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(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.
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.
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
5) DD batuk kering dan berdahak
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.
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.
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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.
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.
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.
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