Evaluation of disease of respiratory system

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Lesson 1
Evaluation of Disease of Respiratory System
By: Tsegaye Melaku
[MSc, Clinical Pharmacist]
Jimma University
tsegayemlk@yahoo.com or tsegaye.melaku@ju.edu.et
+251913765609
August, 2018
Respiratory disorders Pharmacotherapy

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4.  The majority of diseases of the respiratory system present with cough
and/or dyspnea
 Fall into one of three major categories:
1. Obstructive lung diseases- most common
– Air has trouble flowing out of the lungs due to airway
resistance
– Causes a decreased flow of air
– Primarily disorders of the airways,
– Such as asthma, COPD, bronchiectasis, and bronchiolitis.
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5. 2. Restrictive disorders
– lung tissue and/or chest muscles can’t expand enough
– Creates problems with air flow, mostly due to lower lung
volumes
– Include parenchymal lung diseases, abnormalities of the
chest wall and pleura, and neuromuscular disease.
3. Abnormalities of the vasculature
– Pulmonary embolism, pulmonary hypertension, and
pulmonary veno-occlusive disease
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9.  Dyspnea and Cough
–It is cardinal symptoms
–The words a patient uses to describe SOB can suggest
certain etiologies for dyspnea.
–Patients with obstructive lung disease often complain of
“chest tightness” or “inability to get a deep breath”
–Patients with CHF more commonly report “air hunger” or a
sense of suffocation
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10.  The tempo of onset and the duration of a patient’s dyspnea…..useful
– Acute SOB : usually associated with sudden physiological changes
– Laryngeal edema, bronchospasm, MI,
– Pulmonary embolism, or pneumothorax.
– Gradual progression of SOB
– COPD and idiopathic pulmonary fibrosis (IPF)
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 Dyspnea and Cough…

11. – Most asthmatics do not have daily symptoms,
– But, experience intermittent episodes of SOB
– Mostly associated with triggers
 Focus on factors that incite dyspnea
– Asthma & COPD- exacerbated by specific triggers
 Dyspnea on exertion: often an early symptom of underlying lung or
heart disease
– Warrants a thorough evaluation
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 Dyspnea and Cough…

12.  Cough:
– Duration, sputum production, triggers
– Quantity and quality of the sputum (blood-streaked)
 Chronic cough (defined as that persisting >2months)
– Commonly associated with asthma, COPD and chronic
bronchiectasis
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 Dyspnea and Cough…

13.  Additional Symptoms
– Wheezing: suggestive of airways disease, particularly asthma
– Hemoptysis: sxs of a variety of lung diseases, including
infections of the respiratory tract, bronchogenic carcinoma, PE
– Chest pain or discomfort: pneumothorax, PHTN
– Abdominal bloating or distention and pedal edema– related to
cor-pulmonale
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14.  Current or previous cigarette smoking
 Inhalational exposures at work (e.g., asbestos, silica) or home (e.g.,
wood smoke)
 Travel predisposes- TB burden area
 Irradiation and medications
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15.  Vital signs: PR, RR, To
 Pulse oximetry
 P/E:
– Inspection: kyphoscoliosis, using accessory muscles
– Percussion: pleural effusions (dull to percussion), pneumothorax
(hyper-resonant note)
– Palpation:
– Auscultation: Wheezes, Rhonchi (with secretions)
– Egophony: the sound “AH” instead of “EEE” when a patient
phonates “EEE.”
– Quiet chest: in emphysema
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16.  Pedal edema,
– If symmetric, may suggest cor pulmonale;
– If asymmetric, it may be due to DVT and associated PE
 JVP raised: Right side HF
 Pulsus paradoxus: sign in a patient with obstructive lung disease
 Clubbing: cystic fibrosis, IPF, and lung cancer
 Cyanosis: hypoxemic respiratory disorders
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17.  Measure lung volume, capacity, rates of flow, and gas exchange
 It is an effort dependent test used to assess for obstructive
pathophysiology: seen in asthma, COPD, and bronchiectasis
FEV1/FVC<70%: diagnostic of obstruction
A total lung capacity <80% of the patient’s predicted value
defines restrictive pathophysiology
 Arterial blood gas testing
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18. PFT measures
–Tidal volume (VT): amount of air inhaled or exhaled during
normal breathing.
–Minute volume (MV): total amount of air exhaled per minute.
–Vital capacity (VC): total volume of air that can be exhaled
after inhaling as much as you can.
–Functional residual capacity (FRC): amount of air left in lungs
after exhaling normally.
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19.  PFT measures….
– Residual volume. : amount of air left in the lungs after exhaling as much as
you can.
– Total lung capacity: total volume of the lungs when filled with as much air as
possible.
– Forced vital capacity (FVC): amount of air exhaled forcefully and quickly
after inhaling as much as you can.
– Forced expiratory volume (FEV): amount of air expired during the first,
second, and third seconds of the FVC test.
– Forced expiratory flow (FEF): average rate of flow during the middle half
of the FVC test.
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20.  Ultrasound of the chest or
 Plain chest radiograph
 Bronchoscopy
 Biopsies
 Genetic testing
 Echocardiogram
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21. Thank You
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