Introduction to Respiratory

System

• Development of the lungs

• Classification of lung
problems
• Important symptomatology
 Classification
• Anatomical

• Interstitial lung diseases

• Pleural diseases
• Airways diseases
 Classification cont

Physiological

• Obstructive (COPD,asthma, and bronchiectasis)

Limitation of airflow

• Restrictive(Idiopathic pulmonary fibrosis)

Decreased lung compliance and small lung
volumes
 Classification cont
Pulmonary vascular diseases( increased
pulmonary vascular resistance)
Obstruction to blood flow as a result of blood
clots (e.g., pulmonary embolus)
Blood vessels abnormal changes (e.g.,
pulmonary arterial hypertension).
 Classification cont

• Disorders of respiratory control

(extrapulmonary abnormalities causing
abnormal ventilation)
• Sleep disorders as obstructive sleep apnea
• Neuromuscular system disorders such as
myasthenia gravis and polymyositis
Symptoms
 Dyspnea ( Shortness of Breath)
A common complaint of respiratory and non respiratory problems

• Timing and acuity of onset

• Exacerbating and alleviating factors
• Degree of functional impairment
• Associated symptoms
• Environmental triggers

Recent, of sudden onset, and accompanied by chest pain

(pneumothorax, pulmonary embolism, and pulmonary edema )

Slowly progressive
(chronic obstructive pulmonary disease (COPD), pulmonary fibrosis,
pulmonary arterial hypertension, and neuromuscular disorders )
• Orthopnea is dyspnea that occurs in the supine
position( Heart failure and abdominal distension
pressing on the diaphragm
• Paroxysmal nocturnal dyspnea (1 to several hours
after lying down :congestive heart failure)
• Nocturnal worsening occurs also in asthma (Early
Morning Dipping)
• Exercise-induced asthma causes dyspnea 15 to 30
minutes after the cessation of exercise.
 Wheezing
Important symptom of asthma

Other conditions congestive heart failure;

endobronchial obstruction by tumor, foreign
body, or mucus; and acute bronchitis.
 Cough
• The most common cause of acute cough is acute bronchitis

• The three most common causes of chronic cough are postnasal drip,
asthma, and gastroesophageal reflux disease.

• Cough May be mild and infrequent, or it may be severe enough to induce

emesis or syncope.

• Cough may be dry or may produce sputum or blood (i.e., hemoptysis).

• Long lasting dry irritative cough occur in those taking angiotensin-

converting enzyme [ACE] inhibitors and Bordetella pertussis infection (i.e.,
whooping cough) and viral lower respiratory tract infections and
occationaly in asthma(cough-variant asthma)
 Sputum
• More than occasional production of sputum is
abnormal

• Quantity, color, timing, and presence or

absence of blood

• Purulent sputum usually means a bacterial

infection but can be seen in inflammatory
conditions
 Hemoptysis
• Is a very important symptom.
• The volume may be scant or large enough to
cause asphyxiation
• The most common cause is bronchitis
• BUT Important causes has to be excluded as
Pulmonary tuberculosis, Pulmonary embolism and
Lung malignancy
Massive hemoptysis( more than 500 mL of blood in
24 hours) is rare and is an emergency state
 Chest pain
Usually results from pleural disease, pulmonary vascular
disease, or musculoskeletal system because no pain
receptors exist in the lung parenchyma.

Lung cancer, for example, does not cause pain until it

invades the pleura, chest wall, vertebral bodies, or
mediastinal structures.

Pleuritic chest pain characterized as a sharp or stabbing

pain with deep inspiration(pulmonary emboli, infection,
pneumothorax, and collagen vascular disease ).
 Past History
History of pneumonia, tuberculosis, or chronic bronchitis,

previous X ray reports .

Patients with the acquired immunodeficiency syndrome

(AIDS) are at high risk for Pneumocystis jiroveci
pneumonia and tuberculosis.

Immunosuppression from long-standing steroid use may

predispose to tuberculosis and other lung infections.
 Drug History
Lung toxicity can result from many therapeutic actions

Pulmonary embolism from use of the oral contraceptive pill,

Interstitial lung disease from cytotoxic agents

(e.g.,methotrexate, cyclophosphamide, bleomycin),

Bronchospasm from β-adrenergic receptor blockers or

nonsteroidal antiinflammatory drugs

Cough from ACE inhibitors.

 Enviromental history
Tobacco smoke is the most
prevalent environmental toxin
causing lung disease

Occupational history

Travel history
 Family History
Important in assessing the risk for genetic lung
diseases such as cystic fibrosis and α1-
antitrypsin deficiency and susceptibility to
asthma, emphysema, or lung cancer.