the surface tension within

the alveoli, preventing them from

collapsing and reducing the pressure

required to re-inflate them.

• Surfactant is not produced until 24-28

weeks’ gestation, so consider lung

development in a premature baby.

• Two-thirds of the work of breathing is to overcome surface tension. 22

Lung Anatomy

Two cone-shaped lungs, separated by the heart.

Surfaces:

• Apex (extends above clavicle).

• Base (over diaphragm).

• Costal (rib) surface.

• Medial surface.

Lobes:

• Right lung: Three lobes.

• Left lung: Two lobes (due to the heart). Blood supply:

• From the pulmonary artery (left and right).

apex = Latin for tip / peak

Pleura and Pleural Cavity

The pleura are serous membranes that

surround the lungs.

• The pleura contain a visceral and a parietal

layer, with a pleural cavity in between.

• The visceral and parietal pleura form a

double layer separated by 5 - 10ml of

serous fluid that prevents friction.

• The pleura adhere to the lungs so that the

lungs are sucked to the pleura (‘passive

dilation’) — helps expansion of the lungs.

• A pneumothorax occurs when damage to the pleura allows air into the pleural cavity.

visceral = pertaining to organs parietal = walls of a cavity

Ventilation

ventus = Latin for ‘wind’

Ventilation is the process through which O₂and

CO₂are transported to and from the lungs.

• A normal cycle of ventilation during quiet

breathing involves 12 - 15 breaths per minute.

• Ventilation involves two main phases:

1. Inhalation (approx. two seconds).

2. Exhalation (approx. three seconds)

(followed by a brief pause).

• Breathing can come from two areas:

- Abdominal (diaphragmatic) breathing —

where most breathing should come from.

- Upper rib breathing.

Muscles of Ventilation

Two types of ventilation muscles: primary

and secondary.

Primary muscles:

• Intercostal muscles (internal and external):

• Attached between ribs at right angles.

• Contraction pulls ribs upwards (inhalation)

expanding outward and increasing size of rib cage.

• Diaphragm:

• Attached to the lower ribs, sternum and

lumbar spine. A domed muscle that

separates the thoracic and abdominal cavity.

• Contraction moves the diaphragm into the

abdomen and draws air into the lungs.

Muscles of Ventilation

The secondary muscles of ventilation

(also called accessory muscles) assist in breathing.

• These muscles are often over-recruited in patients suffering with breathlessness (e.g. asthmatics). They can become shortened and fatigued.

• Most accessory muscles are located around the neck and chest.

The scalenes:

• Examples of secondary muscles of ventilation include the trapezius, sternocleidomastoid, and the scalenes.

Ventilation

Inhalation:

• Inhalation is an active process requiring muscles.

• Negative pressure in the thoracic cavity causes air

to enter lungs down a pressure gradient.

Exhalation:

• Exhalation is typically a passive process —

muscles relax.

• This occurs through the elastic recoil of the lungs.

• Should only be active during forceful breathing.

• If elasticity is lost, for example, in pulmonary

fibrosis, exhalation can become active with the

recruitment of internal intercostal and abdominal

muscles.

Lung Volumes

The average pair of human lungs

can hold about six litres of air.

• However, only a small amount of this

capacity is used during normal

breathing (as highlighted in the image).

• The tidal volume represents the normal

volume of air that enters the lungs during

inspiration when no extra effort is applied.

• A normal tidal volume is about 500ml.

• Men generally have larger lung volumes, as

do taller individuals, non-smokers,

athletes and those living at higher altitudes.

Gases

Inspired air contains a large quantity of nitrogen and oxygen. • As oxygen has a strong affinity

(attraction) for haemoglobin, oxygen will readily enter the blood and bind with haemoblogin molecules.

• Haemoglobin is the key component of red blood cells and transports oxygen in the blood.

Atmospheric Gases:

Gas:	Inspired air:	Expired air:
Oxygen:	21%	16%
Carbon dioxide:	0.04%	4%
Nitrogen and rare gases:	78%	78%

• Nitrogen doesn’t bind to haemoglobin. _{Furthermore, nitrogen is not used or}

created in the body, so any nitrogen

that has dissolved in the blood will

remain at the same concentration.

Gases in Blood: Oxygen

98.5% of oxygen in the blood is transported by haemoglobin (Hb) in red blood cells. • 1.5% of oxygen is dissolved in plasma (oxygen dissolves poorly in water).

• Haemoglobin changes colour depending on how much oxygen is bound to the molecule. • Oxyhaemoglobin is when plenty of oxygen is bound to Hb. Deoxyhaemoglobin is Hb that lacks oxygen.

• Oxygen is an essential gas in the body. Cells use oxygen to create the energy that is required for various processes.

oxy- = oxygen

haem- = blood

globus = a spherical protein

Gases in Blood: Carbon Dioxide

Carbon dioxide diffuses into the

blood from respiring cells easily. It

is transported in the following

ways:

• 70% found in plasma as HCO^3- (bicarbonate).

• 23% carried in RBCs (bound to haemoglobin).

• 7% dissolved in plasma (the water component of blood).

Bicarbonate

CO₂+ H₂O ↔ H₂CO₃↔ H⁺+ HCO₃- Carbonic acid

Gases in Blood: Carbon Dioxide

Bicarbonate buffer reaction (to control blood pH):

• CO₂diffuses down its concentration

gradient from tissues into the blood.

• Because of the high-water content

of blood, CO₂combines with water

to produce carbonic acid (H₂CO₃).

• As carbonic acid is unstable, it decomposes

immediately into bicarbonate and H⁺.

• Hydrogen is exhaled and excreted in

urine to reduce the acidity. In addition,

the bicarbonate formed is alkaline, which

buffers the acidity of blood to keep pH stable.

Respiratory System: Blood pH

pH is the measure of acidity, alkalinity and neutrality. • Blood pH needs to be controlled within very narrow limits. • Low pH = elevated H⁺ion concentration (more acidic).

• High pH = more alkaline.

What causes a low pH (acidity) in the blood?

• 🡹 CO₂: When CO₂dissolves in the blood, it

causes an increase in H⁺ions and thus an increase

in acidity. This leads to respiratory acidosis.

• It is not just CO₂that causes acidosis; exercise

produces lactic acid, and fasting produces ketoacids

which enter the blood. This is called metabolic acidosis.

• Ventilation helps to lower the acidity of body fluids via

Regulating Blood pH

Increase in acidity is managed in three ways:

1. Buffer systems

• Temporarily bind to H⁺removing

them from solution (i.e. proteins,

bicarbonate).

2. Increased exhalation of CO₂

3. Kidney excretion of H⁺

• Slow mechanism.

• Kidneys can also synthesise new

bicarbonate and reabsorb

bicarbonate, thus influencing pH.

buffer = to lessen or moderate the impact of something

Cell Respiration

Cell respiration describes the process of energy production (ATP) within cells. • Glucose is the primary organic molecule

metabolised for ATP production although fats and proteins are also used.

Energy is produced by either:

1. Aerobic respiration (with oxygen) 38 ATP (total yield) + water + CO_2. 2. Anaerobic respiration (no oxygen) 2 ATP (total yield) + lactic acid.

Remember: ATP is

adenosine triphosphate, the energy currency in the body.

The oxygen availability of cells depends on the functioning of the respiratory system (breathing and gas exchange), as well as circulation to deliver oxygen.

Ventilation Control

The control of ventilation is primarily involuntary.

• The respiratory centre is in the brainstem (medulla

oblongata and pons). This receives

inputs from different parts of the body.

• Chemical receptors found in the brainstem

measure CO₂and acidity (H⁺concentration).

• Chemical receptors in the aorta and carotid

artery measure CO₂, O₂and acidity levels.

• Stretch receptors in the walls of the bronchi

and bronchioles detect over-inflation.

• If receptors detect high arterial CO₂, this triggers

hyperventilation (to excrete / exhale excess CO₂).

Summary Quiz:

1) Name the TWO gases that are exchanged in alveoli.

2) Where does internal respiration take place?

3) How many lobes does the left lung have?

4) Name the artery that supplies the lungs.

5) Indicate the location of the respiratory centre in the brain. 6) List THREE functions of the nasal cavity.

7) Is exhalation generally an active or passive process?

8) Name TWO primary muscles of ventilation.

9) Describe the function of the mucociliary escalator.

10) Explain the effect of high blood concentrations of carbon dioxide on blood pH.

Smoking and the Respiratory System

Smoking cigarettes significantly increases

the risk of lung diseases.

• Cigarettes contain substances known as

carcinogens. Carcinogens are substances

that can cause cancer.

• Smoking also damages the delicate cilia that

line the respiratory tract. Normally these cilia

would sweep trapped particles out of the lungs.

• Following cilia damage, mucus and trapped

particles build up in the lungs, causing a

smoker’s cough, whilst also increasing the risk

of pulmonary infections, bronchitis and emphysema.

Research has shown that 15 cigarettes smoked = one genetic mutation 39

Respiratory Investigations:

Common Signs and Symptoms

• Congestion. • Runny nose. • Sneezing.

• Cough.

• Sputum.

• Wheezing. • Chest pain. • Breathlessness.

ortho = straight/upright dys- = difficulty

-pnoea = breathing

Cyanosis:

Inadequate oxygenated blood in an area. Due to:

• Dyspnoea (difficulty breathing). • Orthopnoea (breathless when lying down).

• Hyperventilation (over-breathing). • Cyanosis.

1. A peripheral arterial disease (i.e. blockage).

2. Lung disease (poor gas exchange). 3. Heart failure (inability to deliver oxygenated blood).

Sputum Differential Diagnosis

The following table describes the key appearances of sputum and what each appearance might indicate:

Sputum type:	Sputum characteristics:	Possible causes:
Mucoid	Clear, grey / white.	Asthma and bronchitis.
Purulent	Thick, yellow / green.	Infections (bronchitis, pneumonia).
Serous	Clear, frothy, pink.	Pulmonary oedema.
Blood	Blood.	Lung cancer, TB, pulmonary embolism, clotting disorders.

purulent = containing pus

Investigations

^{Medical investigations:}• Blood test (i.e. white blood cell count,

inflammatory markers).

^{• Biochemistry tests. • Sputum analysis and microbiology.}• Imaging — chest x-ray, MRI, CT.

Physical examination:

• Percussion (tapping to the thoracic

cage) and auscultation.

• Respiratory function tests — measure

inspiration / expiration of lungs and

gaseous exchange in the lungs / circulation.

Naturopathic investigations (later in the course).

Respiratory Examination

Finger clubbing:

Lung cancer, COPD or cystic fibrosis

^Percussion:Chest deformity:

‘Barrel chest’

(seen in COPD)

_{Auscultation:}X-Ray – lung tumour:

Respiratory Pathologies: _rhin-_{= nose}

Rhinitis

Rhinitis is inflammation of the nasal mucosa.

• The inflammation leads to mucosal swelling and an increase in the volume and viscosity of nasal secretions (mucus).

CAUSES:

• Immune compromise (leading to viral, bacterial or fungal infections); i.e. related to emotional stress, medications, diet etc.

• Allergic rhinitis (e.g., due to pollen, spores, mites) — IgE stimulates mast cells to release histamine.

-itis = inflammation

Rhinitis can be acute or

chronic...

• Non-allergic rhinitis (associated with environmental and lifestyle changes; e.g. pollution, diet, drugs

such as NSAIDs, stress, etc).

Rhinitis

SIGNS AND SYMPTOMS:

• Itchy runny nose, sneezing, stuffy nose, ↓ smell.

COMPLICATIONS:

• Nasal polyps, ear infections, loss of smell.

TREATMENT:

• Allopathic: Anti-histamines, decongestants, steroid nasal sprays.

• Natural: Nutritional (immune modulation and anti-inflammatory) — raw honey, apple cider vinegar, quercetin, probiotics.

Herbs (e.g. echinacea, nettle), homeopathy,

Echinacea

Common Cold

Infection of the upper respiratory tract.

• Those with lower immunity become infected with virus.

SIGNS AND SYMPTOMS: gradual onset, lasting two to seven days: • Rhinorrhoea (runny nose), sneezing, sore throat and mild fever.

ALLOPATHIC DRUG TREATMENT:

• Symptomatic: Painkillers, decongestants.

NATURAL TREATMENT:

• Nutritional (immune support) — vitamin C in high

doses, zinc, vitamin D, steam inhalations with mint, thyme, eucalyptus, colloidal silver, rest. Acupuncture and homeopathy. • Herbal medicine, e.g., echinacea, elderberry.

Influenza (Flu)

Influenza is an acute respiratory disease,

associated with various strains of the flu virus.

• Incubation period: One to four days (time

between microbial exposure and first symptoms).

• Symptoms tend to be systemic, more severe

and last longer.

• Flu vaccinations often don’t provide effective

immunity as the virus mutates (the vaccine

also produces significant adverse effects).

SIGNS AND SYMPTOMS:

• Sudden onset: Fever and shivering, malaise,

muscle and joint pain, rhinitis, sore throat.

Influenza (Flu)

ALLOPATHIC TREATMENT:

• Antiviral drugs — reduces viral shedding. To be taken within 48hrs, but very poor effectiveness and adverse effects.

• Antibiotics to prevent secondary bacterial

infection (adverse effects: Lowered immunity,

diarrhoea, poor digestion and thrush).

• Flu vaccine in vulnerable populations.

NATURAL TREATMENT:

• Herbal medicine (immune system support and anti-viral herbs). • Homeopathy, nutritional (immune support) — garlic,

vitamin C in high doses, zinc, vitamin D, quercetin,

steam inhalations with mint, thyme, eucalyptus, rest.

Flu Complications

• Secondary infections while the immune system

is depleted due to primary flu infection.

• Post-viral syndrome (chronic fatigue syndrome)

following compromised immune system.

• Morbidity / mortality — influenza pandemics such

as the pandemic of 1918 which is estimated to have

killed between 50-100 million people (2.7-5.4% of the

world population - consider that this pandemic followed

the huge loss and distress of World War 1.

• Pigs are known as mixing reservoirs as they can

host both human and non-human viruses, potentially

allowing the mixing of viral genes creating a new virus.

Cold v. Flu

	Common Cold:	Influenza:
Onset:	• Gradual.	• Rapid.
Symptom distribution:	• Localised (upper respiratory tract).	• Systemic (body aches, joint pains etc.)
Duration:	• Two‒seven days.	• Seven‒14 days.
Cause:	• Rhinovirus.	• Influenza virus.
Headache:	• Rare.	• Common.
Runny nose:	• Common.	• Sometimes.
Complications:	• Less likely.	• More serious.

Sinusitis

Inflammation of the membranous lining of one or more of the sinuses (rhinosinusitis).

sinus = sinuses -itis = inflammation

• Sinusitis can be acute or chronic (> three months).

• Often associated with immune compromise. - - - Frequently follows a respiratory infection.

An infected tooth may cause

the sinuses to become infected also.

SIGNS AND SYMPTOMS:

• Pain over affected sinus and congestion.

• Sinus headaches.

• Fever, nasal drip, change in tone of voice, reduced sense of smell.

Sinusitis

ALLOPATHIC DRUG TREATMENT:

• Painkillers, decongestants.

NATURAL TREATMENT:

• Nutritional (vitamin C in high doses,

zinc, vitamin D, steam inhalations

with mint, thyme, eucalyptus).

• Herbal medicine (immune system

support, antiviral and decongestant

herbs; e.g. eyebright, echinacea).

• Homeopathy, acupuncture. Netty pot drainage.

Nasal Polyps

Nasal polyps are soft, non-cancerous (benign) masses of oedematous nasal mucosa.

CAUSES / RISKS:

• The end-product of chronic inflammation, due to: • Viral, bacterial or fungal.

• Allergies - chronic rhinitis.

PATHOPHYSIOLOGY:

• Chronic inflammation causes the blood vessels in the lining of the nose and

sinuses to become more permeable,

allowing water to accumulate in the cells. • Over time, as gravity pulls on these waterlogged tissues, they may develop into polyps.

oedema = fluid swelling 53

Nasal Polyps

SIGNS AND SYMPTOMS:

• Difficulty breathing, runny nose, persistent

stuffiness.

• Chronic sinus infections, reduced sense of smell.

^{• Dull headaches, snoring, mouth breathing.}• Can cause sleep apnoea.

ALLOPATHIC TREATMENT:

• Intranasal steroids (adverse effects).

• Anti-histamines, anti-fungals, surgery.

NATURAL TREATMENT:

• Treat the cause. Nutrition and herbal

medicine for immune modulation / support.

• Homeopathy and acupuncture (relieve blockage).

^tonsill^{= tonsils}Tonsillitis -itis = inflammation

Tonsillitis describes inflammation of the tonsils.

• Common type of infection in children

5–10 years and 15–25 years.

• Viral (common cold or flu virus) or

bacterial (streptococci).

• Short incubation period.

SIGNS AND SYMPTOMS:

• Sore throat that becomes worse when swallowing. • Fever over 38^oC.

Tonsils are

immune /

lymphoid tissue positioned in the oral and nasal passageway as a first line of

defence.

Tonsillitis

COMPLICATIONS:

• Middle ear infection, quinsy (abscess).

ALLOPATHIC TREATMENT:

• Painkillers, antibiotics (adverse effects: Lowered

immunity, disturbed gut function (diarrhoea, bloody

stools, poor digestion and absorption, candida).

• Surgery (tonsillectomy) — loss of immune tissue.

NATURAL TREATMENT:

• Nutritional (support immune system and reduce

inflammation), lozenges, gargles, colloidal silver.

• Herbal medicine — anti-microbial, immune

support; i.e. echinacea, calendula, sage.

• Homeopathy and acupuncture.

Quinsy (peritonsillar abscess)

An abscess that has formed around the tonsils, occurring as a result of tonsillitis.

• Mostly affecting adolescents and young adults.

SIGNS AND SYMPTOMS:

• Severe unilateral throat pain, dysphagia, unilateral earache, trismus (limited mouth opening), fever, swollen lymph nodes.

TREATMENT:

• Allopathic: Antibiotics, pus drainage, surgery. • Alternative: Herbal medicine, nutritional support, lozenges, gargles, colloidal silver. Homeopathy and acupuncture.

peri- = Greek for around tonsillar = of the tonsils abscess = collection of pus

dys- = difficulty

-phagia = swallowing

Pharyngitis

An acute inflammation of the mucous membrane of the pharynx.

• Usually accompanies colds and tonsillitis and is often accompanied by swollen lymph nodes.

ALLOPATHIC TREATMENT:

• Painkillers for virus (adverse effects). • Antibiotics — adverse effects.

NATURAL TREATMENT:

pharyng- = pharynx -itis = inflammation.

• Herbal medicine (anti-microbial, immune support), nutritional (support immune system and reduce

inflammation), lozenges, gargles, acupuncture. Homeopathy.

Laryngitis

Laryngitis describes inflammation of the larynx.

• Can be acute or chronic:

• Acute: Viral, bacterial.

• Chronic: Overuse — repeated strain, irritants (smoke, fumes), acid reflux.

SIGNS AND SYMPTOMS:

• Hoarseness, weak voice or voice loss. • Sore / dry / tickly throat.

• Dry cough.

• Difficulty breathing (in children).

laryng- = relating to larynx -itis = inflammation.

Again, you must

consider why the

host immune system is failing to prevent

disease…

Laryngitis

ALLOPATHIC TREATMENT:

• Antibiotics (consider adverse effects).

• Avoid smoking and smoke,

maintain oral hygiene.

NATURAL TREATMENT:

• Herbal medicine (anti-microbial, immune support); i.e., echinacea, boswellia, turmeric, ginger, red sage.

• Nutritional (support immune system and reduce inflammation) — garlic, onions, steam inhalations. Homeopathy and acupuncture.

Boswellia

Asthma

Asthma is a chronic airway disease with

reversible narrowing of the bronchi and

bronchioles.

• An inflammatory condition combined with

bronchial hyper-responsiveness with

varying degrees of immune cell infiltration.

• Airflow obstruction due to oedema, mucus buildup and smooth muscle proliferation (= problems exhaling).

• Asthma can develop at any age, but most

commonly affects children under 10 years of age,

with another peak in the elderly.

• Leukotrienes are key chemical inflammatory

mediators in asthma. They are bronchoconstrictors.

Asthma

The prevalence of asthma is increasing.

Possible reasons for this include:

• Earlier weaning.

• Inadequate exposure to pathogens in

childhood.

• Inherited dysbiosis (imbalance of gut flora)

and antibiotic use in children.

• Food additives.

• Leaky gut syndrome.

• Nutritional deficiencies’ i.e., C, D, E, magnesium.

Asthma

ASTHMA CLASSIFICATION:

• Extrinsic (or atopic) asthma:

• Affecting children typically, immunologically

mediated with an increase in IgE antibodies. Brought on by exposure to allergens e.g., pollen, dust, animal dander.

• Intrinsic asthma:

• A bronchial reaction that is not due to

antigen-antibody stimulation. Adult onset typically.

• Common triggers include anxiety, chemicals, exercise, cold air, drugs (NSAIDs, beta blockers), stress, dust, etc. 63

Asthma

This image highlights the pathological

changes that occur in the bronchioles of

an asthmatic patient.

• Smooth muscle contracts and immune

cells infiltrate the bronchioles as part of

the inflammatory process, which

obstructs the airways.

Asthma

SIGNS AND SYMPTOMS:

• Recurrent episodes of breathlessness

and chest tightness.

• Wheezing when exhaling.

• Nocturnal coughing, occasionally with

thick clear or yellow sputum.

• Accessory muscles of ventilation are

overused and can cause aching in

the neck and upper back.

DIAGNOSIS:

• Based on signs / symptoms and history.

• Spirometry.

Asthma

ALLOPATHIC TREATMENT:

• Bronchodilators (blue inhaler).

• Corticosteroids (brown inhaler) — many adverse

effects.

NATURAL TREATMENT:

• Nutritional — fruit and vegetables, antioxidants (e.g.,

vitamin C and E, quercetin), onions and garlic, omega-3s, magnesium (bronchodilator), eliminate food allergens.

• Herbal medicine; e.g., boswellia, turmeric, astragalus,

gingko, liquorice.

• Homeopathy and acupuncture.

• Avoid irritants (dust, smoke etc.) and allergens, allergy treatment, breathing exercises, manual therapy.

Asthma Attack

• An asthma attack can be life-threatening.

• Do not hesitate to call for help. It is severe if the patient cannot speak in sentences and has more than 25 breaths per minute (tachypnoea).

• Encourage the patient to sit down (not lie down) and take slow, steady breaths. Try to keep the patient calm.

• Use inhaler (usually blue bronchodilator) every 30‒60 seconds, up to a maximum of 10 puffs.

• CALL AN AMBULANCE IF YOU CANNOT GET THE PATIENT’S SYMPTOMS UNDER CONTROL.

tachy- = rapid

-pnoea = breath 67

Bronchitis

Bronchitis describes inflammation of the bronchial tubes. Inflammation can be acute or chronic.

• Viral or bacterial infections can result from compromised immunity (considered a lower respiratory tract infection). Can be associated with environmental irritants.

• When an irritant enters the airways, goblet cells secrete mucus to flush it out. If mucus is overproduced, the respiratory system attempts but struggles to clear it.

• This can increase airway resistance and cause breathing difficulties.

bronch- = bronchi -itis = inflammation.

Bronchitis

SIGNS AND SYMPTOMS:

• Hacking unproductive cough, becoming

productive within days (thick yellowy mucus).

• Fever, sore throat, shortness of breath,

headache, runny or blocked nose, muscle pain.

• Signs: Crackles on auscultation, tachypnoea,

tachycardia, cyanosis.

TREATMENT APPROACHES:

• Allopathic: Antibiotics (adverse effects).

• Alternative: Herbal medicine (anti-microbial,

immune support), nutritional (support immune

system and reduce inflammation), avoid irritants.

Homeopathy, acupuncture.

Chronic Obstructive Pulmonary Disease (COPD)

COPD causes airflow limitation that is progressive and not fully reversible. The airflow limitation is due to airway and functional lung tissue damage.

• A chronic inflammatory response of the

lungs (usually to inhaled toxins).

• COPD refers to a combination of two

main pathologies (of varying proportions):

- Emphysema 🡪 walls of the alveoli

damaged and destroyed, leading to

reduced gas exchange.

- Chronic bronchitis 🡪 the bronchial lining is

constantly irritated and inflamed 🡪 thick mucus.

COPD

Chronic Bronchitis:

Emphysema:

Pathology:

• Inflammation and

thickening of bronchial lining with mucus

hyper-secretion.

• Dilation of alveolar sacs by destruction of alveolar wall, leading to collapse of alveoli during expiration

Key symptoms:

• Cough and wheezing.

• Breathlessness.

CAUSES:

• Smoking (accounts for 90% of COPD in Western countries). • Exposure to lung irritants (air pollution, industrial chemicals, dusts, etc.), genetic susceptibility.

COPD

• Smoking cigarettes and inhaling

other irritants leads to high levels

of oxidative stress in the

respiratory tract.

• Oxidative stress damages the

delicate cilia and promotes

chronic inflammation throughout

the respiratory tract.

• Cells are damaged and scar.

This, as well as excess mucus

production, leads to airflow obstruction.

COPD

SIGNS AND SYMPTOMS:

• Chronic cough with sputum, dyspnoea.

• Prolonged expiration and wheeze.

• Frequent infections.

• Signs: Tachypnoea, breathlessness on

exertion, pursed lips breathing, patients

may lean forward and rest arms on the table,

flapping tremor, cyanosis, hyperinflation of

chest (barrel chest), clubbed nails.

COMPLICATIONS:

• Chronic hypoxaemia 🡪 pulmonary hypertension. • Recurrent respiratory infections.

• Respiratory failure.

hypo = below normal -ox = oxygen

-aemia = blood

tachy = fast / rapid -pnoea = breathing

COPD

ALLOPATHIC TREATMENT:

• Smoking cessation. Bronchodilators,

corticosteroids, oxygen therapy.

NATURAL TREATMENT:

• Herbal medicine:

- Anti-inflammatory and immune enhancing

(i.e., echinacea, andrographis, cat’s claw).

- Mucous membrane support (i.e., goldenseal, eyebright). • Nutritional (support immune system and reduce

inflammation), i.e., vitamin C, zinc, quercetin, ginger.

• Avoid irritants (dust, smoke, etc.) and allergens;

allergy treatment, acupuncture and homeopathy.

COPD

Emphysema chest

NORMAL EMPHYSEMA

CT scan:

Dilation of alveolar sacs by

destruction of alveolar wall

Pneumonia

Pneumonia is an infection of the alveoli

and terminal bronchioles, mostly bacterial.

• Associated with an infiltration of neutrophils

with inflammation and oedema.

• Most common in infants, children and the elderly. Higher risk if the patient is immune suppressed.

SYMPTOMS AND SIGNS:

^{• Cough and purulent sputum which may be blood}stained.

• Breathlessness, fever, malaise.

bronchiole

fluid in bronchiole

• Signs: Tachypnoea, crepitations on auscultation.

pulmonary = of the lungs

^fibrosis^{= scarring}Pulmonary Fibrosis _idiopathic_{= unknown cause}

Gradual replacement of the one-layer-thick epithelial cell lining in alveoli with fibrotic tissue.

• Fibrotic (scar) tissues are less able to

exchange oxygen and CO_2.

CAUSES:

• Idiopathic (IPF): Unknown, may be

genetic, presents around 70 years.

• Smoking, asbestos, some drugs, radiation

therapy, accompanies some diseases (autoimmune, e.g. RA).

SIGNS AND SYMPTOMS:

• Progressive dyspnoea, chronic cough, fatigue,

discomfort in the chest, loss of appetite, weight loss.

Pulmonary Fibrosis

Currently no effective allopathic treatments.

NATURAL TREATMENT:

• Herbal medicine (anti

inflammatory, bronchodilators, immune modulation).

• Nutritional (support immune system and reduce

inflammation).

• Avoid irritants (dust, smoke, etc.) and allergens, allergy treatment. • Acupuncture and homeopathy.

Normal lung

histology:

Pulmonary fibrosis histology:

Normal chest

CT scan:

Pulmonary fibrosis CT:

Obstructive Sleep Apnoea

a- = absence

-pnoea = breathing

Intermittent and repeated upper airway collapse during sleep leading to interrupted breathing.

• Causes / risks: Include obesity, male gender, middle-aged, smokers, alcohol, sedatives, nasal obstruction (rhinitis, polyps).

• Treatment with nasal continuous positive

airway pressure (CPAP), lifestyle modification.

It is essential to treat the cause.

SIGNS AND SYMPTOMS:

• Loud snoring, daytime sleepiness, morning headache, morning drowsiness, nocturnal choking, reduced libido. Diagnosis by polysomnography.₇₉ © CNM: Human Sciences – Respiratory System. BQ/MC

Pneumothorax

A pneumothorax describes air

accumulation within the pleural cavity, causing part, or all, of a lung to collapse.

• Air enters via defect in visceral or parietal pleura (e.g. rib fracture).

• Can be simple (i.e. heart remains central) or tension (unstable — progressive buildup of air shifting the heart away).

CAUSES:

pneumo = lungs or air thorax = cavity under ribs

• Spontaneous — rupture of cyst / pocket of air,

tuberculosis, cystic fibrosis, emphysema.

• Traumatic (damage to pleura) — fracture, surgical complication.