The Respiratory System

1. The Respiratory System Dr Enmei Liu Division of Respiratory Disorders Children’s Hospital

2. Symptoms of Respiratory Disease • Cough • Sputum • Haemoptysis • Chest pain • Breathlessness • Wheeze

3. Symptoms of Respiratory Disease • Cough • Sputum • Haemopysis • Chest pain • Breathlessness • Wheeze

4. Cough

5. Symptoms of Respiratory Disease • Cough • Sputum • Haemoptysis • Chest pain • Breathlessness • Wheeze

6. Sputum

7. Symptoms of Respiratory Disease • Cough • Sputum • Haemoptysis • Chest pain • Breathlessness • Wheeze

8. Causes of Haemoptysis

9. Symptoms of Respiratory Disease • Cough • Sputum • Haemopysis • Chest pain • Breathlessness • Wheeze

10. Disorders--Causes of Chest Pain

11. Symptoms of Respiratory Disease • Cough • Sputum • Haemopysis • Chest pain • Breathlessness • Wheeze

12. Increased Work of Breathing

13. Causes of Breathlessness

14. Symptoms of Respiratory Disease • Cough • Sputum • Haemopysis • Chest pain • Breathlessness • Wheeze

15. Case Study

16. History An 8-month-old girl presented to the emergency room in respiratory distress associated with wheezing and a temperature of 38.8°C. She had been ill for 2-3 days with a “cold and have awoken that morning with tachypnea, cough, and wheezing.She had had a similar episode about 2 months before. In addition, she had a chronic pruritic rash on the face, trunk, and extremeties for 2 months which improved when treated with cortisone-type cream. Her nose was always “running” according to the mother. She had been a very colicky baby for the first 6 months, but not “bothered” by milk at present. A 10-year-old brother had had a similar history in infancy, but had “outgrown” these problems, having only occasional hay fever now.

17. Physical Examination The infant was tachypneic, coughing and crying with slight duskiness of the lips. Nasal exam showed swollen, red nasal turbinates.There was increased anterior-posterior diameter of the chest with marked retractions. On auscultation the air exchange was good with rhonchi and diffuse wheezes heard throughout both lung fields. An eczematous type rash was noted on the face,trunk, and extremities. The child was given an adrenalin shot with only slight improvement. She was, therefore, admitted to the ward.

18. Laboratory Data • Chest film showed marked hyperaeration with no • evidence of pneumonia • CBC (complete blood count) showed normal • Viral cultures several weeks later reported the recovery • of respiratory syncycial virus (RSV).

19. Clinical Course After several days of supportive measures including intravenous hydration and oxygen She made an uneventful recovery.

20. Questions

21. This child probably has : • recurrent brochiolitis • bronchial asthma • asthmatic bronchitis • wheezy bronchitis

22. Which of the following suggests the correct diagnosis? A.     History of previous episodes B.     Response to adrenalin C.     Family history D. Presence of eczema, rhinitis, and possible allergic gastroenteritis

23. Answer this question true or false The isolation of RSV helps distinguish bronchiolitis from asthma.

24. Which test might be useful in distinguishing bronchiolitis from asthma? A.     Peripheral blood and nasal eosinophilia B.     Total serum IgE C.     Allergic skin tests D. All of the above

25. The most useful therapeutic Modalities for this child’s immediate problem include A.     adequate hydration B.     humidified oxygen C.     antibiotics D. bronchodilators E. steroids

26. To prevent future episode, which measures should be taken? A.     Allergy workup B.    Good dust and animal avoidance C.     Nothing, since the child will outgrow this D. Elimination diet

27. Summary

28. Bronchial Asthma

29. Asthma is a Major Public Health Problem • Nearly 5 million children have asthma (6.9% of children under 18) • It is one of the most common chronic childhood illnesses • It is a leading cause of school absences

30. In 1994, 17 countries in WHO GINA  Global Initiative for Asthma

31. Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial hyperresponsiveness to a variety of stimuli.

32. What is Asthma? A disease that: • Is chronic • Produces recurring episodes of breathing problems • Coughing • Wheezing • Chest tightness • Shortness of breath

33. Environmental factors Genetic predisposition Bronchial Inflammation Upper respiratory tract infection Allergens Exercise Emotional upset Bronchial Hyperreactivity+trigger factors Oedema Bronchoconstriction Mucus Production Airways Narrowing Symptoms

34. What are the Symptoms of Asthma? • Shortness of breath • Wheezing • Tightness in the chest • Coughing at night or after physical activity; cough that lasts more than a week • Waking at night with asthma symptoms (a key marker of uncontrolled asthma)

35. What Happens During an Episode of Asthma? • The lining of the airways becomes swollen (inflamed) • The airways produce a thick mucus • The muscles around the airways tighten and make airways narrower

36. What Makes Asthma Worse? • Allergens • Warm-blooded pets (including dogs, cats, birds, and small rodents) • House dust mites • Cockroaches • Pollens from grass and trees • Molds (indoors and outdoors)

37. What Makes Asthma Worse? • Irritants • Cigarette smoke and wood smoke • Scented products such as hair spray, cosmetics, and cleaning products • Strong odors from fresh paint or cooking • Automobile fumes and air pollution • Chemicals such as pesticides and lawn treatments

38. What Makes Asthma Worse? • Infections in the upper airways, such as colds (a common trigger for both children and adults) • Exercise • Strong expressions of feelings (crying, laughing) • Changes in weather and temperature

39. Investigation • Eosinophil-eosinphilia • Serum IgE • Skin test • Chest X-ray:hyperinflation • Lung function:FEV1, peak expiratory flow rate(PEFR with peak flow meter)

40. Differential Diagnosis • Brochiolitis • Inhaled foreign body • Tuberculosis • Congenital abnormality of lung, airway or heat idiopathic

41. Causes of Recurrent Wheezing • Aspiration (i.e., gastroesophageal reflux) • Asthma • Bronchiolitis • Bronchopulmonary dysplasia • Cardiac disease • Cystic fibrosis • Foreign-body aspiration • Mediastinal masses

42. Is There A Cure For Asthma? Asthma cannot be cured, but it can be controlled.

43. How Is Asthma Controlled? • Follow an individualized asthma management plan • Avoid or control exposure to things that make asthma worse • Use medication appropriately • Long-term-control medicine • Quick-relief medicine

44. Drugs in Asthma Type of DrugDrug Beta2 bronchodilators Short-acting Salbutamol Long-acting Salmeterol Anticholinergic bronchodilator Ipratropium Bromide Preventative/prophylactic treatment Inhaled steroids Budesonide Beclomethasone Fluticasone Sodium cromoglycate Methyl xanthines Theophylline Oral steroids Prednisolone

45. How Is Asthma Controlled? • Monitor response to treatment • Symptoms • Peak flow • Get regular follow-up care

46. How are Asthma Episodes Controlled? • Know the signs that asthma is worsening • Treat symptoms or drop in peak flow at first signs of worsening • Monitor response to therapy • Seek a doctor’s help when it is needed

47. What Should People with Asthma Be Able To Do? • Be active without having asthma symptoms; this includes participating in exercise and sports • Sleep through the night without having asthma symptoms • Prevent asthma episodes (attacks) • Have the best possible lung function (e.g., good peak flow number) • Avoid side effects from asthma medicines