Pulmonology and the Respiratory System

Learning Goals

• Define pulmonology.

• Describe the main function(s) of the respiratory system.

• Describe common respiratory diseases.

• Describe common respiratory laboratory, diagnostic, and radiologic procedures.

• Describe common respiratory medical procedures, drugs, and surgical procedures.

• Identify commonly used abbreviations in pulmonology.

Pulmonology

• Definition: The medical specialty that studies the respiratory system.

The Respiratory System

• Overview:

  • Comprises a pathway of air passages that begins in the nose and ends in the lungs.

  • Primary Functions:

  • Bring oxygen (O₂) into the body.

  • Expel the waste product carbon dioxide (CO₂).

Major Organs of the Respiratory System

• Upper Respiratory System

• Lower Respiratory System

The Nose, Nasal Cavity, and Pharynx

• Parts of the Upper Respiratory System:

  • The nose includes the nasal cavity, which is divided by the septum.

  • The pharynx is commonly referred to as the throat.

Nose and Pharynx Diseases

• Upper respiratory infection (URI):

  • An infection of the upper respiratory tract, commonly known as a head cold.

  • Causes: Can be bacterial or viral.

  • Treatment:

  • Antibiotics are effective against bacterial colds but NOT against viral colds.

  • Transmission: Spread by contact with an infected individual or inhaling infectious particles.

Lung Diseases

• Abnormal Breath Sounds (BS):

  • Lung sounds that differ from normal may indicate a lung disease or condition.

  • Normal sound: Soft wind through a tunnel.

  • Types of Abnormal Sounds:

  • Pleural Friction Rub: Creaking or grating sounds from inflammation of pleura.

  • Crackles/Rales: Irregular crackling or bubbling due to fluid or infection in alveoli.

  • Rhonchi: Humming, whistling, or snoring from mucus or obstruction.

  • Stridor: High-pitched crowing due to edema or obstruction.

  • Wheezes: High-pitched whistling or squeaking, often from asthma attacks.

Respiratory Diseases

• Cough:

  • A protective mechanism to expel substances from the lungs.

  • Expectoration: Coughing up sputum.

  • Derivatives:

    • ex- = away from

    • pector/o- = chest

    • -ation = process

  • Hemoptysis: Coughing up blood-containing sputum.

  • Derivatives:

    • hem/o- = blood

    • -ptysis = condition of coughing up

Specific Lung Diseases

• Legionnaires’ Disease:

  • A severe, sometimes fatal bacterial infection, initially presents flu-like symptoms and can lead to severe pneumonia.

• Influenza:

  • Viral respiratory infection that can range from mild symptoms to life-threatening conditions.

• Tuberculosis (TB):

  • A contagious disease caused by *Mycobacterium tuberculosis, causing nodules (tubercules) in the lungs; notable for its waxy coating which confers drug resistance; requires a 9-month treatment regimen.

• Severe Acute Respiratory Syndrome (SARS):

  • A severe, communicable viral illness, often fatal, associated with close contact and enclosed spaces; COVID-19 is classified as a SARS virus.

• Pneumonia:

  • Infection of lung lobes characterized by fluid, white blood cells, and microorganisms filling the lung passages.

  • Types include bacterial, viral, double (both lungs), aspiration.

  • Etymology: pneum/o- = lung; air; -ia = condition, state.

• Empyema:

  • Localized pus in the lung due to bacterial infection.

  • Etymology: em- = in; py/o- = pus; -ema = condition.

• Pulmonary Edema:

  • Fluid accumulation in alveoli, often resulting from left-sided heart failure, chest trauma, or pneumonia.

• Pulmonary Embolism:

  • A traveling clot or fat globule that blocks blood flow in the lungs, often resulting in shortness of breath (SOB).

  • Pathway of Embolus: Originates from veins, travels to heart, enters pulmonary arteries, potentially causing alveolar collapse in affected regions.

• Reactive Airway Disease:

  • An umbrella term for conditions characterized by reversible airway narrowing and wheezing.

• Asthma:

  • Characterized by hyperreactivity of bronchi/bronchioles to allergens, leading to inflammation, excess mucus, and bronchospasm.

Bronchi and Bronchiole Diseases

• Bronchiectasis:

  • Permanent enlargement and loss of elasticity in bronchioles; results in secretion accumulation.

  • Etymology: bronchi/o- = bronchus; -ectasis = condition of dilation.

• Bronchitis:

  • Infection or inflammation of bronchi, can be acute (viral or bacterial) or chronic (commonly due to smoking or pollution).

• Chronic Obstructive Pulmonary Disease (COPD):

  • Chronic lung disease characterized by airflow limitation, often due to smoking or prolonged air pollution.

  • Symptoms include chronic inflammation, severe coughing, and sputum production which can result in barrel chest.

• Cystic Fibrosis (CF):

  • Genetic disorder caused by a recessive gene, affecting respiratory and digestive systems, leading to thick mucus secretion that obstructs alveoli and frequent lung infections.

• Occupational Lung Diseases:

  • Diseases caused by constant exposure to inhaled particles in the workplace.

  • Examples: Asbestosis, Black lung disease.

• Lung Cancer:

  • Most prevalent in smokers associated with cancerous tar deposits; presents as a large tumor along with other darkened areas in the lung due to tar.

Effects of Vaping

• Misconception: E-cigarette aerosol is often mistaken for harmless water vapor, however, it contains harmful substances.

• Substances Found in E-Cigarettes:

  • Nicotine (highly addictive)

  • Cancer-causing chemicals

  • Heavy metals (nickel, tin, lead)

  • Volatile organic compounds

  • Flavorings (e.g., diacetyl, linked with serious lung disease).

• Health Implications:

  • Can exacerbate asthma and other lung conditions.

  • Causes lung scarring (like bronchiolitis obliterans or "popcorn lung").

  • May lead to EVALI (E-cigarette, or vaping, product use associated lung injury) which can have fatal consequences.

  • Some components can potentially cause cancer.

  • Addiction Risk: Nicotine can create a cycle of dependency and increased exposure to nicotine even in supposedly nicotine-free products.

  • Second-hand Risks: Individuals nearby may be exposed to harmful chemicals.

  • Explosions: Serious injuries and burns have occurred due to vaping device malfunctions.

Thorax Diseases

• Pneumothorax:

  • Air accumulation in pleural space leading to lung collapse, often resulting from penetrating trauma.

  • Etymology: pneum/o- = air, lung; -thorax = chest.

• Hemothorax:

  • Presence of blood in thoracic cavity due to trauma.

  • Etymology: hem/o- = blood; -thorax = chest.

• Pleural Effusion:

  • Excess fluid in pleural space due to inflammation or infection.

• Pleurisy:

  • Condition marked by inflammation of pleura and resultant friction sound during breathing.

  • Etymology: pleur/o- = lung membrane; -isy = condition.

Mechanics of Breathing

• Inspiration:

  • Expansion of rib cage and air inhalation.

• Expiration:

  • Contraction of rib cage leading to air exhalation.

Respiratory Diseases

• Apnea:

  • Absence of spontaneous respiration, can affect infants and older adults; obstructive sleep apnea may occur.

  • Etymology: a- = without; pne/o- = breathing.

• Dyspnea:

  • Abnormal or difficult breathing, can occur during exertion in patients with lung diseases.

  • Etymology: dys- = abnormal; -pnea = breathing.

• Bradypnea:

  • Abnormally slow breathing due to brain damage or imbalance in blood chemistry.

  • Etymology: brady- = slow.

• Tachypnea:

  • Abnormally fast breathing often due to lung disease.

  • Etymology: tachy- = fast.

• Orthopnea:

  • Difficulty breathing while lying down; patients may need to sit or semi-upright to breathe.

  • Etymology: orth/o- = straight.

• Cyanosis:

  • Bluish-gray skin coloring due to low oxygen and high CO₂ levels in blood.

  • Etymology: cyan/o- = blue; -osis = abnormal condition.

• Hypercapnia:

  • Elevated levels of CO₂ in arterial blood.

  • Etymology: hyper- = above; capn/o- = carbon dioxide.

• Hypoxemia:

  • Decreased oxygen levels in arterial blood.

  • Etymology: hypo- = below; ox/o- = oxygen.

Laboratory and Diagnostic Procedures

• Arterial Blood Gases (ABGs):

  • Blood test assessing oxygen and CO₂ levels in arterial blood.

• Carboxyhemoglobin:

  • Test measuring carbon monoxide levels in blood, typically for patients with smoke or fume exposure.

• Oximetry:

  • Noninvasive test to evaluate blood oxygen saturation.

• Pulmonary Function Test (PFT):

  • Breathing assessment to measure the air volume forcefully inhaled or exhaled; often done for cystic fibrosis patients.

• Sleep Study:

  • Procedure for diagnosing obstructive sleep apnea, utilizing sensors to measure various parameters.

• Sputum Culture and Sensitivity (C&S):

  • Lab test determining the causative bacterium of infections and antimicrobial susceptibilities.

• Tuberculosis Test:

  • Assess whether a patient has been exposed to TB.

• Radiologic Procedures:

  • Chest Radiography (CXR): X-ray examination of the chest.

  • CT & MRI Scans: Imaging techniques providing detailed lung structure images.

  • Lung Scan: Procedure with inhaled radioactive air and injected drugs for assessing lung function.

Medical Procedures

• Cardiopulmonary Resuscitation (CPR):

  • Emergency procedure for restoring breathing and circulation; consists of mouth-to-mouth and chest compressions.

• Auscultation and Percussion (A&P):

  • Assessment method using a stethoscope for breath sounds combined with fingertip tapping.

• Chest Percussion Therapy:

  • Techniques to help loosen mucus, common in cystic fibrosis care.

• Incentive Spirometry:

  • PROMOTES deep breathing post-surgery via a measuring device.

• Nebulizer Treatment:

  • Medication aerosolization for inhalation.

• Endotracheal Intubation:

  • Placement of a tube in the trachea to establish an airway or supply oxygen.

• Oxygen Therapy:

  • Supplemental oxygen provision for patients with respiratory ailments, using devices like nasal cannula or oxygen masks.

Drugs Used in Respiratory Treatment

• Antibiotics: Address bacterial infections in the respiratory system.

• Antituberculars: Specific antibiotics for treating tuberculosis, requiring a multi-drug regime over 9 months.

• Antitussives: Agents that suppress a nonproductive cough center in the brain.

• Antivirals: Fight influenza in at-risk patients and may also treat pneumonia.

• Bronchodilators: Medications that help relax bronchial smooth muscle to enhance air passage.

• Corticosteroids: Reduce inflammation by blocking immune responses in the lungs.

• Expectorants: Thin mucus secretions to promote expulsion through coughing.

• Smoking Cessation Drugs: Assist in reducing nicotine dependence gradually.

Surgical Procedures

• Bronchoscopy:

  • A procedure involving the insertion of a bronchoscope to examine the trachea and bronchi.

• Chest Tube Insertion:

  • Placement of tubing in thoracic cavity for draining excess air, fluid, or blood.

• Lung Resection: Surgical removal of lung tissue, potentially for biopsies or managing emphysema.

• Thoracentesis:

  • Needle insertion into the thoracic cavity for fluid extraction.

• Thoracotomy: A surgical incision into the thoracic cavity, usually the first step for thoracic procedures.

• Tracheostomy:

  • Procedure establishing an opening for respiratory support; involves plastic tube insertion.

Abbreviations in Pulmonology

• A&P: Auscultation and percussion

• ABG: Arterial blood gases

• AFB: Acid-fast bacillus

• AP: Anteroposterior

• AQI: Air Quality Index

• ARDS: Adult Respiratory Distress Syndrome

• BS: Breath sounds

• C&S: Culture and sensitivity

• COPD: Chronic obstructive pulmonary disease

• CPR: Cardiopulmonary resuscitation

• CXR: Chest X-ray

• SOB: Shortness of breath

• TB: Tuberculosis

• URI: Upper respiratory infection

Summary of Abbreviation Definitions

• The document includes multiple abbreviations commonly used in pulmonology along with their full definitions for academic and clinical reference.

Note: This study guide includes in-depth explanations, definitions, and procedural overviews essential for a comprehensive understanding of pulmonology and the respiratory system, suitable for anyone seeking complete knowledge in this area.