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Dr. Hani Hussein, MDRespiratory department
Jordan University Hospital
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Respiratory System Functions 1. supplies the body with oxygen and disposes of carbon
dioxide2. filters inspired air3. produces sound4. contains receptors for smell5. rids the body of some excess water and heat6. helps regulate blood pH
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Organization and Functions of the Respiratory System Consists of an upper respiratory tract (nose to
larynx) and a lower respiratory tract ( trachea onwards) .
Conducting portion transports air. - includes the nose, nasal cavity, pharynx,
larynx, trachea, and progressively smaller airways, from the primary bronchi to the terminal bronchioles
Respiratory portion carries out gas exchange. - composed of small airways called respiratory
bronchioles, alveolar ducts and alveoli.
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Figure 23.2
The Respiratory Epithelium of the Nasal Cavity and Conducting System
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The symptoms of the respiratory diseaseCough.Sputum production.Haemoptysis.Breathlessness(dyspnea).Chest pain.WheezeApnea.Others(weight loss, fever, fatigue…)
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Cough Forced expulsive maneuver against initially
closed glottis.Normal protective mechanism for clearing
the tracheo-bronchial tree of secretions and foreign material.
Patients seek medical advice when excessive, alteration their lifestyle or concern about ehe cause specially fear of cancer.
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Can be voluntary or as reflex.Afferent pathway: receptors within the
sensory distribution of the trigeminal, glossopharyngeal, superior laryngeal and vagus nerves.
Efferent pathway: recurrent laryngeal nerve and the spinal nerves.
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Acute: less than 3 weeks.Chronic: more than 8 weeks.The most common cause of acute cough is
acute viral upper respiratory tract infection.frequency.Severity of cough: sever cough with airway
obstruction cause cough syncope.
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Causes Acute cough ( less than 3 weeks)
Viral respiratory tract infectionBacterial infection(acute bronchitis)Inhaled foreign bodyInhalation of irritant: dust/fumes.Pneumonia.Acute extrinsic allergic alveolitis
Chronic cough(more than 8 weeks)
GERD.AsthmaPost viral hyper-reactivity.Chronic rhinitis/sinusitisLung tumour.Tuberculosis.Interstitial lung disease.bronchiectasisSmoking .Medication: ACE inhibitors, Beta blocker
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Sound:Bovine cough: hoarseness of voice suggest lung
cancer invading the left recurrent laryngeal nerve.
Whooping cough: pertusis.Moist cough: secretions(URTI, acute
bronchitis, chronic bronchitis, bronchiactesis).
Dry cough painful are seen in pneumonia and tracheitis.
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Chronic dry cough: interstitial lung disease, drug induced cough, asthma.
Timing of the cough:Morning productive cough: chronic bronchitis.Nocturnal cough: bronchial asthma.Daytime cough: GERD, chronic sinusitis.Cough that improved at weekends, holidays are
seen in occupational asthma.
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origin Common Causes Features
Pharynx Post nasal drip persistent
Larynx Laryngitis, croup, whooping cough, tumour
Harsh, painful, persistent associated with stridor.
Trachea TracheitisBronchitis (acute-chronic)Asthma
Bronchial carcinomaPneumonia Bronchiactesis Pulmonary edema Pulmonary TBLung fibrosis
Painful Productive, morning Dry or productive , worse at night or exposure to cold, allergens.Persistent with hemoptysis Dry initially then productiveExcessive sputum, more in supine Night, white or pink sputumDifferent, fever, weight lossDry ,irritant, disturbing
Others Drug induced ACE inhibitors, Beta blocker
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Sputum production Sputum expectoration always is abnormal.Amount.Viscosity.Color.Taste or smell.Solid material.Character.
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Types of sputumType Appearance Cause
Serous Clear , watery Frothy may be pink.
Acute pulmonary edemaAlveolar cell CA(rare)
Mucoid Clear, grey, whiteViscid.
Chronic bronchitisAsthma
Purulent Yellow
Green
Acute bronchopulmonary infectionAsthma (esinophils)
Longer duration infectionPneumonia, cystic fibrosis, lung abscess, bronchiactasis
Rusty Rusty red Pneumococcal pneumonia
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Chronic bronchitis and COPD usually cause clear sputum if color changed this indicate infection.
Yellow sputum: live neutropils in acute infection, esinophils in asthma.
Green sputum due to lysed neutrophils.Rusty sputum caused by lysed RBCs.Foul smell or vile-tasting indicates anaerobic
bacterial infection or empyema
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Haemoptysis Coughing blood.Should always investigated.True haemoptysis or not.Amount of blood.Streaks of blood, fresh bright or clot.Duration: if more than one week think of
LUNG CANCER.
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causes of haemoptysis Tumour Malignant: Benign:Lung CA bronchial carcinoidEndobronchial metastases
Infection Bronchiactesis, TB, lung abscess, cystic fibrosis
Vascular Pulmonary infarction, AV malformation
Vasculitis Wegner’s granulomatosis, goodpastures syndrome .
Trauma Chest trauma, inhalation foreign body. Iatrogenic: due to procedure.
Cardiac Mitral valve disease, acute left ventricular failure
HematologicalBleeding disorders, anticoagulation
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Breathlessness Undue awareness of breathing or the need to
breath more.Shortness of breath, not enough air enter.Mode of onset: Sudden or gradual.Duration and progression.Variability, aggravating/ relieving factor.Severity.Associated symptoms.
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Causes of dyspnea Non cardiopulmonary causes:Anemia, obesity, psychogenic, neurogenic,
metabolic acidosis.Cardiac:Left ventricular failure, mitral valve disease,
cardiomyopathy, percardial effusion, constrictive pericarditis.
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Pulmonary:Airways: laryngeal tumor, foreign body,
bronchial asthma, COPD, lung CA, bronchiactesis.
Parenchyma: lung fibrosis, TB, pneumonia, sarcoidosis, tumor.
Pulmonary circulation: PE, pulmonary HTN, pulmonary vasculitis.
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Pleural: pneumothorax, effusion, diffuse pleural fibrosis.
Chest wall: kyphoscoliosis, ankylosing spondylitis.
Neuromascular: mysthenia gravis, neuropathies, muscular dystrophy, guillian barre syndrome.
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Dyspnea (modes of onset, duration and progression)
Minutes:PE asthmaPneumothorax acute left ventricular failureInhaled foreign body
Hours to days:Pneumonia Asthma Exacerbation of COPD.
Weeks to months:Anemia respiratory neuromascular disordersPlueral effusion
Months to years:Pulmonary fibrosis Pulmonary TBCOPD
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Chest pain Chest pain can originate from: o The pleurao The chest wall.o The mediastinal structures.The lungs are not source of pain; autonomic
innervations only.
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Pleural pain:
Sharp stabbing, increased by inspiration or coughing due to irritation to parietal pleura.
Localized: upper six ribsReferred : irritation at the diaphragmatic
part of the parietal pleura(phrenic nerve) to neck and shoulder.
Lower six ribs: through intercoastal nerves, pain is in the upper abdomen
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The most common causes of pleuritic chest pain :
Pulmonary embolism. Pneumonia. Pneumothorax. Rib fracture
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Chest wall pain: musculoskeletalPatient with chronic cough, asthma usually
complaining from chest tightness.Sever lacerating may indicate malignancy.Mediastinal pain:Retrosternal,central pain.Pulmonary infarction, or tumor invading
mediastinal structure.
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Wheezing or stridorWheeze: high pitched whistling sound
produced by passage of air through narrowed small airways.
usually during expiration, but may be in both inspiration and expiration in severe narrowing.
stridor: rattling sound(loud) mostly during inspiration caused by partial obstruction of major airways
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Wheeze:Bronchial asthmaCOPD Stridor:Upper airway obstruction Vocal cord dysfunctionTumorForeign body
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Apnea/hypopnea Apnea is absence of breathing, awareness of
stoop breathing.Hypopnea: reduction in airflow or respiratory
movements by more than 50% for 10 seconds or more.
Obstructive sleep apnea: multiple apnea during sleep, excessive day time sleep, general weakness.
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Weight loss:Consider significant weight loss if 10KG of
weight during 3 months.Lung CAPulmonary TB ,chronic infection or cystic
fibrosis.Fever:High grade indicates infectionRelapsing fever in Lung abscess or TB