4a. Pathologies of The Respiratory System

PATHOLOGIES OF THE
RESPIRATORY STSEM –
I
Dr. Ramsha Syed, PT
Demonstrator
Department of Rehabilitation & Health Sciences
Nazeer Hussain University
Contents:
• Aging and the Pulmonary System
• Emphysema
• Chronic bronchitis
• Asthma
• Pulmonary embolism
• Cystic fibrosis
Pathology: implications for the Physical therapist by: Catherine

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Cavallaro Goodman, 4th edition
Learning Objectives:
• Understand the physiological and structural changes that
occur in the pulmonary system as a result of aging
• Recognize and describe infectious and inflammatory diseases
affecting the pulmonary system
• Understand the underlying causes and pathophysiological
mechanisms responsible for these diseases
• Recognize and describe obstructive diseases affecting the
pulmonary system
• Understand the underlying causes and pathophysiological
mechanisms responsible for obstructive pulmonary diseases

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Learning Outcomes:
Upon completing this course, students should be able to:
• Demonstrate a comprehensive understanding of the age-
related changes affecting the pulmonary system
• Demonstrate the ability to identify and differentiate between
infectious and inflammatory diseases of the pulmonary system
based on clinical presentations
• emonstrate the ability to identify and differentiate between
obstructive diseases of the pulmonary system based on clinical
presentations
• Explain the etiology and pathophysiology of specific
obstructive pulmonary diseases

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Introduction to Topic
• The lungs are ingeniously constructed to carry out their cardinal function: the
exchange of gases between inspired air and blood.
• Developmentally, the respiratory system is an outgrowth from the ventral wall of
the foregut.
• The midline trachea develops two lateral outpocketings, the lung buds.
• The right lung bud eventually divides into three branches—the lobar bronchi—
and the left into two lobar bronchi, thus giving rise to three lobes on the right and
two on the left. The right main stem bronchus is more vertical and more directly in
line with the trachea.
• Consequently, aspirated foreign materials, such as vomitus, blood, and foreign
bodies, tend to enter the right lung more than the left.
• The lobar right and left bronchi branch dichotomously, giving rise to progressively
smaller airways.
• Accompanying the branching airways is the double arterial supply to the lungs,
that is, the pulmonary and bronchial arteries.
Pathology: implications for the Physical therapist by: Catherine Cavallaro Goodman, 4th
edition 5
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AGING AND THE PULMONARY
SYSTEM
The lung matures by age 20–25 years, and thereafter aging is associated with progressive
decline in lung function. The alveolar dead space increases with age, affecting arterial
oxygen without impairing the carbon dioxide elimination
• Decreases in peak airflow and gas exchange

• Decreases in measures of lung function such as vital capacity (the maximum amount of
air that can be breathed out following a maximum inhalation)
• Weakening of the respiratory muscles
• Decline in the effectiveness of lung defense mechanisms

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Chronic Obstructive Pulmonary Disease
•Includes diseases that cause airflow obstruction
1. Chronic Bronchitis
2. Emphysema
•Risk Factors include environmental exposures and host
factors
•Primary symptoms are cough, sputum production and
dyspnea

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EMPHYSEMA

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EMPHYSEMA
• Is a chronic obstructive pulmonary disease.
• It is often caused by exposure to toxic chemicals, including long-term
exposure to tobacco smoke.

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• Infectious
• Allergens
• Smoking
• Hereditary
• Air pollution
• Agents

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• Dyspnea with insidious onset progressing to Chronic cough, sputum
production
• Severe dyspnea with slight exertion.
• On inspection, hyper- inflated “barrel chest” wheezing, fatigue, and
tachypnea due to air trapping, muscle wasting, and pursed- lip
breathing (pink- puffers) On auscultation, diminished breath sounds
with crackles, wheezes, rhonchi, and
• Hyper resonance with percussion and a decrease in fremitus
prolonged expiration Hypoxemia and hypercarpnia,
• Anorexia, weight loss, weakness, and inactivity.
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• Encourage the client to be in a smoking cessation program
• Encourage the client to do pursed- lip breathing which can help to
slow and control the rate and depth of expiration, prevents lung
collapse and airways
• Instruct the client about having a proper activity pacing
• Instruct client to have inspiratory muscle training
• Breathing exercises
• Administer oxygen therapy at low volumes as prescribed
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• Bronchodilators;
• Albuterol (Ventolin), levalbuterol (Xopenax)
• Corticosteriods;
• Budesonide ( Pulmicort), beclomethasone (Beclovent)

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CHRONIC
BRONCHITIS

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CHRONIC BRONCHITIS
• A disease of the airways
• The presence of cough and sputum production for at least three months in
each of two consecutive years.
• Chronic exposure to smoke or other pollutant irritates the airways,
resulting in hypersecretion of mucus and inflammation, thickened
bronchial walls and narrow bronchial lumen.
• Hereditary
• History of cigarette smoking
• Frequent respiratory infections

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•Antibiotics
• Chronic, productive cough in
winter months (earliest sign) • Amoxicillin (Amoxil) doxycycline
(Vibramycin)
- cough is exacerbated
by cold weather, dampness, • Bronchodilators ephedrine
and pulmonary irritants (Primatene ) salmeterol (Serevent
) salbutamol (Ventolin)
• Shortness of breath
• Corticosteroids prednisone
(Deltasone) ipratropium
(Atrovent)
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ASTHMA

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ASTHMA
• Asthma is a disease in which inflammation of the airways causes
airflow into and out of the lungs to be restricted. When an asthma
attack occurs, the muscles of the bronchial tree become tight and the
lining of the air passages swells, reducing airflow and producing the
characteristic wheezing sound. Mucus production is increased.
• The word asthma is derived from the Greek aazein, meaning \"sharp
breath\“.

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• Allergens – it is one of the predisposing factors because asthma
attacks are mostly caused by allergens. It is the most common
predisposing factor.
• Too much activity (play) – too much activity may lead to shortness of
breath that causes compensation that results to hyperventilation or
increased RR.
• Air pollution – it can be a predisposing factor because pollution in the
air may lead to irritation of the airway.

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• Shortness of breath (dyspnea)
• Wheezing • Albuterol Sulfate
• Cough • Ventolin
• Rapid breathing (tachypnea) • Salbutamol
• Prolonged expiration
• A rapid heart rate (tachycardia)
• Rhonchous lung sounds (audible
through a stethoscope)
• Over-inflation of the chest.

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PULMONARY
EMBOLISM

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PULMONARY EMBOLISM
• Pulmonary embolism refers to the obstruction of the base or one or
more branches of the pulmonary arteries by a thrombus (or
thrombus) that originates somewhere in the venous system or in the
right side of the heart. Gas exchange is impaired in the lung mass
supplied by the obstructed vessel. Massive pulmonary embolism is
life-threatening and can cause death within the first 1 to 2 hours after
the embolic event.
• It is a common disorder associated with trauma, surgery (orthopedic,
major abdominal, pelvic, gynecologic), pregnancy, oral contraceptive
use, congestive heart failure, age older than 50 years,
hypercoagulable states, and prolonged immobility. Most thrombi
originate in the deep veins of the legs.
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• Inactivity
• Prolonged bed rest
• Certain surgical procedures
• Some medical conditions
• Being overweight
• Pacemakers or venous catheters
• Pregnancy and childbirth
• Supplemental estrogen
• Family history Smoking
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• Symptoms depend on the size of the thrombus and the area of the pulmonary artery
occlusion.
• Dyspnea is the most common symptom.
• Tachypnea is the most frequent sign.
• Chest pain is common, usually sudden in onset and pleuritic in nature; it can be
substernal and may mimic angina pectoris.
• Fever
• Tachycardia

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• Cough
• Diaphoresis
• Hemoptysis
• Syncope
• Shock
• Sudden death may occur

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2. Preventing Thrombus Formation
1. Providing General Care Ensure
• Understanding of need for • Encourage early ambulation and active and passive leg
continuous oxygen therapy. exercises.
• Provide nebulizers, incentive • Instruct patient to move legs in a \"pumping\"
spirometry, or percussion and exercise.
postural drainage. • Advise patient to avoid prolonged sitting, immobility,
• Encourage deep-breathing and constrictive clothing.
exercises. • Do not permit dangling of legs and feet in a dependent
position.
• Instruct patient to place feet on floor or chair and to
avoid crossing legs.
• Do not leave intravenous catheters in veins for
prolonged periods.

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3. Monitoring Anticoagulant and Thrombolytic 4. Minimizing Chest Pain,
Therapy Pleuritic
• Place patient in semi-Fowler's

• Advise bed rest, monitor vital signs every 2 position; turn and reposition
hours, limit invasive procedures. frequently.
• Measure PT or activated PTT every 3 to 4 hours • Administer analgesics as

after thrombolytic infusion is started to confirm prescribed for severe pain.
activation of fibrinolytic systems.
5. Managing Oxygen Therapy
• Assess for hypoxia (pulse

oximetry), deep breathing,
incentive spirometry, nebulizer
therapy, percussion, and postnasal
drainage.
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• Anti-coagulant: – Heparin – Warfarin
• Thrombolytics: – Reteplase (Retavase) – Tenecteplase (Tnkase) – Streptokinase (Streptase)

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CYSTIC FIBROSIS

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CYSTIC FIBROSIS
• This is an autosomal recessive inheritance disease caused by a
defective gene which causes the body to produce thick, sticky mucus
that clogs the lungs, making it difficult to breathe and causing life-
threatening lung infections.
• The gene that has been thought to cause cystic fibrosis is called cystic
fibrosis transmembrane conductance regulator or CFTR. This gene has
been located on chromosome 7

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• Productive cough
• Wheezing
• Gastrointestinal problems (eg. abdominal pain, weight loss)
• Hyperinflation of the lung fields on chest x-ray
• Nasal polyps
• Sinusitis
• Male and female infertility
• Clubbing of the extremities

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• Promote removal of pulmonary secretions; chest physiotherapy, including postural
drainage, chest percussion, and vibration, and breathing exercises
• Remind client to avoid exposure to crowds and to persons with known infection
• Emphasize the importance of adequate fluid and dietary intake to promote removal of
secretions and to ensure an adequate nutritional status
• Bronchodilators (such as albuterol or salmeterol), which are used to make breathing
easier. Bronchodilators may also make it easier to cough up mucus.
• DNase (such as Pulmozyme), which is used to thin mucus in the lungs.
• Mucolytics (such as Mucomyst), to thin mucus in the lungs and also in the intestines.
These are not used very much, because they can irritate the lungs.
• Antibiotics are medicines that kill bacteria that cause infections.

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Conclusion/Summary:
• In conclusion, the study of pathologies of the respiratory system is of
paramount importance in the field of healthcare and medical education.
The respiratory system, a complex network of organs and processes
responsible for oxygen exchange and maintaining acid-base balance, is
vulnerable to a wide range of diseases and disorders that can significantly
impact an individual's quality of life and overall health.
• Throughout our exploration, we have delved into various facets of
respiratory system pathologies, including aging-related changes, infectious
and inflammatory diseases, and obstructive diseases. We've learned to
recognize, understand, and differentiate these conditions, from age-related
pulmonary changes to conditions like pneumonia, asthma, and chronic
obstructive pulmonary disease (COPD).
Pathology: implications for the Physical therapist by: Catherine Cavallaro Goodman, 4th edition 37
References/Additional References:
• Pathology: implications for the Physical therapist by: Catherine
38
Questions & Answers Session
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Contact Information:
Dr. Ramsha Syed, PT

Demonstrator
Department of Rehabilitation
&
Health Sciences
Nazeer Hussain University
ramsha.syed@nhu.edu.pk
40
THANK YOU
41

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PATHOLOGIES OF THE

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

• Decreases in peak airflow and gas exchange

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

• Place patient in semi-Fowler's

• Measure PT or activated PTT every 3 to 4 hours • Administer analgesics as

• Assess for hypoxia (pulse

• Thrombolytics: – Reteplase (Retavase) – Tenecteplase (Tnkase) – Streptokinase (Streptase)

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Pathology: implications for the Physical therapist by: Catherine

Dr. Ramsha Syed, PT

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