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Respiratory Diseases – Diseases of the Human Respiratory System

Respiratory Diseases – Diseases of the Human Respiratory System

You may take breathing for granted, thinking that it is just an involuntary reflex action. But for the millions of people who suffer from respiratory diseases, each breath is a major accomplishment. Those people include patients with chronic lung problems, such as asthma, bronchitis,and emphysema, but they also include heart attack and accident victims,premature infants, and people with cystic fibrosis, lung cancer, or AIDS. In this booklet, however, we propose to discuss some of the common respiratory diseases.

The human respiratory system not only provides oxygen to each cell of the body but also removes body wastes, filters out infectious agents, and provides air needed for speech.Although the lungs are able to with stand abuse in the form of smoke and other pollutants, a number of disorders impair its function. Some of these maladies are temporary and relatively harmless; others may be life-threatening. Any chronic breathing problem or other cough should be checked promptly. Take care of your lungs and they will take care of you. The information in this booklet is not intended as medical advice – the doctor knows best. This booklet only intends to help patients make informed decisions.

What we call the common cold is actually a set of symptoms of upper respiratory infection caused by a wide range of infectious viruses. Symptoms include watery nasal discharge, sneezing, stuffiness, sore throat, fatigue, muscle aches and headache, and - occasionally - fever. If the doctor suspects a cold, he will look out for inflamed nasal lining, a swollen turbinate, clear mucus or a red throat. In any case, call him if your fever fails to subside in 48 to 72 hours or if it exceeds 102 degrees F.

Because of the large number of viruses that can cause viral rhinitis, it is impossible for the body to develop immunity against a cold. The body may become immune to a particular virus. However, another one may come along producing the same symptoms. That is also the reason why no preventive vaccine has been developed for the common cold.

Colds do not arise because you become chilled or wet. The viruses that cause colds pass from person to person, usually through body contact with nasal secretions or because viruses come into contact with nasal secretions or braes. A cold usually takes 7 to 10 days to subside.

Over the counter decongestant medications and acetaminophen can temporarily reduce the symptoms of a cold. Recent studies suggest that the zinc, taken in the form of lozenges three or four times a day, may help reduce the length of the cold. However, these studies are inconclusive. Prevention, therefore, is the best defense against colds. Except for symptomatic treatments, there is no effective medical therapy for colds.

Asthma

Perhaps the most commonly discussed respiratory disease after the common cold is asthma. The word asthma is derived from a Greek work meaning “breathlessness” or “panting”, both of which accurately describe an asthma attack. It is, however, not just another “breathing problem”. To physicians who treat asthma, it is a serious medical condition” untreated asthma can be fatal.

Asthma is a condition in which the airways of the lungs become either narrowed or completely blocked, obstructing normal breathing. This obstruction of the lungs, however, is reversible, either spontaneously or with medication. That is why asthma is technically called Reversible Obstructive Airway Disease (ROAD)

Air reaches the lung through the windpipe (trachea), which divides into two large tubes (bronchi), one for each lung. Each bronchi further divides into many little tubes (bronchioles), which eventually lead to tiny air sacs (alveoli), in which oxygen from the air is transferred to the bloodstream, and carbon dioxide from the bloodstream is transferred to the air.

Although everyone’s airways have the potential for constricting in response to allergens or irritants, the asthmatic’s airways may become obstructed by constriction of the muscles surrounding the airway or inflammation and swelling of the airway or increased mucus production which clogs the airway.

Once the airways have become obstructed, it takes more effort to force air through them and breathing becomes laboured. This forcing of air through constricted airways can make a whistling sound, called wheezing. Irritation of the airways by excessive mucus may also provoke coughing. Because exhaling through the obstructed airways is difficult, too much stale air remains in the lungs after each breath. This decreases the amount of fresh air which can be taken in with each new breath, so not only is there less oxygen available for the whole body, but more importantly, the high concentration of carbon dioxide in the lungs causes the blood supply to become acidic. This acidity in the blood may rice to toxic levels if the asthma remains untreated.

Asthma episodes can be triggered by a variety of factors, most notably allergens, infections, environmental pollutants, and nonspecific stimuli such as exercise and emotional states. Between 50 and 70 per cent of adults with asthma suffer from allergies. In children under three years of age, viral infections are likely to be the most common trigger. After three years, allergies also begin to play an increasing role as a trigger. After 20 years of age, occupational exposure to toxic substances and allergens also can be important triggers for asthma.

Common allergens associated with asthmatic responses are: Foods:
Nuts, peanuts, chocolate, eggs, citrus fruits, milk

Plants or plant products:
Pollens, grasses, mold spores

Animal or insect materials:
Dust mites, animal dangers, feathers, canine or feline saliva Numerous scientific studies have shown that avoidance of specific allergens in patients with asthma who have been previously sensitized will result in improved asthma symptoms and decreased medication requirements.

When the respiratory system is working properly, the air we breathe passes in and out of the lungs through a network of airways. But for people with asthma, even a minor irritant will set off an immune response that can shut down the airways. Asthmatic symptoms are usually quite variable, someone with asthma may go for periods of time without symptoms, and then suddenly have severe episodes for days at a time. The most common symptom is wheezing.

Routine treatment for asthma includes inhaled bronchodilators, injected epinephrine (adrenalin), or intravenous theophylline. Broncho dilators are drugs which open up or dilate the constricted airways.
Taking anti-inflammatory drugs, aimed at reducing asthma is a relatively new approach to treating asthma. The idea behind it is that if the underlying inflammation of the airways is reduced, the bronchi may become less hyperactive, making future attacks less likely.
For asthma which is strongly triggered by allergies, allergen avoidance can often greatly reduce the amount of medication needed to control the asthma. Taking anti-allergic medications or taking shots for allergy desensitization are other alternatives.

Is respiratory therapy a dying field? If I can"t find a job as an RT, what can I do?

I occasionally check my statcounter to see what Google inquiries or searches lead someone to the RT Cave. If I think the landing page did not answer the question, I humbly try to provide the answer in this post.

So, here are Your RT Queries:

1. Should children use a face mask for a a breathing treatment? I think most studies recommend a mask is the best method to get the most medicine into a child’s lungs. A mouthpiece is the best method, yet many children can’t use a mouthpiece. Check out this link and this link for more detail.

2. Do I need a respiratory therapist for a Cpap? If you are in a hospital and need a CPAP you will inevitably have to deal with the CPAP experts. However, outside the hospital you can obtain a CPAP from your home care establishment, or may run into a CPAP machine if you have a sleep study. I guess the answer to your question is yes and no but not necessarily so.

3. How do you write prvc settings? Where I work PRVC is the default mode per our ventilator protocol, where if there is no order we automatically use PRVC. In fact, if PRVC is available, I see no reason to use any other mode unless you have a greater objective.

4. Respiratory therapist dying field: I do not believe RT is a dying field. In fact, there is no evidence of such. Respiratory therapists are an essential part of the patient care team. They are the lung experts, and rather than being utilized less in the future, I think they will be utilized more.

5. Why elevate hob for patient with COPD? Because it helps them to expand their lungs so they can get more air in. It helps relieve the feeling of dyspnea, or air hunger. Try slouching forward in your chair. Now try to take in a deep breath. Now sit straight up as you can, and try to take in a deep breath. It is much easier when you are in a high position. When you’re not short-of-breath you don’t think of things like this, yet when your short-of-breath you quickly learn it’s easier to breath sitting high, or even standing.

6. I can’t find a job in respiratory therapy, so what should I do? I know there is a squeeze on hiring at most hospitals. Your best bet might be to spread your application around and be willing to move if necessary. Chances are the jobs available will be pool positions. Another thing you might want to try is another job in the hospital, such as a nurses assistant or a tech. Sure these might not be the ideal jobs, but at least it would help pay the bills while helping you get your foot in the door. Good luck.

7. Are crackles found at the base of the lungs in chf patients? While the CHF patient is having an episode of acute heart failure, yes there will be crackles. This is the sound of fluid in the lungs. Between acute episodes, there ideally should not be crackles. However, this will also depend on the overall health of the patient too. End stage COPD patients have a tendency to CHF, yet many COPD patients have crackles all the time in the bases. This isn’t so much fluid, but the air sacs opening and closing with inspiration. Yet, during acute CHF episodes, the crackles will be more prominent, may fill the lungs about half way up, and sound like water in the lungs. Stay tuned, because on 9-1-2010 I will publish a post everything you need to know about CHF.

8. Wet lung sounds: See #7 above. Also see the lung sound lexicon.

9. DNR full code definition: This refers to do not resuscitate. According to Wikipedia: “document is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. Abbreviated DNR, such an order may be instituted on the basis of an advance directive from a person, or from someone entitled to make decisions on their behalf, such as a health care proxy.” I believe (as I wrote here) that DNR orders can be a good thing, especially if you have a patient who is chronically ill or at an elevated age. I believe there comes a point where it’s better to let nature take its course. Not only is this better on the patient, but on the family. So, it’s a good idea to plan ahead.

10. Why don’t we give 100% oxygen to patients on ventilators?: Because oxygen is a drug, it should be utilized as a drug. New studies (like this one) show that even being on oxygen greater than 60% for as little as three hours can do damage to the lungs. So it is essential that if a patient require oxygen at greater than 60%, that he is weaned off as soon as possible. Stay tuned, because I have more research coming up in an upcoming post.

Respiratory Masterclass in COPD and Asthma, Dubai, 21-22 January 2012

Dear Respiratory friends,

I want to share with you my experience from Respiratory Masterclass in COPD and Asthma which took place in Dubai, 21-22 January 2012. The meeting was dedicated to the new COPD and Asthma guidelines, which were launched recently.

There were 2 days full of new knowledge and experience. Faculty team was conducted by Professor Paul Jones from St Georges University of London, UK – world-known leader in respiratory research. Everybody knows his questionnaire: Saint-George Respiratory Questionnaire (SGRQ) which became classical, was validated in many languages and new one COPD Assessment Test (CAT test), which became the part of new GOLD classification of COPD.

There were many brilliant presentations by world opinion leaders in Asthma and COPD. Professor David Manino from University of Kentucky College of Public Health Lexington, USA presented new statistical data about COPD: COPD: the big picture.

Professor Wisia Wedzicha from London, UK presented results of ECLIPSE Study.

Professor Neil Barnes from London, UK dedicated his presentation to the new treatment implications of the 2011 GOLD guideline.

New Medicine believed to be cure for respiratory tract ailments

Modern asthma medicine has immensely improved over the past 20 years, and this has allowed many asthmatics — myself included — a chance to live a normal life. Yet when it comes to allergies, not many advances have been made. This new medicine is supposed to cure both.

A relatively new, family owned pharmaceutical company called Pharmaco International, which is located in Muskegon, Michigan, has come up with a formula it says can be mixed with a propellant and inhaled to prevent inflammation caused by an abnormal response to common allergens and other asthma triggers. The medicine has two functions:

1. It blocks the release of inflammatory markers that cause the asthma and allergy response








2. It creates a steady release of the hormone cortisol which helps reduce inflammation

This new medicine will have a Generic name Allerguterol and the Brand name by Pharmaco will be Allergaway. Pharmaco scientists have been having trouble finding the right chemical composition for pill form, however as a spray, or as an inhaler, the medicine works.

Because it comes in inhaler form, it will have to be used prior to exposure to allergens or asthma triggers. So, chances are most asthmatics will have to use the medicine daily, and for many of us more than once per day. This may be burdensom, yet perhaps worthwhile if the medicine works out as expected.

The FDA has not yet been presented with papers for approval Other diseases the medicine is believed to cure are:

• Arthritis








• Eczema








• Nasal allergies








• Pneumonia








• Acute Bronchitis








• Bronchiolitis








• Sinusitis








• More

Of course it is April Fools, so I might just be pulling your leg!

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Sample Respiratory Case Study ASTHMA IN CHILDREN

ASTHMA IN CHILDREN

           

A. Description of Disease:  Textbook Manifestations

Asthma is a serious and potentially life-threatening illness affecting many children. It is characterized by episodic or chronic wheezing, cough, and a feeling of tightness in the chest as a result of bronchoconstriction. Its morbidity and mortality are increasing, and its fundamental cause is still unknown despite intensive research. A child who is frequently coughing or has respiratory infections should be evaluated for asthma. Additionally, a child who coughs after running or crying may also have asthma. Recurrent night cough is common, as asthma is often worse at night (American Lung Association, 2006).

 

B. Possible Etiology/Epidemiology

As mentioned, the basic cause of the lung abnormality in asthma is not yet known. However, three abnormalities are present in asthma: airway obstruction that is at least partially reversible, airway inflammation, and airway hyperresponsiveness to a variety of stimuli. Episodes of asthma often are triggered by some condition or stimulus. Common triggers of asthma are exercise, infections, allergy, irritants, and weather.

 

C. Implications on growth and development

Asthma is one of the most pervasive chronic illnesses in the United States, and it disproportionately affects children from low-income, urban, and/or ethnic minority backgrounds. Pediatric research has provided evidence that children who have been diagnosed with asthma experience compromises in psychological, behavioral, and social. The results from one study of urban children indicate young kids with asthma often exhibit behavioral problems, and that in many cases, children with persistent asthma may struggle in more than one area of behavior (KidsHealth, 2006). However, some studies also have found that children with asthma fare as well as their healthy peers in terms of psychosocial functioning (Mitchell, 2005).

 

D. Pertinent normal and abnormal lab data and diagnostic tests with significance for nursing care

Chest x-ray: May reveal hyperinflation of lungs, flattened diaphragm, normal findings during periods of remission.

Pulmonary function tests: Done to determine cause of dyspnea, whether functional abnormality is obstructive or restrictive, to estimate degree of dysfunction and to evaluate effects of therapy. Exercise pulmonary function studies may also be done to evaluate activity tolerance in those with known pulmonary impairment/progression of disease.

Arterial blood gases (ABGs): Determined degree and severity of disease process, e.g., most often PaO2 is decreased, PaCO2 is often decreased, pH normal or acidotic, and mild respiratory alkalosis secondary to hyperventilation in asthma.

Lung scan: Perfusion/ventilation studies may be done to differentiate between the various pulmonary diseases.

Complete blood count and differential: Increased eosinophils in asthma.

Sputum culture: Determines presence of infection, identifies pathogen.

Cytologic examination: Rules out underlying malignancy or allergic disorder.

Electrocardiogram (ECG): Right axis deviation and peaked P waves in severe asthma.

Exercise, ECG, stress test: Helps in assessing degree of pulmonary dysfunction, evaluating effectiveness of bronchodilator therapy, planning/evaluating exercise program.

Children with congenital malformations of the vascular system and of the gastrointestinal and respiratory tracts may present with wheezing. The presence of other congenital malformations, special attention to cases in which symptoms begin before age 1 year, x-ray studies, and a high index of suspicion will lead to a diagnosis of congenital malformation as a cause of wheezing.

Foreign-body obstruction must be considered, particularly in children with unilateral wheezing or sudden onset of wheezing with no prior history of respiratory symptoms. Opaque foreign bodies are readily visible on x-ray. Non-opaque foreign bodies are more of a problem, but the diagnosis can be reestablished by a history of sudden onset of cough and wheezing in a previously well child, combined with asymmetric diaphragmatic movement on inspiratory and expiratory chest x-rays. Viral infections of the upper respiratory tract involving the epiglottis, glottis, and subglottis generally cause signs and symptoms of croup (inspiratory stridor, high-pitched cough, and hoarseness) that are distinct from the lower airways signs and symptoms of asthma.

 

E. Management

            Nursing priorities include (a) maintain airway patency, (b) assist with measures to facilitate gas exchange, (c) enhance nutritional intake, (d) prevent complications and slow the progression of asthma, and (e) provide information about disease process of asthma and the prognosis and treatment regimen.

            An important component of any intervention model designed to mitigate the impact of asthma on inner city children is the ability to efficiently and reliably identify children who are likely to have poorly controlled asthma. Ideally, this process would identify children with previously diagnosed asthma who are not receiving adequate therapy as well as children with undiagnosed asthma. Schools have received increasing attention as strategic sites for this process. School-based case identification methods that have been tested include parental surveys and exercise challenge procedures (Hanley-Lopez, 2004).

            A holistic approach to the nursing care of children is required and involvement of the family is essential. The role of the children’s nurse is multifaceted and continually evolving. It includes being the carer, health educator and health promoter, the researcher, empowerer and the advocate. Children’s nurses must harness their power and influence: by working collaboratively with policymakers, other clinicians and service users, they can strive to give children the priority they deserve. Policy developments, the shift in care from hospital to the community and the recognition given to family centred care mean that children’s nurses must increasingly address the wider issues that influence child health and family wellbeing (Ross, 2003).

            Discharge goals include (a) ventilation/oxygenation adequate to meet self-care needs, (b) nutritional intake meeting caloric needs, (c) the infection treated or prevented, (d) disease process or prognosis and therapeutic regimen understood, and (e) plan in place to meet needs after discharge.

 

F. Prognosis

            Children with asthma have acute episodes when the air passages in their lungs get narrower as a result f different triggers. Because of this, their breathing becomes more difficult. These problems are caused by an oversensitivity of the lungs and airways.

            The allergic reaction that occurs in asthma is believed to occur in the following way: the child forms abnormally large amounts of IgE antibodies, and these antibodies cause allergic reactions when they react with the specific antigens that have caused them to develop in the first place. When the child breathes in pollen to which he or she is sensitive, the pollen reacts with the antibodies that are attached to mast cells and causes them to release several different substances. The combined effects of all these factors are to produce (1) localized edema in the walls of the small bronchioles, as well as secretion of thick mucus into the bronchiolar lumens, and (2) spasm of the bronchiolar smooth muscle (Guyton & Hall, 2000).

 

G. Health promotion activities, teaching/learning and discharge needs.

            Given the age of the child, he or she could have deficient knowledge regarding condition, treatment, self-care and discharge needs. This learning need is usually due to lack of information/unfamiliarity with information resources, information misinterpretation, and lack of recall/cognitive limitation (Doenges et al, 2002), the last of which could be applicable to the child. The parents or the guardian of the child should therefore be present along with the child during health promotion activities and teaching/learning and discharge needs.

            The desired outcomes for these activities are to (a) verbalize understanding of condition/disease process and treatment, (b) identify relationship of current signs/symptoms to the disease process and correlate these with causative factors, and (c) initiate necessary lifestyle changes and participate in treatment regimen. The health promotion activities and teaching of disease process and other needs is outlined below:

Nursing Actions/Interventions

Rationale

Explain or reinforce explanations of individual disease process. The child as well as the parents or guardian are encouraged to ask questions.

Decreases anxiety and can lead to improved participation in treatment plan.

Instruct or reinforce rationale for breathing exercises, coughing effectively, and general conditioning exercises.

Specific breathing exercises can strengthen the muscles of respiration, help minimize collapse of small airways, and provide the child with means to control dyspnea. General conditioning exercises increase activity tolerance, muscle strength, and sense of well being.

Stress importance of oral care/dental hygiene.

Decreases bacterial growth in the mouth, which can lead to pulmonary infections.

Discuss importance of avoiding people with active respiratory infections. Stress the need for routine influenza/pneumococcal vaccinations.

Decreases exposure to and incidence of acquired acute respiratory infections.

Discuss individual factors that may trigger or aggravate condition like excessively dry air, wind, environmental temperature extremes, pollen, tobacco smoke, aerosol sprays, air pollution. Parents/guardians should be encouraged to explore ways to control these factors in and around the home, school or any environment which the child stays.

These environmental factors can induce/aggravate bronchial irritation, leading to increased secretion production and airway blockage.

Provide information about activity limitations and alternating activities with rest periods to prevent fatigue.

Having this knowledge can enable parents of the child to make informed choices/decisions to reduce dyspnea, maximize activity level, perform most desired activities and prevent complications for the child.

Upon discharge, discuss importance of medical follow-up care, periodic chest x-rays, and sputum cultures.

Monitoring disease process allows for alterations in therapeutic regimen to meet changing needs and may help prevent complications.

Instruct asthmatic patient in use of peak flow meter, as appropriate.

Peak flow level can drop before the patient exhibits any signs/symptoms of asthma during the “first time” after exposure to trigger. Regular use of the peak flow meter may reduce the severity of the attack because of the earlier intervention.

Provide information and encourage participation in support groups, e.g., American Lung Association, public health department.

The child and the parents or guardian may experience anxiety, depression, and other reactions as they deal with asthma that will have an impact on their lifestyle. Support groups and/or home visits may be desired or needed to provide assistance, emotional support, and respite care.

Refer for evaluation of home care if indicated. Provide a detailed plan of care and baseline physical assessment to home care nurse as needed on discharge from acute care.

Provides for continuity of care. may help reduce frequency of rehospitalization.

Discuss respiratory medications, side effects, adverse reactions.

The child may be on several respiratory drugs that have similar side effects and potential drug interactions. It is important that the parents or the guardian of the child understand the difference between nuisance side effects and untoward or adverse side effects.

 

 

Website research

 

URL: http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22691

            This website is maintained by the American Lung Association, an organization whose mission is to prevent lung disease and promote lung health. The American Lung Association exists outside the internet and is the oldest voluntary health organization in the United States. The association is geared on fighting lung disease in all forms, most especially asthma, tobacco control, and environmental health. A section on Asthma and Children is in the website which has been used as a reference for this paper. The site is appropriate for everyone who is concerned about their lung health and would like to know more about lung problems. Health care professionals and ordinary individuals concerned about lung health can use the site. The information provided in the website are useful, relevant and reliable. The facts presented agree with some which are found in textbooks and journals. This site can be trusted since this is maintained by a reputable health organization and is likely to be more impartial and trustworthy than one privately developed. However, the site presents a disclosure that all information contained in their website is not a substitute for medical advice or treatment, and they recommend consultation with a health care professional or a doctor. There was no specific date as to when the site has been updated but the year printed on the page is 2006.

 

 

URL: http://www.nlm.nih.gov/medlineplus/asthmainchildren.html

            The name of the website is Medline Plus and is maintained by the U.S. government, specifically the U.S. National Library of Medicine and the National Institutes of Health. Regarding asthma, it contains links to other websites including that of the American Lung Association. The site provides health information regarding almost any kind of health issue, most are linked to other websites. Everyone could make use of the site, not just those who have children with asthma or lung problems. Although a section is dedicated to children with asthma, there are also other pages for adults with asthma. The website could be trusted that it provides useful and reliable information based on the fact that this is maintained by the government and includes information taken from other reliable websites. The site is last updated on November 3, 2006.

 

URL: http://kidshealth.org/research/asthma_behavioral.html

            This is a link taken from the Medline Plus website and contains an article entitled “Behavioral Problems Often Present in Children with Asthma,” which is a review of a study. This website is called Kids Health for Parents. From the name of the website alone, one can tell that this site has parents of little children as its target audience. Aside from asthma, the website offers information regarding other health concerns of children. The information used in the article is reliable and useful since it is taken from a published study in the Pediatrics journal. The article mentioned has been reviewed in February 2006, suggesting that the website could be recently updated.

 

URL: http://pediatrics.about.com/cs/conditions/a/asthma.htm

            This site, about.com, is a commercial organization offering information about virtually everything, not only about health concerns. The target audience of this site is everyone who wishes to know something about any topic. If one wishes to know about asthma, one could just click the link provided that would bring one to the page about asthma. A topic about Asthma in Children, created on November 20, 2003, is provided in one of its pages. The writer of this article is a doctor named Vincent Iannelli. Compared to the previous websites that have been mentioned, this one still contains information that is useful but less reliable.

 

URL: http://www.umm.edu/pediatric-info/asthma.htm

            This is an educational institution website of the University of Maryland Medical Center. It provides various resources regarding medical issues, among them children’s health. The page on asthma in children was last reviewed on May 14, 2003 by a University of Maryland Medicine expert. Compared to commercial organizations, educational institutions can be more trusted regarding the content of their site. The target audience of this website could be medicine students and other health care professionals, but is not strictly limited only to them. Everyone could access the website and do research regarding issues in medicine.

Credit:ivythesis.typepad.com