4.4 – Respiratory Diseases, Disorders and Diagnostic Testing

A variety of diseases can affect the respiratory system, such as asthma, emphysema, chronic obstruction pulmonary disorder (COPD), and lung cancer. All of these conditions affect the gas exchange process and result in labored breathing and other difficulties (Betts, et al., 2013).

The Effects of Second-Hand Tobacco Smoke

The burning of a tobacco cigarette creates multiple chemical compounds that are released through mainstream smoke, which is inhaled by the smoker, and through sidestream smoke, which is the smoke that is given off by the burning cigarette. Second-hand smoke, which is a combination of sidestream smoke and the mainstream smoke that is exhaled by the smoker, has been demonstrated by numerous scientific studies to cause disease. At least 40 chemicals in sidestream smoke have been identified that negatively impact human health, leading to the development of cancer or other conditions, such as immune system dysfunction, liver toxicity, cardiac arrhythmias, pulmonary edema, and neurological dysfunction. Tobacco and second-hand smoke are considered to be carcinogenic. Exposure to second-hand smoke can cause lung cancer in individuals who are not tobacco users themselves.

• It is estimated that the risk of developing lung cancer is increased by up to 30 percent in nonsmokers who live with an individual who smokes in the house, as compared to nonsmokers who are not regularly exposed to second-hand smoke.
• Children who live with an individual who smokes inside the home have a larger number of lower respiratory infections, which are associated with hospitalizations, and a higher risk of sudden infant death syndrome (SIDS). Second-hand smoke in the home has also been linked to a greater number of ear infections in children, as well as worsening symptoms of asthma (Betts et al., 2013).

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a term used to represent a number of respiratory diseases including chronic bronchitis and emphysema. COPD is a chronic condition with most symptoms appearing in people in their mid 50s. Symptoms include shortness of breath, cough, and sputum production. Symptoms during flare ups or times of exacerbation may include green or brown mucus, increase in the viscosity or amount of mucus, chest pain, fever, swollen ankles, headaches, dizziness, and blue lips or fingers. There is no cure for COPD. Shortness of breath may be controlled with bronchodilators. The best plan is to avoid triggers and getting sick. Clients with COPD are advised to avoid people who are sick, get the flu shot and reduce their exposure to pollution and cigarette smoke. While there are several risk factors, 80% of cases are associated with cigarette smoking (Government of Canada, 2018). To learn more about COPD visit the Public Health Agency of Canada’s web page on COPD [New Tab].

Asthma

Asthma is a common chronic condition that affects all age groups. In 2011/2012, there were 3.8 million Canadians diagnosed with asthma and a disproportionate number of children and youth (Government of Canada, 2018). To learn more, visit the Asthma in Canada Data Blog [New Tab]. Asthma is a chronic disease characterized by inflammation, edema of the airway, and bronchospasms which can inhibit air from entering the lungs. Bronchospasms can lead to an “asthma attack.” An attack may be triggered by environmental factors such as dust, pollen, pet hair, or dander, changes in the weather, mold, tobacco smoke, and respiratory infections, or by exercise and stress (Betts, et al., 2013).

Symptoms of an asthma attack involve coughing, shortness of breath, wheezing, and tightness of the chest. Symptoms of a severe asthma attack require immediate medical attention and may include dyspnea that results in cyanotic lips or face, confusion, drowsiness, a rapid pulse, sweating, and severe anxiety. The severity of the condition, frequency of attacks, and identified triggers influence the type of medication that an individual may require. Longer-term treatments are used for those with more severe asthma. Short-term, fast-acting drugs that are used to treat an asthma attack are typically administered via an inhaler. For young children or individuals who have difficulty using an inhaler, asthma medications can be administered via a nebulizer (Betts, et al., 2013).

Lung Cancer

Lung cancer is a leading cause of cancer death among both males and females in Canada, with 98% occurring in adults over 50. Symptoms often appear in the late stages, with 50% being diagnosed at stage IV (Government of Canada, 2019a). Symptoms may include shortness of breath, wheezing, blood in the mucus, chronic chest infections, dysphagia, pleural effusion, and enlarged lymph nodes. There are two types of lung cancer: small cell lung cancer (SCLC), linked to cigarette smoking, grows quickly and metastasizes; non-small cell lung cancer (NSCLC) is more common and grows slowly. Changes in lung cells may lead to benign tumours or malignant tumours. Cancers that start in other parts of the body may metastasize to the lungs. Risk factors include smoking, air pollution, family history of exposure to second-hand smoke, exposure to radon gas, and exposure to carcinogens (Government of Canada, 2019). Treatment will depend on the type of lung cancer and the stage at diagnosis. Treatments may include surgery, chemotherapy, targeted therapy, immunotherapy, and radiation therapy (Government of Canada, 2019).

Sleep Apnea

Sleep apnea is a chronic disorder that occurs in children and adults. It is characterized by the cessation of breathing during sleep. These episodes may last for several seconds or several minutes, and may differ in the frequency with which they are experienced. Sleep apnea leads to poor sleep. Symptoms include fatigue, evening napping, irritability, memory problems, morning headaches, and excessive snoring. A diagnosis of sleep apnea is usually done during a sleep study, where the patient is monitored in a sleep laboratory for several nights. Treatment of sleep apnea commonly includes the use of a device called a continuous positive airway pressure (CPAP) machine during sleep. The CPAP machine has a mask that covers the nose, or the nose and mouth, and forces air into the airway at regular intervals. This pressurized air can help to gently force the airway to remain open, allowing more normal ventilation to occur (Betts et al., 2013).

Respiratory System Medical Terms in Use

Medical Specialties and Procedures Related to the Respiratory System

Respiratory Medicine (Respirology)

Respiratory medicine is concerned with the diagnosis and treatment of diseases related to the respiratory system. Respiratory medicine requires in-depth knowledge of internal medicine.  A physician who specializes in respirology is called a respirologist. Physicians specialize with three years in either adult or pediatric respiratory medicine in addition to three-years core training in internal medicine or pediatric medicine (Canadian Medical Association, 2018). For more information, visit the Canadian Medical Association’s information page on respirology [PDF].

Respiratory Therapists (RTs)

Respiratory Therapists (RTs) are health care professionals that monitor, assess, and treat people who are having problems breathing. RTs are regulated, which means they must be a member of the College of Respiratory Therapists of Ontario to work as an RT in Ontario. RTs are trained in ventilation and airway management, cardiopulmonary resuscitation, oxygen and aerosol therapy. They care for patients during cardiac stress-testing, pulmonary function testing, smoking cessation, high-risk births, rehabilitation, and surgery. They treat patients with asthma, bronchitis, COPD, emphysema, heart disease, and pneumonia (College of Respiratory Therapists of Ontario, n.d.). For more information, visit the College of Respiratory Therapist’s College of Respiratory Therapist’s What is a Respiratory Therapist? [New Tab] web page.

Thoracic Surgeon

A thoracic surgeon refers to a surgeon who has specialized in either thoracic (chest) surgery or cardiothoracic (heart and chest) surgery and cares for or performs surgery for patients with serious conditions of the thorax (London Health Sciences Centre, 2020). To learn more, visit the London Health Science Centre’s Welcome to Thoracic Surgery web page [New Tab].

Spirometry Testing

Spirometry testing is used to find out how well lungs are working by measuring air volume.

• Respiratory volume describes the amount of air in a given space within the lungs, or which can be moved by the lung, and is dependent on a variety of factors.
• Tidal volume refers to the amount of air that enters the lungs during quiet breathing, whereas inspiratory reserve volume is the amount of air that enters the lungs when a person inhales past the tidal volume.
• Expiratory reserve volume is the extra amount of air that can leave with forceful expiration following tidal expiration.
• Residual volume is the amount of air that is left in the lungs after expelling the expiratory reserve volume.
• Respiratory capacity is the combination of two or more volumes.
• Anatomical dead space refers to the air within the respiratory structures that never participates in gas exchange, because it does not reach functional alveoli.
• Respiratory rate is the number of breaths taken per minute, which may change during certain diseases or conditions.

Both respiratory rate and depth are controlled by the respiratory centres of the brain, which are stimulated by factors such as chemical and pH changes in the blood. These changes are sensed by central chemoreceptors, which are located in the brain, and peripheral chemoreceptors, which are located in the aortic arch and carotid arteries. A rise in carbon dioxide or a decline in oxygen levels in the blood stimulates an increase in respiratory rate and depth (Betts, et al., 2013).

Attribution

Except where otherwise noted, this chapter is adapted from “Respiratory System” in Building a Medical Terminology Foundation by Kimberlee Carter and Marie Rutherford licensed under CC BY 4.0. / A derivative of Betts et al., which can be accessed for free from Anatomy and Physiology (OpenStax). Adaptations: dividing Respiratory System chapter content into sub-chapters.