Respiratory system disorders, Helpful for B.pharm 2nd semester students.

1. Respiratory DisorderS
Ruchi Pal
Assistant Professor
Maa Bhagwati College of
Pharmacy, Lucknow.
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2. Respiratory system-
 Respiration is a type of metabolic process which involves energy production
indirectly by the oxidation of complex substances.
 The respiratory system mainly consists of the upper respiratory tract, alveoli,
bronchi, bronchioles, trachea, pleura, and pleural cavity.
Disorder-
 A disorder is defined as a state of irregular functioning of the body.
 The respiratory system disorders or respiratory diseases are the medical terms
used to study about the various types of infections, allergies and other
diseases related to the different organs, tissues and specialized cells of the
human respiratory system.
 Respiratory Diseases include Asthma, Chronic obstructive pulmonary
disease(COPD), Tuberculosis, Pulmonary fibrosis, Pneumonia, & lung cancer.
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4. ASTHMA
 A condition in which a person's airways become
inflamed, narrow and swell and produce extra
mucus, which makes it difficult to breath.
 Asthma can be minor or it can interfere with daily
activities. In some cases, it may lead to a life-
threatening attack.
 Chronic inflammation is associated with airway
hyper responsiveness that leads to recurrent
episodes of wheezing breathlessness, chest
tightness, and coughing, particularly at night or
early morning.
 It can be controlled not cured.
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5. Three-step problem-
1-Airway inflammation
2-Airways hyper-responsiveness to stimuli
3-Muscles within airways contract
(Bronchospasm)
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6. How does asthma works?
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7. Types of Asthma
(1) Allergic / Atopic / Extrinsic Asthma →
Hyper- responsiveness to inhalation specific allergen such as house dust, pet dander,
feathers, molds, pollen, food.
(2) Non - allergic / Non-atopic / Intrinsic Asthma -Irritants in air not related to allergies
such as air pollution, cold, heat, weather changes, fumes, smoke, room deodorants, RTI
(Respiratory tract infections), emotions, NSAIDs, Preservatives, stress .
 ETA (Exercise-Induced Asthma).
• Occupational Asthma
(3) Mixed Asthma.
(4) Cough variant Asthma - Persistent dry cough.
(5) Nocturnal Asthma -Worsen at night.
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8. Causes & Risk factors
Combination of environmental &
Genetic factors.
 Airborne allergens
 Respiratory infection
 Physical activity
 Cold air
 Air pollutants & irritants.
 Hay fever & other allergies.
 Certain medications.
 Strong emotions & stress.
 Food allergy.
 GERD (Gastro esophageal reflux diseases)
 Low birth weight
 Extreme changes in weather
 Eczema
 Family history
 Menstrual cycle
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9. Pathogenesis of Asthma
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10. Sign & Symptoms of Asthma
Shortness of breath.
Chest tightness or pain.
Wheezing when exhaling, which is a common sign of asthma in children.
Trouble sleeping caused by shortness of breath, coughing or wheezing.
Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.
Fatigue
Mental confusion
Extreme anxiety
Fever
Central cyanosis
Nasal flaring
Diaphoresis
Mucus production
Status asthmaticus.
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11. Classification based upon severity
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12. Complications
Status asthmaticus is a sustained state of asthma which results
when airways remain blocked for prolonged periods (days &
weeks) & also do not respond to any treatment.
Pneumonia is a bacterial or viral lung infection.
Atelectasis occurs when a part of lung collapse due to airway
obstruction with large amount of mucus.
Underperformance & fatigue is a very common asthma
complication.
Absenteeism from workplace is also very common.
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13. Diagnosis
1) Medical history
2) Physical examination.
3) Spirometry (spirometer)
4) Peak expiratory flow (PEF)
5) Pulse oximetry
6) Chest X-ray-
 Asthma or other respiratory condition occurs.
 To find out infection, foreign bodies & other conditions of lungs.
7)Allergy blood testing-
Known allergens inhale by patients
(allergens cause asthma attacks)
Take blood sample
IgE level high
Find out the particular allergen that cause disease.
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14. 8)Blood gases-
Arterial blood gases analysis
Blood sample collects
Find pH Level, Oxygen level, carbon dioxide level, acid-
base balance.
9)CBC (Complete blood count)-
 Eosinophils level
 Erythrocytes sedimentation rate
 WBCs count
10)Sputum culture-
 To find out/diagnose infection.
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15. Treatment
• Long term medications
1)Inhaled corticosteroids-
 Fluticasone propionate,
 budesonide,
 beclomethasone.
2)Leucotriene modifiers-
 Montelukast
 Zafirlukast
3)Long-acting beta agonist (LABA)-
 Formoterol
 Salmeterol
4)Combination inhalers.
• Quick relief medications
1-Short acting beta agonists (SABA)-
 Albuterol
 Levalbuterol
2-Anticholenergics
 Ipratropium bromide
3-Oral & Intravenous corticosteroids
 Prednisolone
 Methyl prednisolone.
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16.  Bronchial thermoplasty-
 Bronchial thermoplasty is a treatment for severe asthma. It's a way to open your airways.
 Bronchial thermoplasty is an asthma treatment that targets the smooth muscle in the lungs.
 Bronchial thermoplasty is an innovative, new, non drug procedure developed for the
treatment of severe persistent asthma.
 The treatment uses heat to shrink the smooth muscle so it can't tighten and cause asthma
symptoms. The treatment involves three sessions, with three weeks between each session.
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17. • Non-pharmacological (No medication)
Oxygen therapy
Postural drainage / chest physiotherapy
 To drain out mucus
Coughing & deep breathing exercise (YOGA)
Avoidance of known allergens.
 Allergy causing food or any other things.
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18. COPD(Chronic Obstructive Pulmonary Disorder)
• Also known as-
Chronic obstructive lung disease (COLD)
Chronic obstructive airway disease (COAD)
Chronic airflow limitation (CAL)
Chronic obstructive respiratory disease (CORD)
A group of lung diseases that block airflow and make it difficult to breathe.
Emphysema and chronic bronchitis are the most common conditions that make up COPD.
COPD is a condition in which air flow is obstructed by emphysema, chronic bronchitis or both.
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19. Causes
Cigarette smoking
Exposure to smoke from biomass.
Exposure to dust of polluted air.
Alpha antitrypsin deficiency can cause emphysema in non smokers.
An association of low birth weight.
Genetic effects.
long-term exposure to irritating gases or particulate matter.
Types of COPD
Chronic bronchitis
It involves long term
cough with mucus.
Emphysema
It involves damage to
lungs over time.
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20. Pathogenesis of COPD
Noxious gases
inhalation
Abnormal
inflammatory response
in airways,
parenchyma,
pulmonary vacuoles
Body attempts to
repair the chronic
inflammation
Narrowing in the air
ways
Over time injury &
repair process causes
scar tissue formation
Permanent
narrowing of airway
lumen
Parenchymal
destruction
(Emphysema)
Airflow obstruction
resulting in-
Muscular weakness
Increased circulatory
inflammatory
markers.
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21. Sign & Symptoms of COPD
Shortness of breath
Wheezing (whistling sound during breathing)
Chest tightness (effort in breathing)
Ongoing (chronic) cough (sputum)
Difficulty with routine activities
Fatigue
Weight loss
Muscle loss
Frequent colds or flu
Dyspnea- Difficulty in breathing
Enlarged alveoli
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22. Advanced symptoms (Severe COPD)
 Cyanosis-bluish discoloration of skin (lips, nails appears blue)
 Morning headache ( due to high level of carbon dioxide)
 Hemoptysis- Blood in cough / mucus.
 Swollen feet & ankle.
Lungs not properly functioning
More efforts by heart to pumps blood
 Complications
 Respiratory infections ( flu, cold, pneumonia)
 Heart problems ( Heart attack)
 Lung cancer
 Pulmonary hypertension
 Depression
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23. Diagnostic Evaluation of COPD
Medical history
Physical examination
Chest X-ray
CT Scan
Lung function test (LFT)/ Pulmonary function test (PFT)
• Spirometry
• Lung volumes
ABG Analysis ( Arterial blood gas analysis)
Take blood from arteries
Observe level of oxygen, carbon dioxide & pH of blood
Pulse oximetry ( Oxygen saturation level)
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24. Treatment
Pharmacological treatment
1)Nicotine replacement therapy-
• Smoking
• Exposure to smoke
2)Bronchodilators-
• Beta 2 agonist (salmeterol, albuterol)
• Anticholinergics
• Theophyline
3)Anti-inflammatory agents
• Fluticasone
• Budesonide
4)Mucolytics
• Guaifenesin
• N-acetylcysteine
5) Antibiotics
• Amoxicillin
6)Alpha-1-Antitrypsin deficiency treatment
• Replacement
7)Vaccination
• Flu & pneumonia vaccines
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25.  Non-Pharmacological treatment
1) Nebulization ( Inhalers)
2) Oxygen therapy
3) Exercise
4) Pulmonary rehabilitation
5) Surgery
 Bullectomy
 Lung volume reduction surgery
 Lung transplant
A bullectomy is a surgical procedure to remove bullae—
air-filled spaces in the lungs that can compress healthy
lung tissue and cause symptoms such as dyspnea
(shortness of breath), repeated infections, and
pneumothorax (lung collapse).
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26. Bronchiectasis
• Bronchiectasis is a disease in which there is permanent enlargement of parts of
the airways of the lung.
• It is a condition in which the bronchial tubes of lungs get permanently destroyed,
and become wide and thick.
• Caused by recurrent airway infection & inflammation.
• Persistent, irreversible, pathological dilation (& out pouching) of the bronchi &
bronchioles secondary to destruction of airway cartilage and elastic tissue.
• Could be primary (lung was normal) or secondary (lung had a problem before the
Bronchiectasis).
Primary: e.g. Adenovirus
Secondary: cystic fibrosis-prevent clearance of organisms from the lungs.
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27. Causes of bronchiectasis
1.Cystic fibrosis (CF)-
 An inherited life-threatening disorder that damages the lungs & digestive system.
 It affects the cells that produce mucus, sweat & digestive juices( fluids become thick & sticky).
2.Infection:
 Tuberculosis (TB)
 Severe pneumonia
• Viral pneumonia: Adenovirus or influenza virus.
• Bacterial pneumonia: Staphylococcus aureus & Hemophilus influenzae.
3.Immotile ciliary syndrome (aka Kartagener or primary ciliary dyskinesia)
• The immotile-cilia syndrome is a congenital disorder characterized by all the cilia in the body being either
immotile or showing an abnormal and inefficient beating pattern. Most symptoms come from the ciliated
airways (nose, paranasal sinuses, and bronchs) and from the middle ear.
4.Toxin inhalation
 Chemical fumes
 Aspiration (e.g. gastric content)
5.GERD(Gastro esophageal reflux diseases)
6.Yellow nail syndrome.
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28. Pathogenesis of bronchiectasis
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30. Sign & Symptoms
• Bronchiectasis develops symptoms in a few months or years, and
includes:
Chronic cough,
Blood with cough,
Thick mucus with cough,
Wheezing sounds during breathing,
Breathlessness,
Pain in chest,
Loss in weight,
Fatigue,
Clubbing ( thickening of skin under nails and toes ), &
Recurring infections in airways.
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31. Diagnosis of bronchiectasis
1)Pathology
 Gross examination
 Usually in the lower lobes
 Bronchi & bronchioles: dilated, cylindrical & saccular. The dilations extend to the
lung periphery.
 Could be tubular, cylindrical, varicose
 Filled with pus
 Microscopic ( Histopathology)
Dilation of bronchi & bronchioles
Inflammatory cells and inflammatory debris.
2) Radiologically
CXR:
 Usually nonspecific.
 Might show some infiltrates “tram-tracking”: dilation of airways.
 Crowded bronchial markings extending to the periphery.
CT
 Crowded bronchial markings extending to the periphery.
HRCT- (High-Resolution Composed
Tomography
Scanning is the standard test for confirming
the diagnosis.)
3) Sputum analysis, gram stain &
culture.
4) Sweat chloride test for CF.
5)Test for HIV/ AIDS
6)Immunoglobulin (gamma-globulin)
levels.
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32. Treatment of bronchiectasis
Antibiotics-for recurrent pneumonias
Remove mucus
• Percussion
• Postural Drainage
Surgery
Chest Physiotherapy (CPT)
Oxygen therapy
Bronchodilators
Antibiotics
Vaccinations
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33. THANK YOU
 Inhale the future, exhale the past
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