Respiratory Pathophysiology 1-3

Respiratory diseases terminology

Hypo-perfusion: inadequate blood flow to pulmonary capillaries
Hypo-ventilation: inadequate air flow to alveoli
Hemoptysis: blood in sputum
Productive cough: mucus (sputum) producing or secretion expelled out with cough
Non- productive cough: cough is not productive of sputum
Tachypnea: increase in respiratory rate
Dyspnea: difficulty in breathing
Respiratory diseases signs & symptoms :
Cough : is a reflex response to clear mucous, or fluids accumulated in lower respiratory tract
Tachypnea: rapid breathing, increase in respiratory rate
Dyspnea: is shortness of breath
• It indicates hypoventilation
• Can associated with wheezing; whistling sound of air being forced through narrowed airway
Cyanosis: bluish appearance of skin/ mucous membrane due to un- oxygenated blood. It indicates hypoperfusion
Peripheral cyanosis: due to peripheral causes like vasoconstriction
Central cyanosis: inadequate blood oxygenation from lungs

Diseases of upper respiratory tract

Common cold:
◦ Mostly viral etiology

◦ Acute inflammation of mucosa of upper respiratory tract; leads to copious secretion of mucous

Tonsillitis/ Pharyngitis/ Laryngitis

• Acute inflammation of mucosa of respiratory passages
• Pathogens: mostly Viral, but bacteria can be involved
• Cough, pain in throat, difficulty in swallowing, hoarseness of voice
Obstructive Lung Disease
• Diseases that block or affect the airways, so the lumen become narrow and can interfere entry of oxygen into &
removal of carbon dioxide out of lungs
• Lung airway obstruction typically produce Hypoventilation
• Obstruction may be due to excessive secretion, foreign body, or inflammation of airways which reduce the lumen of
an airway
The principal pulmonary obstructive conditions are:
• Asthma
• Emphysema
• Chronic bronchitis
Emphysema and chronic bronchitis are combined as chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD )

A disease state characterized by the presence of airflow obstruction due to chronic bronchitis or emphysema; the
airflow obstruction is generally progressive, may be accompanied by airflow hyperactivity, and may be viewed as
partially reversible

Types of COPD
Emphysema
• Permanent and destructive enlargement of airspaces distal to the terminal bronchioles without obvious fibrosis and
with loss of normal architecture
• Always clinically significant airflow limitation
• “pink puffer”
Chronic Bronchitis
• Presence of a cough productive of sputum not attributable to other causes on most days for at least 3 months over
2 consecutive years May be present in the absence of airflow limitation
• “blue bloater”

Risk Factors
• Cigarette Smoking, dominant factor
• Occupational or air pollutants
• Gender: More common in men

Emphysema
• Abnormal enlargement of airways beyond terminal bronchioles, due to destruction of alveolar septa
• With septal damage airways merge to form enlarged sacs
• Alveolar septa have elastic tissues which keeps lung open in expiration
• Loss of alveolar septa means less surface area for gas exchange (hypoventilation) & loss of elastic recoil so small airways collapse
during exhalation
Etiology of emphysema
• Smoking
• Atmospheric pollution
• Genetic factors
• High rate of emphysema in the rare genetic condition of alpha - 1- antitrypsin deficiency

Pathogenesis in emphysema
• Damage of alveolar septa due to decrease quantity of a 1 antitrypsin which acts as an anti-elastase
• Elastases (enzymes produced by neutrophils and macrophages in response to infections and irritants like smoking) which degrade elastic
tissue in walls of alveoli
• Decrease a 1 antitrypsin and increase Elastases by smoking predisposes to destruction of elastic alveolar walls (emphysema)

Morphologic types of Emphysema

Centriacinar :
• Focal destruction limited to the respiratory bronchioles and the central portions of acinus
• Associated with cigarette smoking
• Most severe in the upper lobe

Panacinar:
• Involves the entire alveolus distal to the terminal bronchiole
• Most severe in the lower lung zones

Clinical presentation of COPD

• Dyspnea
• Cough (usually worse in morning, sputum production)
• Wheezing
• Cyanosis
• Right heart failure
• Weight loss, anorexia

Treatment of COPD
• Quit smoking
• Bronchodilators
-Relaxes muscles around airways
• Steroids
- Reduces inflammation
• Antibiotics
Asthma
Bronchial Asthma
Asthma is defined as reversible obstruction of large and small airways due to hyper-responsiveness to various immunologic and non
immunologic stimuli
 CLASSIFICATION
A) Allergic or extrinsic asthma
• IgE mediated
B ) Intrinsic or non-allergic asthma
• Temperature changes
• Cold air
• Odor
• Irritants
• Smoke
• Virus
C) Exercise induced asthma

Treatment of asthma
• Bronchodilators
• Steroids

Cystic fibrosis
• Genetic systemic disease that involve exocrine glands - defective secretions of exocrine glands (mucous, sweat)
• Inherit a defective gene on chromosome 7 called CFTR
• Defect in membrane channels produce thick viscous secretions from glands of lungs, pancreas, liver, intestines, salivary glands
• Mucus is thick and sticky , block the airways leading to dyspnoea, and recurrent chest infections and lung damage

Acute respiratory distress syndrome (ARDS) Pulmonary edema

• Characterized by damage to pulmonary capillaries which increase their permeability, so fluid, proteins and blood enter into the alveoli
causing diffuse alveolar damage, and non- cardiogenic pulmonary edema (collection of fluid in alveoli)

Causes of ARDS
Common causes of ARDS are:
> Aspiration/Acute pancreatitis/Air embolism
> Radiation
> Drug overdose/DIC/Drowning/Diffuse lung disease ( pneumonia)
> Shock/Sepsis/Smoke inhalation
Clinical diagnosis (ARDS)
• Onset is rapid after some injurious event
• Lung become stiff, non- expansible and due to fluid in alveoli, surface area for gas exchange is decreased, resulting hypoventilation
• Patient complaints of Tachypnea, dyspnea, cough, cyanosis
Chronic intrinsic restrictive lung diseases (CIRLD)
• Chronic changes or damage in lung interstitium so lung become stiff with reduce expansibility
• Causes:
• Occupational irritants (also known as Pneumoconiosis)
• Infections
• Idiopathic
• Pathogenesis: deposition of irritants induce inflammatory cell infiltration in lung interstitium, leads to fibroblast proliferation and fibrosis
• Treatment:
• Stop exposure of irritant
Pneumonia
- Reversible acute inflammation of lung parenchyma
Causes:
• Pneumonia can be caused by infectious agents such as bacteria and viruses
• Noninfectious agents such as gastric secretions that are aspirated into the lungs
• Pneumococcus is most common bacteria
• Fever, cough with sputum, chest pain
• X-Ray: consolidation (infiltration of inflammatory cells produce solidification of affected area)
• Treatment: Antibiotics

Pulmonary Tuberculosis
• Chronic infection and inflammation of lung parenchyma due to Mycobacterium Tuberculosis can
lead to caseous necrosis and fibrosis
• Transmits by contaminated sputum (aerosol) and unpasteurized milk
• Chronic productive cough, hemoptysis, and systemic symptoms i.e. weight loss, fever, lymph nodes
enlargement
• Treatment: anti-tuberculous therapy

Respiratory failure
Inability to maintain adequate pulmonary function OR Failure in one or both gas exchange functions, oxygenation and carbon dioxide
elimination
• Respiratory failure is defined as PaO 2 <60 mmHg while breathing air, or a PaCO 2 >40 mmHg
• Two types of respiratory failures
◦ Hypercapnic

◦ Hypoxemic respiratory failure

Respiratory failure (causes)

• Ventilation defects (CNS haemorrhages, brain tumors, neuromuscular defects, drugs)
• Perfusion defects (cardiac failure, pulmonary emboli)
• Gas exchange defects (fibrosis, pneumonia, ARDS emphysema, COPD)
> Lead to hypoxia and hypercapnia
> Often more than one factor operate

Hypercapnic Respiratory Failure (Type II)

HYPOXIC RESPIRATORY FAILURE(TYPE 1)
• When PaCO 2 is more than >40 mmHg
• When PaO 2 is less than <60mmHg with normal or low PaCO
• Hypoxemia is always present
• Most common form of respiratory failure
Causes
Causes
• Hypoventilataion from CNS, Neuromuscular disease, and
>Chronic bronchitis
Chest wall/Pleural diseases
>Emphysema
• Upper airways obstruction
>Pneumonia
>Restrictive lung diseases
>ARDS
Respiratory Failure Symptoms
• CNS:
• Headache
• Visual Disturbances
• Memory Loss
• Pulmonary:
• Cough
• Chest pains
• Sputum production
• Dyspnea

Pulmonary hypertension
• Abnormal elevation in pulmonary artery pressure
Causes:
• left heart failure (most common)
• pulmonary diseases (COPD, interstitial lung disease)
• vascular disease, thromboembolism,
Cor pulmonale indicate right heart failure or ventricular (RV) enlargement secondary to any underlying pulmonary
disease.
-Pulmonary hypertension is the most common cause of cormpulmonale.

Diseases of pleura
Pleuritis: inflammation of pleural membrane resulting from infection, trauma and tumor
Hydrothorax/ pleural effusion: fluid in pleural cavity
Pneumothorax: air in pleural cavity/ pleural space resulting in lung collapse
◦ Pneumothorax results from trauma, fractured ribs, bullet wound, rupture of emphysema bulla

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