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Many health workers have difficulty understanding and interpreting the clinical
signs and symptoms of respiratory diseases. With a clear understanding of the
basic anatomy and physiology of the chest and lungs it is much easier to
understand these signs and symptoms
Bronchus
Middle lobe
Bronchioles
Lower lobe
Pleura
Fissure
Alveolus
Bronchus
Cross-section
of airway
Bronchiole
Trachea and
bronchus
Diagram of the lower respirator y tract and lungs
The airways consist of three layers including a mucous membrane and a muscle
layer. Mucous glands are present in the lining of the airways. These glands
are present until the very small bronchi. There are no mucous glands
in the bronchioles.
The alveoli
Each bronchiole ends in a group of tiny sac-like structures, each one called an
alveolus. Each lung has about 300 million alveoli. They are very small and cannot
be seen easily with the naked eye. Each alveolus is surrounded by a capillary
blood vessel. Gases, e.g. oxygen and carbon dioxide, move across the alveolar
membrane into the blood vessels and vice versa. A continuous exchange of gases
takes place between the alveoli and the capillary blood vessels that surround them.
Bronchiole
Alveolus
Blood
capillary
Alveolus
Carbon dioxide
moves from blood
O2 cell into alveolus
Gas exchange
The exchange of gases can be increased or decreased by breathing at a faster
or slower rate, or by breathing more deeply.
The body can increase the amount of oxygen and decrease the amount of carbon
dioxide in the blood stream by breathing at a faster rate or more deeply.
The body may have to breathe faster because:
c The body needs more oxygen e.g. during exercise, running or straining.
c The normal supply of oxygen is obstructed. There may be some obstruction
to the flow of air in the airways or there may be an obstruction to the
flow of gases across the alveoli into the blood stream. This may be due
to diseases like asthma, bronchitis or pneumonia.
Whatever the cause, the body will try to increase the amount of oxygen in the
blood stream by breathing at a faster rate or more deeply.
Most of the time the lungs are able to provide enough oxygen for the body's needs.
If, for any reason, there is a severe shortage of oxygen in the blood, this will result
in cyanosis. Cyanosis causes a blue colour of the lips, mouth and tongue.
See Chapter 5 of the BASIC MEDICAL SCIENCES manual for more on cyanosis.
There is carbon dioxide in the blood stream. Carbon dioxide is an acidic waste
product of body metabolism. The level of carbon dioxide in the blood may rise
because there may be an over production of carbon dioxide, e.g. from running
or exercising. In some medical conditions, e.g. diabetes, there may be an
over production of acid (ketones) which will also result in deeper breathing.
By breathing faster or deeper the body will usually be able to correct the level
of carbon dioxide. The faster we breathe, the more carbon dioxide is moved
from the blood into the airways and then breathed out of the body.
The normal respiratory rate is 12 - 20 breaths per minute in adults.
A faster breathing rate is called tachypnoea (tachy = fast, pnoea = breathing)
A fast breathing rate (tachypnoea) is an important sign of respiratory disease.
A fast breathing rate can cause dehydration
There is always some moisture (water) in the air that is breathed out.
Therefore a fast breathing rate will result in water being lost from the body.
If the breathing rate is increased for long periods of time it can result in
dehydration. For this reason, it is very important to give plenty of fluids, orally
or intravenously, to patients with respiratory disease or who have fast breathing
rates for other reasons. This is especially important in young infants and children.
Give plenty of fluids to patients
with respiratory disease.
In some diseases where the acid level in the blood rises, e.g. diabetes or
aspirin poisoning, the body will increase its breathing rate to help get rid
of the excess acid.
The heart rate increases when the breathing rate increases. A faster breathing
rate increases the amount of gases exchanged. The heart rate will increase the
flow of blood through the lungs.
When there is a normal breathing rate (12 - 20 breaths per minute), the amount
of oxygen and carbon dioxide in the blood stream is at the correct level for the
body's needs. Most respiratory diseases cause the breathing rate to increase.
Since an increased breathing rate (tachypnoea) can cause dehydration, it is
important to give fluids to patients with respiratory disease.
Different diseases effect different parts of the lungs
Different respiratory diseases effect different parts of the lungs and produce specific
signs and symptoms. Diseases involving the lower respiratory tract include:
c Infection of the bronchi is called bronchitis. In bronchitis the lining of the
bronchi becomes inflamed, the mucous layer becomes thick and much excess
mucus is produced.
c Infection of the bronchioles is called bronchiolitis.
c Infection of the alveoli is called pneumonia. Pneumonia usually affects one or
more lobes (lobar pneumonia).
c Tuberculosis is a chronic infection which usually affects the hilar lymph nodes
and the alveoli.
c Asthma is not a lung infection but an allergic condition. In asthma, the muscle
layer of the smaller bronchi and bronchioles goes into spasm and causes the
airways to narrow.
c Lung cancers usually develop in the bronchi.
c Pleurisy and asbestos dust affect the pleura.