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
Respiratory System History and Physical
Respiratory System History and Physical (Text Version)
Fill in the consultation report with correct words listed below:
- Exert
- Edema
- diuretic
- membranes
- HEENT
- apnea
- heart failure
- lobes
- inspiration
- allergens
- breath
- erythema
- monitor
- asthma
- edema
RESPIRATORY SYSTEM – HISTORY & PHYSICAL EXAMINATION
PATIENT NAME: Randy BURNS
AGE: 56
DOB: July 2
SEX: Male
ATTENDING PHYSICIAN: Joyce Mathers, MD, Pulmonology
HISTORY: This 56-year-old male is presenting with a 2-week history of worsening dyspnea not associated with exertion. The patient states that he does not have to _____[Blank 1] himself for his breathing to get difficult. He feels that “he cannot get his breath” sometimes even with lying in bed. He does report developing a cold and runny nose over the last 10 days, but the worsened breathing seemed to have started a few days earlier than this. He reports that the shortness of _____[Blank 2] has progressively gotten worse in the past 2-3 days. Patient does not report any leg or foot _____[Blank 3].
PAST HISTORY: The patient has a life history of asthma triggered by environmental _____[Blank 4] – grass cutting, trees budding in the spring, street dust etc. He has used a puffer when he has symptoms since he was a child. He has a history of congestive _____[Blank 5] (CHF) and sleep _____[Blank 6] for which he uses a CPAP machine nightly.
PHYSICAL EXAMINATION: GENERAL APPEARANCE: The patient appears laboring in breathing. He is quite distressed. VITAL SIGNS: Temperature 97.1, pulse 88, blood pressure 121/86, weight 209 pounds, height 5 feet 8 inches. _____[Blank 7] : Eye exam PERRLA. Normocephalic, atraumatic. Moist mucous _____[Blank 8]. No oropharyngeal _____[Blank 9]. No signs of infection. Tongue is coated but tonsils are clear. NECK: Supple. No lymphadenopathy. No bruits. LUNGS: There is marked wheezing on _____[Blank 10] bilaterally. Some minimal evidence of consolidation in the lower _____[Blank 11] bilaterally. No rales or rubs. CARDIAC: Irregular rate and rhythm, variable S1 and S2. EXTREMITIES: Some pedal and ankle _____[Blank 12] noted in low extremities. No cyanosis or clubbing.
ASSESSMENT AND PLAN
- Acute shortness of breath with a history of allergic _____[Blank 13]. Rule out upper respiratory infection (URI). Will order chest x-ray stat.
- Atrial fibrillation. Patient has a controlled rate. Will administer one dose of Lovenox overnight.
- Mild symptoms of CHF due to lower extremity edema. Will administer Aldactone to bring this under control. Will _____[Blank 14] the patient’s diuretic volume.
- Plan to admit patient overnight for observation to await stat CXR result and to monitor the effects of _____[Blank 15] and anticoagulant therapies.
___________________________________
Joyce Mathers, MD, Pulmonology
Check your answers: [1]
Activity source: Respiratory System History and Physical by Sheila Bellefeuille and Heather Scudder, licensed under CC BY 4.0. / Text version added.
Respiratory System Consultation Report
Respiratory System Consultation Report (Text Version)
Fill in the consultation report with correct words listed below:
- Oxygen
- pleura
- basal
- hemoptysis
- dyspnea
- thoracostomy
- q. d.
- COPD
- antibiotics
- wheezing
- atelectasis
RESPIRATORY SYSTEM – CONSULTATION REPORT
PATIENT NAME: Wayne SAUNDERS
AGE: 59
DOB: September 7
SEX: Male
DATE OF CONSULTATION: March 29
CONSULTANT: Joyce Mathers, MD, Pulmonology
REASON FOR CONSULTATION: Sudden onset dyspnea and respiratory distress.
HISTORY: This garrulous 59-year-old was seen in the ER today with a complaint of sudden onset _____[Blank 1] and some respiratory distress. Denies any nausea, vomiting, chest pain, _____[Blank 2], cough, fever or chills.
PAST HISTORY: Is positive for asthma and _____[Blank 3] as patient is a lifelong smoker at 1+ packs per day.
ASSESSMENT: CHEST has good air entry bilaterally. No _____[Blank 4]. Bilateral _____[Blank 5] crackles are noted. Some dullness to percussion on the left. CT scan was ordered and shows a left _____ [Blank 6] effusion and acute pneumothorax due to infectious process. Probable comprehensive _____[Blank 7].
MEDICATIONS
- Adalat 30 mg _____[Blank 8].
- Atenolol 50 mg (half dose) q.d.
- Flonase 50 mcg one spray on each side q.d.
- Zoloft 100 mg once q.d.
PLAN
- Admit patient to the unit for treatment and possible left _____[Blank 9] if indicated by lack of improvement on standard therapy.
- Treat with a course of _____[Blank 10] for the URI.
- _____[Blank 11] therapy if indicated by 02 sats.
- Repeat CT scan in 48 hours.
__________________________________
Joyce Mathers, MD, Pulmonology
Note: Report samples (H5P and Pressbooks) are to encourage learners to identify correct medical terminology and do not represent the Association for Health Documentation Integrity (AHDI) formatting standards.
Check your answers: [2]
Activity source: Respiratory System Consultation Report by Sheila Bellefeuille and Heather Scudder, licensed under CC BY 4.0. / Text version added.
Respiratory System Consultation Report
Respiratory System Consultation Report (Text Version)
Fill in the consultation report with correct words listed below:
- Kidney
- respiratory
- childhood
- urinalysis
- shadowing
- mid-thoracic
- pulmonary
- hepatotoxic
- x-ray
- apex
- dyspnea
- flu shot
- myoplasmal
- rasping
- rhinorrhea
- expiration
- rales
- vaccine
RESPIRATORY SYSTEM – CONSULTATION REPORT
PATIENT NAME: Mateo DIAZ
AGE: 22
DOB: June 25
SEX: Male
DATE OF CONSULTATION: April 16
CONSULTING PHYSICIAN: Joyce Mathers, MD Pulmonology
HISTORY: This 22-year-old Hispanic gentleman is referred to me for a 2-week history of new rasping cough associated with a dull right _____[Blank 1] intercostal discomfort. He has some associated _____[Blank 2] on exertion but is otherwise well with no presenting symptoms of a cold or _____[Blank 3] infection. No fever, sputum or _____[Blank 4].
PAST HISTORY: He has a history of _____[Blank 5] asthma that seemed to disappear after he hit his mid-20s. He has a history of extensive travel for work and leisure and most recently was on a work trip to Wuhan, China in late December. He receives a _____[Blank 6] annually and did have the most recent _____[Blank 7] in October 2019.
His physical exam is relatively unremarkable. Blood pressure is 120/83, respirations 12. Temperature normal at 37. Chest exam is CTA with no _____[Blank 8], rhonchi or wheezes. Even on a forced exhalation, we could not reproduce the ______[Blank 9] cough symptom.
ASSESSMENT: A PA and lateral chest _____[Blank 10] revealed a new infiltrate and _____[Blank 11] along the left mid-lung margin all the way to the _____[Blank 12]. Spirometry showed normal pressures on forced _____[Blank 13].
PLAN
- Rule out _____[Blank 14] pneumonia versus other lung infection or infiltrates such as granulomatosis, aspergillosis or sarcoidosis.
- CBC with differential, chem panel, ESR, ACE, and mycoplasma titres.
- Repeat full function tests (PFTs) in 2 weeks.
If required, will treat with Amphotericin B, Tosufloxacin, Macrolide or similar. If any of these treatments are indicated, weekly LFTs and _____[Blank 15] function testing will be required as these classes of drugs is notoriously _____[Blank 16] and nephrotoxic.
I will see the patient again in approximately 4 days to review the results and decide on a course of action – more testing or appropriate treatments as indicated above.
____________________________
Joyce Mathers, MD Pulmonology
Note: Report samples (H5P and Pressbooks) are to encourage learners to identify correct medical terminology and do not represent the Association for Health Documentation Integrity (AHDI) formatting standards.
Check your answers: [3]
Activity source: Respiratory System Consultation Report by Sheila Bellefeuille and Heather Scudder, licensed under CC BY 4.0. / Text version added.
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).
Watch Spirometry (5 min) on YouTube
Media 4.3: freshwaterl. (2009, September 11). Spirometry [Video]. YouTube. https://youtu.be/y9eiVqddVVo
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.
- 1. Exert, 2. Breath, 3. Edema, 4. Allergens, 5. Heart failure, 6. Apnea, 7. HEENT, 8. Membranes, 9. Erythema, 10. Inspiration, 11. Lobes, 12. Edema, 13. Asthma, 14. Monitor, 15. Diuretic ↵
- 1. Dyspnea, 2. Hemoptysis, 3. COPD, 4. Wheezing, 5. Basal, 6. Pleural, 7. atelectasis , 8. q. d., 9. Thoracostomy, 10. Antibiotics, 11. Oxygen ↵
- 1.Mid-thoracic, 2. Dyspnea, 3. Respiratory, 4. Rhinorrhea, 5. Childhood, 6. Flu-shot, 7. Vaccine, 8. Rales, 9. Rasping, 10. X-ray, 11. Shadowing, 12. Apex, 13. Expiration, 14. Myoplasmal, 15. Urinalysis, 16. Pulmonary, 17. Kidney, 18. Hepatotoxic. ↵
absence of a regular heart rhythm
swelling
causing cancer
a condition that lasts a long time with periods of remission and exacerbation
increase in severity of a problem
substance that dilates the bronchi and bronchioles
difficult breathing
pertaining to abnormal discolouration of blue (bluish colour, lips and nail beds) caused by deoxygenation.
difficulty swallowing
noncancerous, harmless
cancerous
Stop/stopping