Dr. Hani Hussein, MDRespiratory department

Jordan University Hospital

Respiratory System Functions 1. supplies the body with oxygen and disposes of carbon

dioxide2. filters inspired air3. produces sound4. contains receptors for smell5. rids the body of some excess water and heat6. helps regulate blood pH

Organization and Functions of the Respiratory System Consists of an upper respiratory tract (nose to

larynx) and a lower respiratory tract ( trachea onwards) .

Conducting portion transports air. - includes the nose, nasal cavity, pharynx,

larynx, trachea, and progressively smaller airways, from the primary bronchi to the terminal bronchioles

Respiratory portion carries out gas exchange. - composed of small airways called respiratory

bronchioles, alveolar ducts and alveoli.

Figure 23.2

The Respiratory Epithelium of the Nasal Cavity and Conducting System

The symptoms of the respiratory diseaseCough.Sputum production.Haemoptysis.Breathlessness(dyspnea).Chest pain.WheezeApnea.Others(weight loss, fever, fatigue…)

Cough Forced expulsive maneuver against initially

closed glottis.Normal protective mechanism for clearing

the tracheo-bronchial tree of secretions and foreign material.

Patients seek medical advice when excessive, alteration their lifestyle or concern about ehe cause specially fear of cancer.

Can be voluntary or as reflex.Afferent pathway: receptors within the

sensory distribution of the trigeminal, glossopharyngeal, superior laryngeal and vagus nerves.

Efferent pathway: recurrent laryngeal nerve and the spinal nerves.

Acute: less than 3 weeks.Chronic: more than 8 weeks.The most common cause of acute cough is

acute viral upper respiratory tract infection.frequency.Severity of cough: sever cough with airway

obstruction cause cough syncope.

Causes Acute cough ( less than 3 weeks)

Viral respiratory tract infectionBacterial infection(acute bronchitis)Inhaled foreign bodyInhalation of irritant: dust/fumes.Pneumonia.Acute extrinsic allergic alveolitis

Chronic cough(more than 8 weeks)

GERD.AsthmaPost viral hyper-reactivity.Chronic rhinitis/sinusitisLung tumour.Tuberculosis.Interstitial lung disease.bronchiectasisSmoking .Medication: ACE inhibitors, Beta blocker

Sound:Bovine cough: hoarseness of voice suggest lung

cancer invading the left recurrent laryngeal nerve.

Whooping cough: pertusis.Moist cough: secretions(URTI, acute

bronchitis, chronic bronchitis, bronchiactesis).

Dry cough painful are seen in pneumonia and tracheitis.

Chronic dry cough: interstitial lung disease, drug induced cough, asthma.

Timing of the cough:Morning productive cough: chronic bronchitis.Nocturnal cough: bronchial asthma.Daytime cough: GERD, chronic sinusitis.Cough that improved at weekends, holidays are

seen in occupational asthma.

origin Common Causes Features

Pharynx Post nasal drip persistent

Larynx Laryngitis, croup, whooping cough, tumour

Harsh, painful, persistent associated with stridor.

Trachea TracheitisBronchitis (acute-chronic)Asthma

Bronchial carcinomaPneumonia Bronchiactesis Pulmonary edema Pulmonary TBLung fibrosis

Painful Productive, morning Dry or productive , worse at night or exposure to cold, allergens.Persistent with hemoptysis Dry initially then productiveExcessive sputum, more in supine Night, white or pink sputumDifferent, fever, weight lossDry ,irritant, disturbing

Others Drug induced ACE inhibitors, Beta blocker

Sputum production Sputum expectoration always is abnormal.Amount.Viscosity.Color.Taste or smell.Solid material.Character.

Types of sputumType Appearance Cause

Serous Clear , watery Frothy may be pink.

Acute pulmonary edemaAlveolar cell CA(rare)

Mucoid Clear, grey, whiteViscid.

Chronic bronchitisAsthma

Purulent Yellow

Green

Acute bronchopulmonary infectionAsthma (esinophils)

Longer duration infectionPneumonia, cystic fibrosis, lung abscess, bronchiactasis

Rusty Rusty red Pneumococcal pneumonia

Chronic bronchitis and COPD usually cause clear sputum if color changed this indicate infection.

Yellow sputum: live neutropils in acute infection, esinophils in asthma.

Green sputum due to lysed neutrophils.Rusty sputum caused by lysed RBCs.Foul smell or vile-tasting indicates anaerobic

bacterial infection or empyema

Haemoptysis Coughing blood.Should always investigated.True haemoptysis or not.Amount of blood.Streaks of blood, fresh bright or clot.Duration: if more than one week think of

LUNG CANCER.

causes of haemoptysis Tumour Malignant: Benign:Lung CA bronchial carcinoidEndobronchial metastases

Infection Bronchiactesis, TB, lung abscess, cystic fibrosis

Vascular Pulmonary infarction, AV malformation

Vasculitis Wegner’s granulomatosis, goodpastures syndrome .

Trauma Chest trauma, inhalation foreign body. Iatrogenic: due to procedure.

Cardiac Mitral valve disease, acute left ventricular failure

HematologicalBleeding disorders, anticoagulation

Breathlessness Undue awareness of breathing or the need to

breath more.Shortness of breath, not enough air enter.Mode of onset: Sudden or gradual.Duration and progression.Variability, aggravating/ relieving factor.Severity.Associated symptoms.

Causes of dyspnea Non cardiopulmonary causes:Anemia, obesity, psychogenic, neurogenic,

metabolic acidosis.Cardiac:Left ventricular failure, mitral valve disease,

cardiomyopathy, percardial effusion, constrictive pericarditis.

Pulmonary:Airways: laryngeal tumor, foreign body,

bronchial asthma, COPD, lung CA, bronchiactesis.

Parenchyma: lung fibrosis, TB, pneumonia, sarcoidosis, tumor.

Pulmonary circulation: PE, pulmonary HTN, pulmonary vasculitis.

Pleural: pneumothorax, effusion, diffuse pleural fibrosis.

Chest wall: kyphoscoliosis, ankylosing spondylitis.

Neuromascular: mysthenia gravis, neuropathies, muscular dystrophy, guillian barre syndrome.

Dyspnea (modes of onset, duration and progression)

Minutes:PE asthmaPneumothorax acute left ventricular failureInhaled foreign body

Hours to days:Pneumonia Asthma Exacerbation of COPD.

Weeks to months:Anemia respiratory neuromascular disordersPlueral effusion

Months to years:Pulmonary fibrosis Pulmonary TBCOPD

Chest pain Chest pain can originate from: o The pleurao The chest wall.o The mediastinal structures.The lungs are not source of pain; autonomic

innervations only.

Pleural pain:

Sharp stabbing, increased by inspiration or coughing due to irritation to parietal pleura.

Localized: upper six ribsReferred : irritation at the diaphragmatic

part of the parietal pleura(phrenic nerve) to neck and shoulder.

Lower six ribs: through intercoastal nerves, pain is in the upper abdomen

The most common causes of pleuritic chest pain :

Pulmonary embolism. Pneumonia. Pneumothorax. Rib fracture

Chest wall pain: musculoskeletalPatient with chronic cough, asthma usually

complaining from chest tightness.Sever lacerating may indicate malignancy.Mediastinal pain:Retrosternal,central pain.Pulmonary infarction, or tumor invading

mediastinal structure.

Wheezing or stridorWheeze: high pitched whistling sound

produced by passage of air through narrowed small airways.

usually during expiration, but may be in both inspiration and expiration in severe narrowing.

stridor: rattling sound(loud) mostly during inspiration caused by partial obstruction of major airways

Wheeze:Bronchial asthmaCOPD Stridor:Upper airway obstruction Vocal cord dysfunctionTumorForeign body

Apnea/hypopnea Apnea is absence of breathing, awareness of

stoop breathing.Hypopnea: reduction in airflow or respiratory

movements by more than 50% for 10 seconds or more.

Obstructive sleep apnea: multiple apnea during sleep, excessive day time sleep, general weakness.

Weight loss:Consider significant weight loss if 10KG of

weight during 3 months.Lung CAPulmonary TB ,chronic infection or cystic

fibrosis.Fever:High grade indicates infectionRelapsing fever in Lung abscess or TB