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1) Anatomy pernafasan atas sampai bawah

The respiratory system (RES-pi-

ra-toˉr-ē) consists of the nose,
pharynx (throat), larynx (voice
box), trachea (windpipe), bronchi,
and lungs (Figure 23.1). Its parts
can be classified according to
either structure or function.
Structurally, the respiratory system
consists of two parts: (1) The
upper respiratory system
includes the nose, nasal cavity,
pharynx, and associated structures;
(2) the lower respiratory system
includes the larynx, trachea,
bronchi, and lungs. Functionally,
the respiratory system also
consists of two parts. (1) The
conducting zone consists of a
series of inter- connecting cavities
and tubes both outside and within
the lungs. These include the nose,
nasal cavity, pharynx, larynx,
trachea, bronchi, bronchioles, and
terminal bronchioles; their
function is to filter, warm, and
moisten air and conduct it into the
lungs.

(2) The respiratory zone consists of tubes and tissues within the lungs where gas exchange occurs.
These include the respiratory bronchioles, alveolar ducts, alveolar sacs, and alveoli and are the main
sites of gas exchange between air and blood.

2) mechanism of cough and how mucus develop

3) The different between obstruksi & restrictive & contoh penyakit

Doctors classify lung disease as either obstructive or restrictive. The term obstructive lung
disease includes conditions that hinder a person’s ability to exhale all the air from
their lungs. Those with restrictive lung disease experience difficulty fully expanding their
lungs. Obstructive and restrictive lung disease share one main symptom–shortness of
breath with any sort of physical exertion. Here’s what you need to know about the
difference between obstructive and restrictive lung disease.
Obstructive Lung Diseases
Obstructive lung disease and its characteristic narrowing of pulmonary airways hinder a
person’s ability to completely expel air from the lungs. The practical result is that by the
end of every breath, quite a bit of air remains in the lungs. Some common conditions
related to obstructive lung disease include:
▪ Chronic obstructive pulmonary disease (COPD), which
encompasses emphysema and chronic bronchitis
▪ Asthma
▪ Bronchiectasis
▪ Cystic Fibrosis
Obstructive lung disease makes breathing especially harder during increased activity or
exertion. Exhalations take longer with obstructive lung disease, so that as the rate of
breathing increases and the lungs work harder, the amount of fresh air circulated into the
lungs, and spent air circulated out, decreases.
Restrictive Lung Diseases

People suffering from restrictive lung disease have a hard time fully expanding their lungs
when they inhale. That is, it’s more difficult to fill lungs with air. This is a result of the lungs
being restricted from fully expanding.  This can occur when tissue in the chest wall
becomes stiffened, or due to weakened muscles or damaged nerves. Any of these factors
can restrict the expansion of the lungs. Some of the conditions classified as restrictive lung
disease include:
▪ Interstitial lung disease
▪ Sarcoidosis
▪ Neuromuscular disease, such as amyotrophic lateral sclerosis (ALS)
▪ Pulmonary fibrosis
▪ Asbestosis
▪ Silicosis
The severity of most lung diseases is tested by using a pulmonary function test.
Obstructive and restrictive lung diseases can cause shortness of breath, severe coughing
and chest pain. Treatments are different for each condition and will require a special
treatment plan provided by your doctor. If you have been diagnosed or suspect that you
might have a lung disease, you should talk to your doctor about your condition
immediately. Do some research on your own to be sure to ask the right questions.

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Nighttime dry cough causes

There are several causes of nighttime dry cough.
Viral infections
Most dry coughs are the result of infections like the common cold and flu. Acute cold and
flu symptoms typically last about one week, but some people experience lingering effects.
When cold and flu symptoms irritate the upper airway, it can take some time for that
damage to heal. While your airways are raw and sensitive, almost anything can trigger a
cough. This is especially true at night, when the throat is at its driest.
Dry coughs can last for weeks after the acute symptoms of your cold or flu disappear.

Asthma
Asthma is a condition that causes the airways to swell and narrow, making it difficult to
breathe. Chronic coughing is a common symptom. Asthmatic coughs can be either
productive or unproductive. Coughing is often worse during the night and early morning
hours.
Coughing is rarely the only symptom of asthma. Most people also experience one or more
of the following:
 • wheezing
• shortness of breath
• tightness or pain in the chest
• coughing or wheezing attacks
• a whistling sound during exhale

GERD
Gastroesophageal reflux disease (GERD) is a type of chronic acid reflux. It happens when
stomach acid rises into the esophagus. Stomach acid can irritate the esophagus and
trigger your cough reflex.
Other symptoms of GERD include:
• heartburn
• chest pain
• regurgitation of food or sour liquid
• feeling like there’s a lump in the back of your throat
• chronic cough
• chronic sore throat
• mild hoarseness
• difficulty swallowing

Postnasal drip
Postnasal drip happens when mucus drips from your nasal passageways down into your
throat. It happens more easily at night when you’re lying down.
Postnasal drip typically occurs when your body is producing more mucus than normal. It
can happen when you have a cold, flu, or allergy. As mucus drips down the back of your
throat, it can trigger your cough reflex and lead to nighttime coughing.
Other symptoms of postnasal drip include:
• sore throat
• feeling of a lump in the back of the throat
• trouble swallowing
• runny nose
Less common causes
There are a few other reasons why you could be coughing at night. Less common causes
of dry cough at night include:
• environmental irritants
• ACE inhibitors
• whooping cough5) DD batuk kering & berdahak
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Wet cough
A wet, productive cough produces sputum (phlegm or mucus from the lungs or sinuses). The
cough sounds soupy and may come with a wheezing or rattling sound and tightness in your
chest.
Most wet coughs are caused by an infection: a common cold, the flu, bronchitis, or pneumonia.
"In acute bronchitis, the cough develops quickly and ultimately disappears," says Dr. Jessica
McCannon, a pulmonologist at Harvard-affiliated Mount Auburn Hospital.
In contrast, some wet coughs are long-term (chronic). These have many possible causes. For
example:
Postnasal drip. This is caused by mucus draining down the throat, the result of allergies, irritants
in the air, a cold, or a sinus infection. "Mucus drips onto the voice box. This stimulates coughing,
to keep the mucus from traveling down into the lungs," explains Dr. Ahmad Sedaghat, an ear,
nose, and throat specialist at Harvard-affiliated Massachusetts Eye and Ear Infirmary. "If mucus
gets into the lungs, it can lead to pneumonia."
Chronic obstructive pulmonary disease (COPD). "The hallmarks of COPD are productive cough,
shortness of breath, and wheezing," Dr. McCannon says. Also possible: frequent respiratory
infections, fatigue, or excess phlegm.
Bronchiectasis. In this disease, mucus pools in small balloon-like pouches and can't be fully
cleared from the lungs.
Nontuberculous mycobacteria infection. This is a noncontagious cousin of tuberculosis. It can
be accompanied by fatigue, weight loss, and a feeling of being generally unwell.

Dry cough
A dry cough (no sputum) is typically a reaction to something irritating your throat, such as a
pollutant in the air. Dry coughs may be either temporary or chronic, caused by any of the
following:
Gastroesophageal reflux disease (GERD). This occurs when the circular muscle between the
esophagus and the stomach fails to tighten properly, allowing acidic digestive juices to squirt
back up from the stomach, irritating the lining of the esophagus and structures in the throat. This
triggers coughing.
Asthma. The coughing is most often accompanied by wheezing, chest tightness, and shortness
of breath that waxes and wanes in severity. Sometimes asthma causes only a dry, bothersome
cough, particularly with exercise or on suddenly breathing cold air.
Nerve sensitivity. Nerves that trigger coughing may be overly sensitive because of damage from
neurological disease, surgery, or injury.
Medication side effects. Some medications cause chronic cough as a side effect. For example,
ACE inhibitors, such as enalapril (Vasotec) and lisinopril (Prinivil, Zestril), cause a persistent cough
in 20% of people who use them.
Heart failure. This condition is marked by a buildup of fluid in the lungs that typically also causes
breathlessness.
Lung cancer. Cough related to lung cancer may be accompanied by weight loss and blood in the
sputum.

A dry cough is often the result of:

• a viral illness, such as a cold or influenza (the flu); or
• a post-viral, or post-infective, cough (cough that persists for weeks after a viral
illness).
However, a dry cough may be a result of other problems, such as:
• asthma;
• gastro-oesophageal reflux;
• smoking;
• allergic rhinitis (hay fever) due to inhaling substances you are allergic to, such as
pollen, dust or pet dander;
• post-nasal drip (the drainage of mucus secretions from the nose or sinuses down
the back of the throat – also known as upper airway cough syndrome);
• laryngitis (inflammation of the larynx, also known as the voice box);
• whooping cough;
• obstructive sleep apnoea and snoring;
• habit cough (a cough that is only present in the daytime and not caused by illness –
it most often affects school-aged children);
• an inhaled foreign body (e.g. food or other objects accidently being inhaled –
usually in babies and small children);
• certain types of lung disease known as interstitial lung disease; or
 • a side effect from a medicine (for example, cough is a possible side effect of most
ACE inhibitors – often prescribed for high blood pressure).
Other, less common, causes of a dry cough include:
• heart failure;
• pulmonary embolism (a blood clot in the lungs); or
• lung cancer.
A dry cough can be aggravated by:
• breathing cold, dry air;
• air pollution;
• inhaled irritants such as dust or smoke;
• exposure to tobacco smoke;
• excessive use of your voice; or
• a change in temperature.

6) Perbandingan inspirasi dan ekspirasi

The two lungs are the primary organs of the respiratory system. Other
components of the respiratory system conduct air to the lungs, such as the
trachea (windpipe) which branches into smaller structures called bronchi.
The process of breathing (respiration) is divided into two distinct phases,
inspiration (inhalation) and expiration (exhalation). During inspiration, the
diaphragm contracts and pulls downward while the muscles between the ribs
contract and pull upward. This increases the size of the thoracic cavity and
decreases the pressure inside. As a result, air rushes in and fills the lungs.
During expiration, the diaphragm relaxes, and the volume of the thoracic cavity
decreases, while the pressure within it increases. As a result, the lungs contract
and air is forced out.

7) DD prolonged expiration

8) All about asthma

Asthma is a chronic, or long-term, condition that intermittently inflames and narrows the
airways in the lungs. The inflammation makes the airways swell. Asthma causes periods of
wheezing, chest tightness, shortness of breath, and coughing. People who have asthma
may experience symptoms that range from mild to severe and that may happen rarely or
every day. When symptoms get worse, it is called an asthma attack. Asthma affects people
of all ages and often starts during childhood.

The goal of asthma management is to achieve control with an asthma action plan. An
asthma action plan may include monitoring, avoiding triggers, and using medicines.

CAUSES

• Immune system
Asthma symptoms occur when the airways of the lungs narrow, which makes it more
difficult to breathe. This narrowing is usually caused by inflammation, which makes the
airways swell and may cause the cells of the airway to make excess mucus.
Bronchospasm, or tightening of the muscles around the airways, also makes the airways
narrow and results in trouble breathing.
Over time, if asthma remains active, the airway walls can become thicker.
• GENE
Genes seem to play a role in making some people more susceptible to asthma. For
example, some genes are involved in how your immune system responds to allergens.
These genes can cause a stronger reaction in your airways when certain substances in
the air end up there. The genes involved may be different in different people.

• ENVIRONMENT
Environmental exposures that may lead to asthma include airborne allergens and virus
infections in infancy or early childhood when the immune system is developing.

Signs and symptoms of asthma may include:

• Chest tightness
• Coughing, especially at night or early morning
• Shortness of breath
• Wheezing, which causes a whistling sound when you exhale
Asthma attacks are episodes that occur when symptoms get much worse. Asthma attacks
can happen suddenly and may be life-threatening. People who have severe asthma
experience asthma attacks more often.
While other conditions can cause the same symptoms as asthma, the pattern of symptoms
in people who have asthma usually has some of the following characteristics:
• They come and go over time, or within the same day.
• They start or get worse with viral infections, such as a cold.
• They are triggered by exercise, allergies, cold air, or hyperventilation from laughing
or crying.
• They are worse at night or in the morning.

DIAGNOSIS

• Medical history
Your doctor may ask about any known allergies and the pattern of your symptoms. This
includes how often symptoms occur, what seems to trigger your symptoms, when or where
symptoms occur, and if your symptoms wake you up at night.

• PF
During the physical exam, your doctor may:
-Listen to your breathing and look for signs of asthma such as wheezing, a
runny nose, or swollen nasal passages
-Look for allergic skin conditions, such as eczema

• Diagnostic test
Several tests may be done to help determine if asthma is likely to be the cause of
symptoms. These tests include:
• Pulmonary function tests such as spirometry, which involves breathing in and out
through a tube connected to a computer. This measures how much and how fast
the air moves when you breathe in and out with maximum effort.
• Spirometry with bronchodilator (BD) test to measure how much and how fast air
moves in and out both before and after you take an inhaled medicine to relax the
muscles in your airway.
• Bronchoprovocation tests to measure how your airways react to specific exposures.
During this test, you inhale different concentrations of allergens or medicines that
may tighten the muscles in your airways. Spirometry can also be done before and
after the test.
 • Peak expiratory flow (PEF) to measure how fast you can blow air out using
maximum effort. This test can be done during spirometry or by breathing into a
separate device, such as a tube.

• Test for other medical condition

Your doctor may want to test for other conditions if your symptoms include:
• A cough without other breathing issues
• Chest pain
• Coughing up mucus often
• Difficult and noisy breathing during exercise
• Shortness of breath with dizziness, light-headedness, or tingling in your hands or
feet
Tests your doctor may use to rule out other medical conditions include:
• Chest X-ray to rule out lung infections, such as tuberculosis, or a foreign substance,
such as an object that was inhaled by accident.
• Electrocardiogram (EKG) to rule out heart failure or arrhythmia while in emergency
care.
• Laryngoscopy to rule out vocal cord problems. The doctor can use this test to look
at your upper airways and the vocal cords.
• Sleep studies to rule out sleep apnea.
• Tests that look at your esophagus and upper digestive system to rule out
gastroesophageal reflux disease (GERD). These tests may include endoscopy, in
which a small camera is placed in the esophagus, or an X-ray of the digestive
system. Tests may also measure the acid in your esophagus or measure how food
or other substances move through the esophagus. Some people have both GERD
and asthma.

TREATMENT

• Control medicine
Control medicines include the following:
• Corticosteroids to reduce the body’s inflammatory response. Your doctor may
prescribe inhaled corticosteroids that you will need to take each day. If your
symptoms get worse, your doctor may increase the dose of the inhaled
corticosteroids to prevent severe asthma attacks or even give corticosteroids by
mouth for short periods. Common side effects from inhaled corticosteroids include a
hoarse voice or a mouth infection called thrush. A spacer or holding chamber on
your inhaler can help avoid these side effects. Using high-dose inhaled
corticosteroids more often or for longer periods may affect growth in young children.
Oral corticosteroids also have more side effects than inhaled corticosteroids
because more of the medicine goes outside the lungs.
• Biologic medicines, such as omalizumab, mepolizumab, resulizumab, and
benralizumab, to target specific parts of the body’s response to allergens. Biologic
medicines are antibodies used in people who have severe asthma. These
medicines are given by injection, either below the skin or in a vein, every few
weeks.
• Leukotriene modifiers to reduce the effects of leukotrienes, which are released in
the body as part of the response to allergens. Leukotrienes cause the airway
muscles to tighten. These medicines block this response, allowing the airways to
open, and reduce inflammation. You take these pills by mouth, alone or with
corticosteroids, depending on what your doctor prescribes.
 • Mast cell stabilizers such as cromolyn, to help prevent airway inflammation caused
by exposure to allergens or other triggers. These medicines stop certain immune
cells from releasing the signals that cause inflammation.
• Inhaled long-acting beta2-agonists (LABAs) keep the airways open by preventing
narrowing of the airways. LABAs may be added to your inhaled corticosteroids to
reduce narrowing and inflammation.

• Short term relief medicine

Short-term relief medicines, also called quick-relief medicines, help prevent symptoms or
relieve symptoms during an asthma attack. They may be the only medicine needed for
mild asthma or asthma that only happens with physical activity.
Your doctor will prescribe a quick-relief inhaler for you or your child to carry at all times.
Learn how to use your asthma inhaler
external link
correctly.
Types of short-term relief medicines include:
• Inhaled short-acting beta2-agonists (SABAs) to quickly relax tight muscles around
your airways. This allows the airways to open up so air can flow through them. Side
effects can include tremors and rapid heartbeat. SABAs are usually the only
medicine used to treat wheezing in children under 5 years old. If symptoms and
medical history suggest asthma, doctors may treat it with inhaled corticosteroids for
a trial period to see if they help. If symptoms do not improve, corticosteroids will be
stopped to avoid side effects.
• Oral and intravenous (IV) corticosteroids to reduce inflammation caused by severe
asthma symptoms.
• Short-acting anticholinergics to help open the airways quickly. This medicine may
be less effective than SABAs, but it is an option for people who may have side
effects from SABAs.

9) what is spirometry and its process

10) what is inflation

excessive distension with air or gas

11) beda asthma & COPD

12) ACO