Dr.

Chandan Thakur

Dr. C. Thakur
Diseases of Respiratory System

Dr. C. Thakur
 Respiratory System
Respiratory system performs gases exchange from our body. We
inhale oxygen (O2) from external environment into body and
exhale carbon dioxide (CO2) from body to external environment.
Respiratory system consists of

 Airways (respiratory tracts)

 Lungs

 Gases exchange fluid (Blood)

 Respiratory muscles

Abnormality in any part may Dr.

cause
C. Thakurrespiratory diseases
The majority of respiratory diseases fall into five major
categories
Obstructive lungs diseases
 Asthma
 COPD
 Bronchiectasis
 Bronchiolitis
Infectious Lungs diseases
 Pneumonia
 Pulmonary tuberculosis
 Upper respiratory infections
Restrictive lungs diseases
 Parenchymal diseases
 Neuromuscular diseases
 Pleural/chest wall diseases
Vascular diseases of lungs
 Pulmonary arterial hypertension
 Pulmonary embolism
Malignant diseases of lungs
 Lungs cancer Dr. C. Thakur
 Epidemiology
 The respiratory diseases excluding lung cancer rank
the fourth mortality causes for urban people and the
first causes in rural area.
 High morbidity, chronic duration, slowly injury of
lung function finally leads to threat to life.
 The diagnosis and therapy of the diseases develops
faster.
(Lungs cancer is the most common cause of cancer
death among men) Dr. C. Thakur
 Common clinical features of respiratory
diseases

 Cough

 Sputum

 Dyspnea (Breathlessness)

 Hemoptysis

 Chest pain

 Chest tightness

Dr. C. Thakur
 Cough
Cough is a reflex which helps to clear foreign substances and
mucus out of lungs and respiratory tracts.
Cough may be characterized as acute (lasting less than 3
weeks), subacute (lasting 3 to 8 weeks), or chronic (persisting
beyond 8 weeks).

Causes
Acute cough: mainly due to acute respiratory infections URTI or LRTI,
Pneumonia, asthma, copd and penumothorax.
Sub acute: mostly due to allergic or rhinosinusitis
Chronic cough: Chronic diseases Asthma, COPD, Interstitial lung diseases
(ILDs)
Drugs induced cough: ACEI induced cough may begin within hours to
months after the initiation of therapy and resolution may occur within 1 to
12 weeks after the cessation of therapy.
GERD related cough: Gastro-Oesophageal Reflux Disorder (GERD) may
cause chronic cough,GERD related cough is likely to be a vagally-mediated
reflux mechanism. Dr. C. Thakur
 Sputum
Sputum is secretary product of respiratory tracts. Sputum may
be mucoid or purulent.

Iron-rust (Rusty) sputum -----StreptoPneumococcal infection

Purulent sputum-----lung abscess or bronchiectasis
Brown jelly sputum-----Klebsiella pneumoniae infection
Pink foamy sputum-----lung edema
Coffee ground sputum-----Amoebic lung abscess
Smelly purulent sputum-----anaerobic
Dr. C. Thakur infection
 Dyspnoea
Breathlessness or shortness of breath (SOB) is the subjective
feeling of uncomfortable or difficult breathing.

Dyspnoea is caused by many diseases

 Respiratory: Asthma, copd, pneumonia or Pleural effusion,
interstitial lung diseases
 Cardiac: AMI, valvular diseases Pulmonary edema and
embolism,
 Neuromuscular: Myasthenia gravis, GB Syndrome, myopathy
 Metabolic: Renal failure, acute diabetes complications, anemia
 Psychiatric: Anxiety disorder and panic attacks
 Other: obesity

Dr. C. Thakur
Respiratory stimuli contributing
Dr. C. Thakur to breathlessness
 Haemoptysis
Haemoptysis is defined as the coughing up of blood derived from the lungs
or bronchial tubes
Haemoptysis is conventionally classified as minimal (blood-streaked
sputum), moderate less than 200 mL per day and severe if blood loss is
greater than 200 mL per day.
It is important to recognize massive haemoptysis quickly, because without
urgent treatment, up to 80% of the patients may die.
Causes of Haemoptysis
Pulmonary
 Airway disease such as Bronchiectasis, Bronchitis (acute and chronic),
Neoplasm etc
Parenchymal disease such as Infectious Tuberculosis, Pneumonia/lung
abscess
Vascular causes such as pulmonary embolism
Cardiovascular
Pulmonary hypertension due to, Mitral stenosis, Aortic aneurysm
Trauma such as Chest injury, Iatrogenic
Dr. C. Thakur
Dr. C. Thakur
 Physical examination of respiratory system
Respiratory auscultation is very important for diagnosis of
respiratory diseases. Normal and abnormal sounds should be
differentiated.

Dr. C. Thakur
 Normal lungs Sounds
Vesicular sound:
It is normal breathing sound, can be heard over most areas of lungs. It is soft
and low pitch with a rustling quality during inspiration and are even softer
during expiration.
Bronchial Sound:
Bronchial or tracheal sounds are heard on the chest at sites which are close to
large airways. In contrast to vesicular sounds they are relatively louder in
expiration than inspiration. It has greater amplitude in expiration than
inspiration. This type of breath sound is heard best over the trachea.

Dr. C. Thakur
 Abnormal lungs Sounds
Crackles (rales):
Cracles sound are brief, discontinuous, popping lungs sound mainly during
inspiration (inhalation). Crackcles are caused by the “popping open” of small
airways and alveoli collapsed by fluid, exudates or lack of aeration during
expiration. Crackles are often described as fine, medium and coarse. Fine
crackles are usually heard in late-inspiration whereas coarse crackles are in
early inspiration.
Rales word is no more used to describe the lungs sound.

Rhonchi (Rhonchus):
Rhonchi are low pitched sounds heard both during inspiration and
expiration. They often have a snoring, gurgling or rattle like quality.
Rhonchi occur in the bronchi mainly due to secretions. Rhonchi usually clear
after coughing.

Dr. C. Thakur
Wheeze:
They are continuous high-pitched, musical sounds heard mainly during
expiration and sometimes inspiration. Wheeze is caused by narrowed or
obstructed airways. Most commonly heard in Asthma and COPD

Stridor:
Stridor is a musical, high-pitched sound that may be audible without a
stethoscope and that indicates upper airway obstruction

Dr. C. Thakur
Pleural Rub:
Pleural rubs sounds are discontinuous or continuous, creaking or grating
sounds similar to rubbing of leather. They are produced due to friction of
pleura due to inflammation. Coughing will not alter the sound. It may
localized to a particular area of chest wall.
[Differentiation methods of pleural run with pericardial rub, make the patient
hold breath for a while, if the rubbing sound continues while the patient
holds a breath, it may be a pericardial friction rub].

Tactile fremitus:
Tactile femitus is vibration palpated with the hand on the chest during
breathing. It indicated consolidation of lung or pleural effusion.

Dr. C. Thakur
 Common Respiratory Investigations
 Chest Radiography (Chest X-ray, CT)
 Magnetic resonance imaging (MRI)
 Nuclear scanning or Positron Emission Tomography (PET)
 Bronchoscope
 Bronchoalveolar lavage (BAL) test
 Sputum test (Cytology and pathogens)
 Lung function test
 Arterial Blood gas (ABG) Analysis
 Pleural effusion analysis and Pleural biopsy
 Skin test for allergy
 Tissue biopsy
 Blood test
Dr. C. Thakur
Chest Radiography -CXR

Dr. C. Thakur
 Common abnormalities seen in Chest X-ray
 Consolidation: infection, infarction, inflammation
 Lobar collapse: mucus plugging, tumor, compression by lymph nodes
 Solitary nodule: tumor, tuberculosis
 Multiple nodules: miliary tuberculosis (TB), dust inhalation, metastatic
malignancy, healed varicella pneumonia, rheumatoid disease
 Ring shadows, tramlines and tubular shadows: Bronchiectasis
 Cavitating lesions: tumor, abscess, infarct, pneumonia (Staphylococcus/
Klebsiella )
 Reticular, nodular and reticulonodular shadows: diffuse
Parenchymal lung disease, infection
 Pleural abnormalities: fluid, plaques, tumor
 Increased translucency: Pneumothorax, Bullae
 Unilateral hilar enlargement: TB, bronchial carcinoma, lymphoma
 Bilateral hilar enlargement: sarcoid, lymphoma, TB, silicosis
 Other abnormalities: Hiatus hernia, Surgical emphysema
Dr. C. Thakur
 Bronchoscopy
Bronchoscopy is an endoscopic technique of visualizing the inside of the
airways for diagnostic and therapeutic purposes. A bronchoscope is inserted
into the airways, usually through the nose or mouth. Specimens may be
taken from inside the lungs.

Dr. C. Thakur
 Bronchoalveolar lavage (BAL) test
Bronchoalveolar lavage is a medical procedure in which a bronchoscope is
passed through the mouth or nose into the lungs and fluid is squirted into a
small part of the lung and then collected for examination. The pathological
examination of lavage fluid is used for diagnosis of lungs disease.

Dr. C. Thakur
Sputum test (Cytology and pathogens)

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Pulmonary Function test

Dr. C. Thakur
 Pulmonary Function test

TLC: The volume in the lungs at maximal inflation, the sum of VC and RV
VC: The volume of air breathed out after the deepest inhalation.
RV: The volume of air remaining in the lungs after a maximal exhalation
IC: The sum of IRV and TV
TV: The volume of air moved into or out of the lungs during quiet breathing
FRC: The volume in the lungs at the end-expiratory position
IRV: The maximal volume that can be inhaled from the end-inspiratory level
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ERV: The maximal volume of air that can be exhaled from the end-expiratory position
Pulmonary Function test Report

Dr. C. Thakur
 Allergen skin test

PPD test Allergen prick test

Dr. C. Thakur