 Signs of pulmonary disease are usually classified as acute or chronic, obstructive or restrictive, and infectious or

noninfectious
o Associated symptoms are
 Dyspnea
 Abnormal sputum
 Hemoptysis
 Altered breathing pattern
 Hypoventilation
 Hyperventilation
 Cyanosis
 Clubbing of the digits
 Chest pain
 Dyspnea – Difficult or labored breathing
o Dyspnea on exertion – first episode may occur with exercise
o Orthopnea – Dyspnea that occurs when lying flat and is common in individuals with heart failure
o Paroxysmal nocturnal dyspnea (PND) – Occurs with individuals with heart failure or lung disease, wake up at
night gasping for air and must sit up or stand up to relieve dyspnea
 Cough – Protective reflex that clears the airways by explosive expiration, presence of a foreign body initiates the
cough reflex, stimulates irritant receptors in the airway
o Acute cough – Commonly caused by upper respiratory infection, usually resolves within 2-3 weeks
o Chronic Cough – Persists for more than 3 weeks, smokers, postnasal drainage syndrome, bronchitis, asthma
 Abnormal sputum would be changes in amount, color consistency and odor of sputum
o Hemoptysis is the coughing up of blood or bloody secretions
 Cheyne-Stokes Respiration – Alternating periods of deep and shallow breathing
 Hypoventilation – CO2 removal does not keep up with CO2 production PaCO2 increases – increases hydrogen ions in
blood – respiratory acidosis
 Hyperventilation – The lungs remove CO2 faster than it is produced – decreased PaCO2 which will lead to respiratory
alkalosis
 Cyanosis – Bluish discoloration of the skin caused by increasing amounts of reduced Hg. Severe anemia and CO
poisoning. Hg binds to CO instead of oxygen
 Clubbing – Bulbous enlargement of the distal segment of a digit, may be graded from 1-5 based on extent of nail bed
hypertrophy
 Pneumothorax – Air or gas in the pleural space caused by a rupture in the visceral pleura or the parietal pleura and
chest wall
 Pleural effusion – The presence of fluid in the pleural space
 Empyema – Infected pleural, pus in the pleural space, pulmonary lymphatics are blocked, develops from
complications of pneumonia, surgery, bronchial obstruction from tumor
 Aspiration – passage of fluid and solid particles into the lung, usually in individuals whose normal swallowing
mechanism and cough reflex are impaired. Right lung is more susceptible to aspiration than left due to branching
angle of right lung, may result in choking and coughing with or without vomiting.
 Atelectasis – collapse of lung tissue
o Compression – external pressure exerted on lung, tumors, air, fluid in pleural space, alveoli collapse
o Absorption – inhalation of concentrated O2
o Surfactant impairment – decreased production of surfactant (reduces surface tension)
 Bronchiectasis – abnormal dilation of bronchi occurs w/ conditions from bronchial inflammation
 Bronchiolitis – diffuse inflammationof the small airways or bronchioles
 Pulmonary edema – excess water in the lung, normal lung is dry. Most common cause is left side heart disease.
 Pulmonary Fibrosis – an excessive amount of fibrous or connective tissue in the lung. When no specific cause is
known “Idiopathic pulmonary fibrosis”, specific causes are inhalation of harmful substances, toxic gases, inorganic
dusts, organic dusts and autoimmune disorders, asbestos exposure.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

 Characterized by airway obstruction

  More force or more time is required to expire air and emptying of lungs is slowed
 The symptoms are wheezing, dyspnea, difficulty breathing
 Most common COPD’s
o Asthma
o Chronic Bronchitis
o Emphysema
 Characterized by airway obstruction that is worse with expiration
o More force and more time is required for expiration (emptying of lungs)
 The main symptom and sign is dyspnea and wheezing
 Most common obstructive diseases are:
o Asthma
o Chronic bronchitis
o Emphysema
 Many individuals have chronic bronchitis and emphysema, these together are called COPD

Asthma

 Chronic inflammatory disorder of the bronchial mucosa

o Causes hyperresponsiveness, constriction of the airways, variable airflow obstruction
 Occurs at ages, most develop at childhood
 Risk factors – Allergen exposure urban residence
 Pathophysiology – Airway epithelial exposure to antigen initiates an immune response in sensitized individuals,
cause inflammation of the bronchial mucosa and hyperresponnsiveness of the airways
 Pathogenesis – IL-4, IL-5, IL-13, eosinophils, mast cells, adrenergic receptors, leukotrienes, Nitric Oxide
o Inflammation, sensitivity to allergens, airway fibroblasts
 Evaluation and treatment – Diagnosis of asthma is supported by a history of allergies and wheezing, dyspnea and
cough or exercise intolerance
o Spirometry is used to evaluate measure FEV1
o Assessment of arterial blood gases
o Hypercapnia with respiratory acidosis signals need for mechanical ventilation
 Immediate oxygen and inhaled beta-agonist bronchodilators
o Status Asthmaticus – Severe bronchospasm in an asthmatic
 Management of asthma attack – Immediate oxygen and inhaled beta agonist, bronchodilators, corticosteroids

Bronchitis, Emphysema

 Risk factors include tobacco smoke, occupational dust and chemicals, outdoor air pollution
 Chronic bronchitis - hypersecretion of mucus and chronic cough for at least 3 months of the year for at least two
consecutive years
o Treatment is bronchodilators
 Emphysema – abnormal permanent enlargement of gas-exchange airways, and destruction of alveolar walls, results
in loss of elastic recoil
 Pathophysiology – Destruction of alveoli by the breakdown of elastin
o Primary Emphysema – Linked to inherited deficiency in enzyme alpha 1 antitrypsin
o Secondary Emphysema – Inhalation of cigarette smoke, pollutants, respiratory infection
 Evaluation – arterial blood gas measurement, FEVI, total lung capacity, CT scan, serum WBC count, sputum sample
 Treatment – smoking cessation, mechanical ventilation, oxygen therapy, inhaled bronchodilator, oral corticosteroids
and antibiotics

Pneumonia

 Infections of the lower respiratory tract often affect the very young, the very old or individuals with impaired
immunity or underlying disease
 Pneumonia – infection of the lower respiratory tract caused by bacteria, viruses, fungi, protozoa or parasites.
  Risk factors – advanced age, immunocompromised, lung disease, alcoholism, impaired swallowing, smoking,
endotracheal intubation, malnutrition, immobilization, cardiac or liver disease and residence in a nursing home
 Categorized as
o Community-acquired (CAP) Streptococcus pneumoniae, ventilator-associated (VAP), healthcare associated
(HCAP), hospital-acquired (HAP). The microorganisms that cause CAP are different from those that cause
HCAP, HAP and VAP.
 Evaluation – physical examination, bronchial breath sounds (pleural effusion) WBC count, chest x-rat, blood culture,
respiratory secretion cultures. Following diagnosis, pathogen is identified by sputum, blood or oral culture
 Treatment – prevention of aspiration, isolation of immunocompromised individuals, adequate ventilation and
oxygenation, antibiotics for bacterial pneumonia, antivirals in severe cases

Tuberculosis

 Infections of the lower respiratory tract often affect the very young, the very old or individuals with impaired
immunity or underlying disease
 Pneumonia – infection of the lower respiratory tract caused by bacteria, viruses, fungi, protozoa or parasites.
 Risk factors – advanced age, immunocompromised, lung disease, alcoholism, impaired swallowing, smoking,
endotracheal intubation, malnutrition, immobilization, cardiac or liver disease and residence in a nursing home
 Categorized as
o Community-acquired (CAP), ventilator-associated (VAP), healthcare associated (HCAP), hospital-acquired
(HAP). The microorganisms that cause CAP are different from those that cause HCAP, HAP and VAP.
 Evaluation – physical examination, bronchial breath sounds (pleural effusion) WBC count, chest x-rat, blood culture,
respiratory secretion cultures. Following diagnosis, pathogen is identified by sputum, blood or oral culture
 Treatment – prevention of aspiration, isolaton of immunocompromised individuals, adequate ventilation and
oxygenation, antibiotics for bacterial pneumonia, antivirals in severe cases

Pulmonary Vascular Disease

 Blood flow through the lungs can be disrupted by disorders that result in occlusion of the vessels, an increase in
pulmonary vascular resistance or destruction of the vascular bed.
 Pulmonary embolism (PE) - occlusion or partial occlusion of the pulmonary artery by an embolus
o Risk factor – conditions that promote blood clotting, hypercoagulability, hormone replacement, oral
contraceptives, pregnancy, coagulation disorders, DVT
o Treatment – administration of anticoagulants, heparin, streptokinase, surgical embolectomy
 Pulmonary hypertension – mean pulmonary artery pressure greater than 25 mmHg at rest (normal 15 – 18 mmHg)
 Overproduction of vasoconstrictors and decreased production of vasodilators
 Treatment – tx of primary disorder, if persist long enough for hypertrophy, PAH is irreversible – only tx is
supplemental oxygen
 Cor pulmonale – secondary to PAH, consists of right ventricular enlargement (hypertrophy, dilaton or both) pressure
overload increases work of right ventricle

Malignancies of the Respiratory Tract

 Laryngeal Cancer – cancer of the larynx is increased by the amount of tobacco smoked and the combination of
smoking and alcohol consumption
o Human Papillomavirus (HPV) is linked to both benign and malignant cancers of larynx
o Highest incidence in men 50 – 75 years old, presenting symptoms are hoarseness, dyspnea and cough
o Laryngeal dysplasia has high chance of progressing to malignancy
 Lung cancers – arise from epithelium of the respiratory tract.
o Risk factors include; bezopyrene, radon gas, metals (chromium, cadmium, arsenic), asbestos fibers, diesel
exhaust, nitrogen mustard gas, silica, vinyl chloride
 Non-Small Cell Lung Cancer (NSCLC)
o Squamous cell carcinoma – strongest association with smoking
o Adenocarcinoma – arise from glands of lungs, occurs more frequently in women, non-smokers and asians