Treatment of Respiratory System

Types of Respiratory Disease / Lung Disease

Sinuses

• Sinusitis nose

Rhinitis

• Vasomotor rhinitis
  • Atrophic rhinitis
  • Hay fever?
• Nasal polyp
• Rhinorrhea
• nasal septum

Nasal septum deviation

• Nasal septum perforation
• Nasal septal hematoma tonsil
• Tonsillitis
• Adenoid hypertrophy?
• Peritonsillar abscess?
• pharynx

Pharyngitis Neck

• Strep throat
• Laryngopharyngeal reflux (LPR)
• Retropharyngeal abscess? larynx

Croup

• Laryngomalacia
• Laryngeal cyst
• Laryngitis
• Laryngopharyngeal reflux (LPR)
• Laryngospasm

Vocal cords

• Laryngopharyngeal reflux (LPR)
• Vocal fold nodule?
• Vocal fold paresis
• Vocal cord dysfunction epiglottis

Epiglottitis trachea

• Tracheitis
• Laryngotracheal stenosis?

Bronchial/obstructive Acute?

• Acute? bronchitis chronic? COPD
• Chronic? bronchitis
• Acute? exacerbations of chronic? bronchitis
• Acute? exacerbation of COPD
• Emphysema)
• Asthma (Status asthmaticus
• Aspirin-induced
• Exercise-induced
• Bronchiectasis

Unspecified

• Bronchitis
• Bronchiolitis
• obliterans
• Diffuse panbronchiolitis

External agents/ occupational lung disease

Pneumoconiosis

• Aluminous
• Asbestosis
• Baritosis
• Bauxite chronic? injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis?
• Berylliosis
• Caplan’s syndrome
• Chalicosis
• Coalworker’s pneumoconiosis
• Siderosis
• Silicosis
• Talcosis
• Byssinosis

Hypersensitivity pneumonitis

• Bagassosis
• Bird fancier’s lung
• Farmer’s lung
• Lycoperdonosis

Others

• ARDS
• Combined pulmonary chronic? injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis? and emphysema
• Pulmonary edema?
• Löffler’s syndrome/Eosinophilic pneumonia
• Respiratory hypersensitivity
  • Allergic bronchopulmonary aspergillosis
• Hamman-Rich syndrome
• Idiopathic? pulmonary chronic? injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।" data-rx-term="fibrosis" data-rx-definition="Fibrosis means excess scar-like tissue formation after chronic injury or inflammation. সহজ বাংলা: অতিরিক্ত দাগের মতো টিস্যু তৈরি হওয়া।">fibrosis?
• Sarcoidosis

By Pathogen

• Viral?
• Bacterial?
  • Pneumococcal
  • Klebsiella)
• Atypical bacterial?
  • Mycoplasma
  • Legionnaires’ disease
  • Chlamydiae
• Fungal?
  • Pneumocystis
• Parasitic
• noninfectious
  • Chemical/Mendelson’s syndrome
  • Aspiration/Lipid

By Route/ Vectors

• Community-acquired
• Healthcare-associated
• Hospital-acquired
• Broncho-
• Lobar
• UIP
• DIP
• BOOP-COP
• NSIP
• RB

Others

• Atelectasis
• circulatory
  • Pulmonary hypertension?
  • Pulmonary embolism?
• Lung abscess?
• Pleuritis/pleurisy
• Pneumothorax
• Hemopneumothorax

Pleural effusion

• Hemothorax
• Hydrothorax
• Chylothorax
• Empyema/pyothorax
• Malignant?
• Fibrothorax
• Mediastinitis
• Mediastinal emphysema
• Respiratory failure
• Influenza
• SARS
• Idiopathic? pulmonary haemosiderosis
• Pulmonary alveolar proteinosis

Tumors

The major histological types of respiratory system cancer are:

• Small cell lung cancer
• Non-small cell lung cancer
  • Adenocarcinoma of the lung
  • Squamous cell carcinoma of the lung
  • Large cell lung carcinoma
• Other lung cancers (carcinoid, Kaposi’s sarcoma, melanoma)
• Lymphoma
• Head and neck cancer
• Pleural mesothelioma, almost always caused by exposure to asbestos dust.
• Pulmonary hamartoma
• Congenital? malformations such as pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM).

Obstructive lung disease

• Asthma,
• chronic? bronchitis,
• bronchiectasis and
• chronic obstructive pulmonary disease (COPD) are all obstructive lung diseases obstruction.
• This limits the amount of air that is able to enter alveoli because of constriction of the bronchial tree, due to inflammation.
• A common cause of COPD including emphysema, and
• Chronic bronchitis is tobacco smoking, and common causes of bronchiectasis include severe infections and cystic fibrosis.

Restrictive lung diseases

Chronic respiratory disease

• Chronic respiratory diseases (CRDs)
• asthma,
• chronic obstructive pulmonary disease, and
• acute respiratory distress syndrome.
• CRDs are not curable; however, various forms of treatment that help dilate major air passages and improve
• shortness of breath can help control symptoms and increase the quality of life.^[5]

Respiratory tract infection

Upper respiratory tract infection

• The most common upper respiratory tract infection is the common cold.
• However, infections of specific organs of the upper respiratory tract such as sinusitis, tonsillitis, otitis media, pharyngitis, and laryngitis are also considered upper respiratory tract infections.

Lower respiratory tract infection

• The most common lower respiratory tract infection is pneumonia, an infection of the lungs which is usually caused by bacteria, particularly Streptococcus pneumoniae in Western countries.
• Worldwide, tuberculosis is an important cause of pneumonia.
• Other pathogens such as viruses and fungi can cause pneumonia, for example, severe acute respiratory syndrome and pneumocystis pneumonia.
• Pneumonia may develop complications such as a lung abscess, a round cavity in the lung caused by the infection, or may spread to the pleural cavity.

Pulmonary vascular disease

Pulmonary vascular diseases are conditions that affect the pulmonary circulation. Examples are

• Pulmonary embolism –  a blood clot that forms in a vein, breaks free, travels through the heart and lodges in the lungs (thromboembolism).
• fat embolism (particularly after bony injury),
• amniotic fluid embolism
• Pulmonary arterial hypertension – elevated pressure in the pulmonary arteries. Most commonly it is idiopathic (i.e. of unknown cause) but it can be due to the effects of another disease, particularly
• cor pulmonale.
• Pulmonary edema
• Pulmonary hemorrhage
• granulomatosis with polyangiitis and Goodpasture’s syndrome.

Causes Of Respiratory Disease / Lung Disease

Since any process that reduces airway dysfunction, below are some of the many of the conditions that can cause lung disease

• Asthma – This condition, in which your airways narrow, swell, and make extra mucus, can make it hard to breathe.
• Allergic reactions – to pollen, chemicals, pet dander, dust, foods, or insect stings
• Acute or chronic bronchitis and COPD – which can produce excess mucus in the respiratory tract and cause the lungs’ passageways to become blocked
• Pneumonia – An infection that inflames the air sacs in your lungs, and they fill with fluid or pus
• Bronchiolitis –This lung infection that inflames the airways and causes congestion usually affects children.
• Emphysema – a lung condition that causes shortness of breath
• Smoking, or breathing in smoke – can make you wheeze.
• Respiratory syncytial virus – This virus can lead to bronchiolitis, a lung infection that inflames the airways and causes congestion or pneumonia.
• Cystic fibrosis – an inherited disease that damages your lungs and makes the mucus extra sticky and thick
• Obstruction of an airway – by a foreign body that has been inhaled (such as a coin)
• Panic – A panic attack can cause a person’s throat to tighten and make breathing difficult.
• Bronchitis – Bronchitis is an inflammation of the bronchial tubes that are often caused by a viral or bacterial infection.
• Cold and flu – Infections that cause the common cold or flu can cause inflammation and breathing problems.
• Pneumonia – Pneumonia is an infection of the lungs.
• Tumor in the lungs
• Congestive heart failure
• Respiratory infections (croup, laryngitis)
• Obstructive airway diseases (asthma,
• chronic obstructive pulmonary disease, anaphylaxis, bronchiolitis)
• Pulmonary peribronchial edema (congestive heart failure)
• Vocal cord dysfunction (paradoxical vocal fold motion, vocal cord paralysis)
• Postnasal drip
• Airway compression –  Intrinsic or extrinsic (squamous cell carcinomas, goiter)
• Hyperdynamic airway collapse (tracheobronchomalacia)
• Carcinoid tumors
• Foreign body inhalation
• Forced exhalation by normal individuals[rx][rx][rx]
• Emphysema
• Gastroesophageal reflux disease (GERD)
• Heart failure
• Epiglottitis (swelling of the “lid” of your windpipe)
• Lung cancer
• Medications (particularly aspirin)
• Sleep apnea, obstructive (a condition in which breathing stops and starts during sleep)
• Pneumonia
• Respiratory syncytial virus (RSV) — especially in young children
• Respiratory tract infection (especially in children younger than 2)
• Smoking
• Vocal cord dysfunction (a condition that affects vocal cord movement)
• Lung cancer
• Sleep apnea
• Vocal cord dysfunction
• Bronchitis
• Pneumonia
• Respiratory tract infection
• Reaction to smoking
• Inhaling a foreign object
• Anaphylaxis
• Bronchiolitis, a viral respiratory infection

Symptoms Of  Respiratory Disease / Lung Disease

• Shortness of breath after exertion or due to a medical condition
• Feeling smothered or suffocated as a result of breathing difficulties
• Labored breathing
• Tightness in the chest
• Rapid, shallow breathing
• Heart palpitations
• Coughing
• Clearly audible, loud, labored breathing
• An anxious, distressed facial expression
• Flaring nostrils
• Protrusion of the abdomen and/or chest
• Gasping
• Cyanosis (pale or blue face, mouth, lips, or extremities)
• Anxiousness,
• Bloody sputum,
• Chest injury
• Chest pain,
• Chest tightness
• Cough
• Dizziness
• Fainting,
• Fatigue
• Heart palpitations,
• Labored breathing,
• Neck pain,
• Pain with inspiration (pleurisy)

Diagnosis Of Respiratory Disease / Lung Disease

Other tests you might have include

• Pulse oximetry  – a device is clipped to your finger or ear lobe, and a light on it measures how much oxygen is in your blood.
• Blood tests, including a complete blood count (CBC) – to see if you have anemia (when your body doesn’t make enough red blood cells) or infection and other tests to check for a blood clot or fluid in your lungs.
• Chest X-ray or a computerized tomography (CT) scan – to see if you have pneumonia, blood clot in your lung, or another lung disease. A CT scan puts several X-rays taken from different angles together to make a more complete picture.
• Electrocardiogram (ECG) –  to measure the electrical signals from your heart to see if you’re having a heart attack and find out how fast your heart is beating and if it has a healthy rhythm.
• Patients should be tested for electrolyte abnormalities – endocrine disorders (specifically hyperthyroid) drug-induced causes, infections, drug or chemical withdrawal, and echocardiography to check for structural heart disease. In patients presenting with ischemic stroke and with no prior history of AF, 72-hour Holter monitoring improves the detection rate of silent paroxysmal.[rx]
• Screening spirometry – Can assess how much air you can breathe
• Complete pulmonary function testing – Can evaluate your breathing capabilities in more detail than screening spirometry by measuring how much air you can breathe in and out, as well as how quickly
• Arterial blood gas measurement – Provides a measure of the oxygen content of your blood, which alerts your doctors if you are becoming low in oxygen
• Echocardiography – May be ordered if your EKG suggests that you have heart disease
• Standard exercise treadmill testing – Evaluates your breathing when you have increased oxygen demands
• Complete cardiopulmonary exercise testing – Evaluates your heart and lung function in detail.
• Chest CT scanning – A CT scan is more sensitive than a chest radiograph in the evaluation of small pneumothoraces and pneumomediastinum, although the clinical significance of these occult pneumothoraces is unclear, particularly in the stable non intubated patient.[rx] The occult collapsed lung is being diagnosed more frequently as methods of evaluating and diagnosing trauma patients become more sensitive. At present, CT scan is the gold standard for detecting occult traumatic collapsed lung not apparent on supine chest X-ray radiograph.[rx]
• Ultrasonography – Use of bedside ultrasonography in the diagnosis of the collapsed lung is a relatively recent development. In some trauma centers, collapsed lung detection is included as part of their focused abdominal sonography for trauma (FAST) examination.[rx] Ultrasonographic features used in the diagnosis of the collapsed lung include the absence of lung sliding (high sensitivity and specificity), absence of comet-tail artifact (high sensitivity, lower specificity), and presence of lung point (high specificity, lower sensitivity). In a study, ultrasonography performed on patients with blunt thoracic trauma had 94% sensitivity and 100% specificity for collapsed lung detection compared with spiral CT scanning[rx,rx].
• Arterial blood gas analysis – Arterial blood gas (ABG) does not replace physical diagnosis nor should treatment be delayed while awaiting results if the symptomatic collapsed lung is suspected. However, ABG analysis may be useful in evaluating hypoxia, hypercarbia, and respiratory acidosis.
• Electrocardiography – In left-sided pneumothorax electrocardiogram (ECG) shows rightward shift of the frontal QRS axis, diminution of the precordial R voltage, decrease in QRS amplitude, and precordial T-wave inversion. With right collapsed the lung, ECG may show diminution of the precordial QRS voltage, right axis deviation, and a prominent R wave in V2 with associated loss of S wave voltage, mimicking posterior myocardial infarction. All these changes are thought to be due to mechanical effects and should not be taken for cardiac ischemia or infarction.

Treatment Of Respiratory Disease / Lung Disease

Initial Stage

An important step in managing lung disease the cause, such as the tumor or a blood clot/ COPD. The doctor may also recommend the following to help relieve your symptoms

• Receiving extra oxygen
• Sitting in front of a fan
• Breathing cooler air by lowering the temperature in a room
• Breathing cleaner air by opening a window, using a humidifier, or getting rid of smoke and pet dander
• Getting a sense of open space by seeing a view of the outside, opening windows, or being in an empty room
• Keeping your head lifted, for example, by using pillows so that you are nearly sitting
• Practicing techniques that take your focus away from the problem, such as relaxation and meditation
• Bronchodilator to open your airways
• Clean the air – Use an air cleaner with a HEPA filter. This will help cut down on allergens that often lead to asthma attacks.
• Try breathing exercises – They can help your lungs work better, which helps with asthma symptoms like wheezing. Try these:
  • Pursed lip breathing – Breathe in through your nose, and breathe out twice as long, with your lips pursed.
  • Belly breathing – Breath in through your nose. Pay attention to how your belly fills with air (put your hands on it). Breathe out through your mouth for at least 2 to 3 times as long as you breathed in.

Physiotherapy Management of Respiratory Disease / Lung Disease

To reduce work and difficulty of breathing

• Body positioning
• Breathing control
• Relaxation technique

To improve ventilation

• Localized thoracic expansion exercise

Sputum mobilization techniques

• Postural drainage
• Deep breathing exercise
• Percussion, shaking, and vibrations

Sputum removal techniques

• Coughing and huffing
• Airway suctioning

Physiotherapy outcome evaluation includes

• Respiratory rate
• Breathing pattern
• Sputum quantity
• Auscultation
• Cough sound
• Oxygen requirement
• SpO2
• Arterial blood gases
• Chest x-ray changes
• Muscle strength
• Functional performance

References