The Upper Respiratory Tract

 Nose—warms the air breathed and filters out bacteria and debris. Nasal
breathing is important for best lung function.
 Sinuses—cavities (holes) in the skull. They connect to the nasal passage
and are lined with nasal tissue.
 Pharynx—passageway that conducts air from the nose to the voice box.
The pharynx also conducts food from the mouth to the esophagus, the
tube that leads to the stomach.
 Epiglottis—flap that covers the entrance to the voice box when we
swallow. It prevents food and liquids from getting into the lungs.
 Larynx—the voice box, located between the pharynx and the windpipe
(trachea).
 Trachea—windpipe. This is the airway connecting the larynx to the
tubes leading to the lungs (bronchi).

The Lower Respiratory Tract

 Bronchi—two tubes that lead from the trachea to the lungs. The bronchi
divide into many smaller airways, called bronchioles.
 Lungs—pair of large spongy organs that take oxygen out of the air we
breathe and exchange it for carbon dioxide in our blood.
 Alveoli—millions of tiny air sacs in the lungs, surrounded by tiny blood
vessels called capillaries. This is where the exchange of oxygen and
carbon dioxide takes place. These sacs look like bunches of grapes.
 Pleura—a membrane that covers the lungs and helps them move freely.

Lung Volumes and Capacities:

Various lung (respiratory) volumes:

 Tidal volume (TV),about 500 mL, is the amount of air inspired during
normal, relaxed breathing.
 Inspiratory reserve volume (IRV), about 3,100 mL, is the additional air
that can be forcibly inhaled after the inspiration of a normal tidal volume.
 Expiratory reserve volume (ERV), about 1,200 mL, is the additional air
that can be forcibly exhaled after the expiration of a normal tidal volume.
 Residual volume (RV), about 1,200 mL, is the volume of air still
remaining in the lungs after the expiratory reserve volume is exhaled.
Summing specific lung volumes produces the following lung capacities:

 Total lung capacity (TLC), about 6,000 mL, is the maximum amount of
air that can fill the lungs (TLC = TV + IRV + ERV + RV).
 Vital capacity (VC), about 4,800 mL, is the total amount of air that can
be expired after fully inhaling (VC = TV + IRV + ERV = approximately
80 percent TLC). The value varies according to age and body size.
 Inspiratory capacity (IC), about 3,600 mL, is the maximum amount of
air that can be inspired (IC = TV + IRV).
 Functional residual capacity (FRC), about 2,400 mL, is the amount of
air remaining in the lungs after a normal expiration (FRC = RV + ERV).

Some of the air in the lungs does not participate in gas exchange. Such air is
located in the anatomical dead space within bronchi and bronchioles—that is,
outside the alveoli.

Upper respiratory tract infection:

 Sinusitis – blockage of sinuses

 Otitis media – infection of the middle ear
 Tonsillitis – inflammation of the tonsils
 Laryngitis – infection of the larynx that leads to loss of voice

Lower respiratory tract infection:

• Pneumonia – infection of the lungs with thick, fluid build up

• Tuberculosis – bacterial infection that leads to tubercles (collections of
encapsulated bacteria)
• Bronchitis.

Obstructive lung disease:

also called COPD or chronic obstructive pulmonary disease, affects the airways
and air sacs (alveoli) of the lungs. The airways narrow or become blocked,
decreasing the amount of air exhaled out of the lungs. People with obstructive
lung disease may feel like they are trying to breathe out through a straw. Over
time, the lungs may get bigger because the air gets trapped. Symptoms of
COPD include shortness of breath, chest tightness, increased mucus, wheezing
and coughing. Treatments may include medicines, inhalers, oxygen use,
breathing retraining, exercise, surgery or lung transplant.

The most common causes of obstructive lung disease are:

  Chronic obstructive pulmonary disease (COPD), which
includes emphysema and chronic bronchitis
 Asthma
 Bronchiectasis
 Cystic fibrosis

Restrictive lung disease:

also called interstitial lung disease, may affect lung tissue by causing scarring,
inflammation (swelling) or thickening of lung tissue. This makes the lungs
unable to expand fully. It becomes hard for the lungs to take in oxygen and
release carbon monoxide. Oxygen and carbon dioxide molecules have a hard
time passing through the lung tissue to enter or exit the blood stream. Other
conditions, such as obesity and scoliosis or side curve to the spine, may also
prevent the lungs from expanding fully and be considered a restrictive lung
disease. Symptoms of restrictive lung disease include shortness of breath,
fatigue especially with activity, chest tightening and increased mucus.
Treatments may include medicines to decrease swelling or the progression of
the disease, breathing retraining, exercise, oxygen use, surgery or lung
transplant. Restrictive lung diseases include: ‰

Some conditions causing restrictive lung disease are:

 Interstitial lung disease, such as idiopathic pulmonary fibrosis

 Sarcoidosis, an autoimmune disease
 Obesity, including obesity hypoventilation syndrome
 Scoliosis
 Neuromuscular disease, such as muscular dystrophy or amyotrophic lateral
sclerosis (ALS)

Lung Diseases Affecting the Airways:

 Chronic Obstructive Pulmonary Disease (COPD):Chronic obstructive

pulmonary disease is an umbrella term that encompasses several
respiratory illnesses that cause breathlessness, or the inability to exhale
normally. People usually experience symptoms, including shortness of
breath, and normally cough up sputum (mucus from the lungs), especially
in the morning.
  Asthma: Asthma is defined as a common, chronic respiratory condition
that causes difficulty breathing due to inflammation of the airways.
Asthma symptoms include dry cough, wheezing, chest tightness and
shortness of breath. Dr. Meyer says there is a major connection between
environmental allergies and asthma. Allergic reactions, infections and
pollution can all trigger an asthma attack.

 Chronic Bronchitis: Chronic bronchitis is a form of COPD emphasized

by a chronic cough. Usually people cough up sputum (mucus from the
lungs), especially in the morning. Dr. Meyer says this happens because
mucus glands in the airways increase output, and patients have to cough
that extra secretion out.

 Cystic Fibrosis: Cystic fibrosis is a genetic respiratory disease caused by

a defective gene that creates thick and sticky mucus that clogs up tubes
and passageways. This mucus causes repeat, and dangerous, lung
infections, as well as obstructions in the pancreas that prevent important
enzymes from breaking down nutrients for the body.
 Bronchiectasis: Dr. Meyer says people who have cystic fibrosis will also
develop bronchiectasis.“Bronchiectasis is a condition in which patients
develop abnormally dilated bronchial tubes. This allows mucus to pool,
causing frequent respiratory tract infections, wheezing and shortness of
breath.

Lung Diseases Affecting the Air Sacs (Alveoli)

 Pneumonia: Pneumonia is a common lung disease caused by an infection

in the air sacs in the lungs. The infections can be bacterial, viral or fungal.
Most people can recover in one to three weeks, but for certain people,
pneumonia can be extremely serious and even life-threatening.
Symptoms, which include cough, fever, shaking chills and shortness of
breath, can range from mild to severe.
 Tuberculosis: A slowly progressive pneumonia caused by the
bacteria Mycobacterium tuberculosis.
 Emphysema - the air sacs lose their elasticity and become overinflated.
This causes air trapping, shortness of breath and a decrease in gas
exchange. The main cause of emphysema is smoking. Emphysema means
over distension of alveoli without any change in the pulmonary tissues &
with or without escape of air into the interstitial tissue causing reduction
in the air space & loosing the elasticity of the alveoli.
 Pulmonary edema: Fluid leaks out of the small blood vessels of the lung
into the air sacs and the surrounding area. One form is caused by heart
 failure and back pressure in the lungs' blood vessels; in another form, direct
injury to the lung causes the leak of fluid.
 Lung cancer has many forms, and may develop in any part of the lungs.
Most often this is in the main part of the lung, in or near the air sacs. The
type, location, and spread of lung cancer determines the treatment options.
 Acute respiratory distress syndrome (ARDS): Severe, sudden injury to
the lungs caused by a serious illness. Life support with mechanical
ventilation is usually needed to survive until the lungs recover.
 Pneumoconiosis: A category of conditions caused by the inhalation of a
substance that injures the lungs. Examples include black lung disease from
inhaled coal dust and asbestosis from inhaled asbestos dust.

Lung Diseases Affecting the Interstitium

The interstitium is the microscopically thin, delicate lining between the lungs'
air sacs (alveoli). Tiny blood vessels run through the interstitium and allow gas
exchange between the alveoli and the blood. Various lung diseases affect the
interstitium:

 Interstitial lung disease (ILD): A broad collection of lung conditions

affecting the interstitium. Sarcoidosis, idiopathic pulmonary fibrosis,
and autoimmune disease are among the many types of ILD.
 Pneumonias and pulmonary edemas can also affect the interstitium.

Lung Diseases Affecting Blood Vessels

The right side of the heart receives low-oxygen blood from the veins. It pumps
blood into the lungs through the pulmonary arteries. These blood vessels can
suffer from disease, as well.

 Pulmonary embolism (PE): A blood clot (usually in a deep leg

vein, deep vein thrombosis) breaks off, travels to the heart, and is pumped
into the lungs. The clot lodges in a pulmonary artery, often causing
shortness of breath and low blood oxygen levels.
 Pulmonary hypertension: Various conditions can lead to high blood
pressure in the pulmonary arteries. This can cause shortness of breath
and chest pain. When no cause is identified, the condition is called
idiopathic pulmonary arterial hypertension.

Lung Diseases Affecting the Pleura

The pleura is a thin lining that surrounds the lung and lines the inside of the chest
wall. A tiny layer of fluid allows the pleura on the lung's surface to slide along the
chest wall with each breath. Lung diseases of the pleura include:
  Pleural effusion: Fluid collects in the normally tiny pleura space between
the lung and the chest wall. Pneumonia or heart failure is usually
responsible. If large, pleural effusions can impair breathing, and should be
drained.
Various kinds of pleural effusion, depending on the nature of the fluid are
o Hydrothorax: Means presence of non inflammatory fluid in the
pleural sac.
o Hemothorax: Means presence of blood in the pleural cavity.
 Pneumothorax: Air may enter the space between the chest wall and the
lung, collapsing the lung. To remove the air, a tube is typically inserted
through the chest wall.
 Mesothelioma: A rare form of cancer that forms on the pleura.
Mesothelioma tends to emerge several decades after asbestos exposure.
 Pleurisy : It means an acute inflammation of the pleura (also known as
pleuritis)causing pain during respiration movements & manifested
clinically by shallow & rapid respiration and signs of pain.

Diaphragmatic hernia is a birth defect or hole in the diaphragm that allows the
abdominal contents to move into the chest cavity.

Postural Drainage: The technique involves placing the patient in a position

which allows gravity to assist in draining mucus from the periphery of the lungs
to the central upper airways .

Gravity assisted drainage positions (also known as GAD or postural drainage)

can be used to assist the clearance of excess bronchial secretions from the
lungs .