COURSE DESCRIPTION. Rev 3.0 July

Transcription

1 COURSE DESCRIPTION This CE course describes the anatomical structures of the respiratory system and their functions. Included in the course are descriptions of common respiratory system diseases and disorders including cause, symptoms, and treatment. Rev 3.0 July

2 COURSE TITLE: A Review of the Respiratory System Author: Lucia Johnson, M.A. Ed, MT(ASCP)SBB Vice President, Recertification National Center for Competency Testing Number of Clock Hours Credit: 3.0 Course # P.A.C.E. Approved: _ Yes X No OBJECTIVES Upon completion of this continuing education course, the professional should be able to: 1. Describe the functions of the respiratory system. 2. List the structures of the respiratory system by upper/lower respiratory tract and conduction/respiration zones. 3. Identify the location and function of each structure of the respiratory system. 4. Describe causes, symptoms, and treatment of respiratory system diseases and disorders. Disclaimer The writers for NCCT continuing education courses attempt to provide factual information based on literature review and current professional practice. However, NCCT does not guarantee that the information contained in the continuing education courses is free from all errors and omissions. 2

3 GLOSSARY Cilia Constrict Dilate DTaP Effusion Exhalation Immunocompromised Inflammation Inhalation Mucus Opportunistic Respiration Sputum Surfactant Td vaccine Tdap vaccine Thoracentesis Slender, hair-like structures that extend from a cell membrane for the purpose of moving fluids and particles Squeeze or tighten; pressure that causes a narrowing Make larger or wide; expand Vaccine given to children 6 years or younger to protect from diphtheria, tetanus, and pertussis Seeping of serous, purulent, or bloody fluid into a body cavity or tissue Movement of air containing carbon dioxide out of the respiratory system Having an impaired immune system Reaction of tissue to irritation, injury, or infection Movement of air containing oxygen into the respiratory system Viscous, slippery substance that consists mostly of mucin, water, cells, and inorganic salts; secreted as a protective lubricant coating by cells and glands of the mucous membranes Infection caused by a pathogen that does not usually cause disease in an individual with a healthy immune system; the pathogens infect those with compromised immune systems The inhalation of oxygen into the lungs and the exhalation of carbon dioxide from the lungs Mucus coughed up from the lower respiratory tract Substance composed of lipoprotein that is secreted by the alveolar cells in the lung; it coats the alveoli and prevents them from sticking together Vaccine given to individuals 7 years or older; prevents against tetanus and diphtheria; boosters recommended every 10 years Vaccine given to individuals 7 years or older; prevents against tetanus, diphtheria, and pertussis; given one time only Procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest INTRODUCTION As the name implies, the primary function of the respiratory system is respiration. Respiration consists of the inhalation (inspiration) of oxygen into the lungs and the exhalation (expiration) of carbon dioxide from the lungs. Other functions include: Filters inspired air: Foreign particles entering the nasal passages are expelled by coughing or sneezing. This action prevents the particles from entering the lower respiratory tract. Assists with regulation of blood ph: If metabolic disorders cause an increase in carbon dioxide in the blood, the respiration rate will increase in an effort to expire carbon dioxide from the lungs. This assists with maintaining a neutral blood ph. Produces sound: When air passes through the pharynx and larynx, the vocal cords in the larynx begin to vibrate. The vibrations help in the production of sounds and speech. Rids the body of some excess water and heat: The respiratory system warms inhaled air and when exhaled, the warmed air carries away some of the body s heat. Cellular activities also produce water which is removed from the body via expiration. The respiratory system can be divided and discussed in two ways: functionally and anatomically. Functionally, the respiratory system is divided into the conducting zone 3

4 and the respiratory zone. The conducting portion transports air; the respiratory portion carries out gas exchange. Anatomically, the respiratory system is divided into the upper and lower respiratory tracts. These structures are identified below per the two types of divisions. Anatomical Structure Conducting Zone Respiratory Zone Upper Respiratory Tract Lower Respiratory Tract Nose X X Pharynx X X Larynx X X Trachea X X Bronchus X X Bronchiole X X Respiratory bronchiole X X Alveolar duct X X Alveoli X X ANATOMY The following two graphics illustrate the respiratory system as a whole and the detailed structures of the nasal cavity. Figure 1: The Anatomical Structures of the Respiratory System (Courtesy of Shutterstock, Inc., Used by Permission) 4

5 RESPIRATORY MUCOSA Figure 2: The Anatomical Structures of the Nasal Cavity (Courtesy of Shutterstock, Inc., Used by Permission) A layer of ciliated epithelial cells line the nose, sinuses, pharynx, larynx, and trachea. This cellular layer is one of the mucous membranes of the body. These cells produce mucus to moisten the airways. Mucus also serves to trap potential pathogens and foreign particles from entering the airways. The cilia (hair-like structures) sweep the mucus upwards towards the mouth so it can be expelled via coughing or sneezing. NOSE The nose consists of bone and cartilage. The boney parts form the bridge of the nose; the remaining flexible portion of the nose is cartilage. Air enters the nose from the outside via the external nares, sometimes called nostrils. Inside the nasal cavity are the nasal conchae. These are folds in the mucous membrane that increase the surface area so the inhaled air can be rapidly warmed and humidified as it passes to the lungs. The nasal conchae are composed of the inferior, medial, superior, and supreme turbinates. Olfactory mucosa, specialized mucous membranes containing smell receptors, is also located in the nasal cavities. Inhaled air leaves the nose via the internal nares to continue down the respiratory tract. The internal nares connect to the pharynx. Paired air spaces called the paranasal sinuses are formed as part of the four bones of the skull. These are the frontal, ethmoidal, spheroidal, and maxillary sinuses. These sinuses warm, moisten, and filter incoming air, as well as adding resonance to the voice. The presence of the paranasal sinuses decreases the weight of the skull bones. 5

6 PHARYNX The pharynx, commonly called the throat, originates at the end of the nasal cavity, and extends to the larynx. The pharynx is the common pathway for both air and food. At its posterior end, the pharynx opens into the larynx and esophagus. Air continues through the larynx and food enters the esophagus. The pharynx is divided into three regions: nasopharynx, oropharynx, and laryngopharynx. Nasopharynx o The nasopharynx is the most superior region of the pharynx. o Normally only air passes through the nasopharynx. Food/drink from the oral cavity is blocked from entering the nasopharynx by the uvula of the soft palate, which elevates when swallowing occurs. o The eustachian tubes connect the nasopharynx to the middle ear in the lateral walls. o The posterior wall of the larynx has one pharyngeal tonsil, commonly called the adenoids. Oropharynx o The middle portion of the pharynx is the oropharynx. It is located immediately posterior to the oral cavity. o Both air and swallowed food/drink pass through the oropharynx. o The palatine tonsils are on the lateral wall of the oropharynx; the lingual tonsils are at the base of the tongue. Laryngopharynx o The laryngopharynx is the narrowed region of the pharynx that extends to the larynx and esophagus. o Both food/drink and air pass through the laryngopharynx. LARYNX The larynx, also called the voice box or glottis, allows for air to move between the pharynx and trachea. It prevents swallowed food from entering the lower respiratory tract. The larynx is composed of three pairs of cartilage (arytenoid, cuneiform, and corniculate) and three individual pieces of cartilage (thyroid, cricoid, and epiglottis). This is held together by muscles and ligaments. The thyroid cartilage is the Adam s apple. The larynx is essential for speech. The inferior ligaments of the larynx are the vocal folds. These are called true vocal cords because they produce sound when air passes through them. The superior ligaments in the larynx are called vestibular folds. These are called false vocal cords because they have no function in producing sound. The false vocal cords protect the vocal folds. 6

7 TRACHEA The trachea is the main airway to the lungs. With each inspired breath, the trachea widens and slightly lengthens, returning to its normal size with respired breath. The trachea is composed of cartilage rings that reinforce the tubular structure and provide rigidity to the walls of the trachea to assure it remains open at all times. The trachea extends from just under the larynx to under the sternum where it divides into two smaller tubes, the right and left primary bronchi, with one tube going to each lung. BRONCHI AND BRONCHIAL TREE The trachea divides into the right primary bronchus and left primary bronchus. After each bronchus enters the lung, it branches into several secondary bronchi. The left lung has two secondary bronchi; the right lung has three secondary bronchi. The secondary bronchi further divide into tertiary bronchi. The tertiary bronchi branch into bronchioles and the bronchioles branch into terminal bronchioles. The terminal bronchioles end in small air sacs called alveoli. With each branching, the amount of cartilage decreases and the amount of smooth muscle increases. This allows for variation in the diameter of the airways. For example, during strenuous exercise, the bronchi dilate, i.e., bronchodilation. In allergic reactions, the bronchi constrict, i.e., bronchoconstriction. LUNGS The lungs contain all of the parts of the bronchial tree except for the primary bronchi. The lungs are paired but not identical organs. The left lung has two lobes and is longer and narrower than the right lung. It also has an indentation called the cardiac notch which allows for the apex of the heart to be situated. The right lung has three lobes and is shorter and broader than the left lung. The volume of the right lung is also greater than the volume of the left lung. The lungs are separated from each other by the mediastinum. The mediastinum is the center portion of the chest cavity and it contains the heart, the aorta, the thymus gland, the chest portion of the trachea, the esophagus, lymph nodes, and important nerves. The only chest organs not contained in the mediastinum are the lungs. The lungs are enclosed by the pleura, which is a double-layered membrane. Serous fluid is produced by the pleura and is found between the membranes. Pleural fluid acts as a lubricant and holds the two layers together as the lungs inflate and deflate. This is the site of two of the most common lung disorders: pleural effusion (excessive accumulation of fluid between the two layers of the pleura) and pneumothorax (collapsing of the lung due to damage to the pleura). Each lung has a large pulmonary artery that carry de-oxygenated blood from the right side of the heart, and two pulmonary veins that carry oxygenated blood to the left 7

8 atrium. The main pulmonary artery arises from the right ventricle, and divides immediately into a right and left pulmonary artery that supplies the respective lungs. The lungs are the vital organ of respiration. The main function of the lungs is to oxygenate the de-oxygenated blood carried to the lungs by the pulmonary artery from the right side of the heart. The primary exchange of gases (oxygen and carbon dioxide) in the lungs occurs in the alveoli. Each lung contains about million alveoli. The alveoli have a specialized thin wall that allows for diffusion of gases between each alveolus and the blood in the pulmonary capillaries. RESPIRATORY SYSTEM DISEASES & DISORDERS ACUTE RESPIRATORY DISTRESS SYNDROME Acute respiratory distress syndrome (ARDS) occurs when the alveoli of the lungs fill up with fluid. This lessens the amount of oxygen available to enter the bloodstream. ARDS occurs most often in individuals who are already critically ill from disease or injuries. Shortness of breath occurs within a few hours or days after the onset of the disease or the injury. Many individuals who develop ARDS do not survive. Those that do survive often have permanent damage to the lungs with complications such as pulmonary fibrosis, pneumothorax, blood clots, abnormal lung function, and memory and cognitive problems resulting from lack of oxygen to the brain. Treatment of ARDS includes the use of oxygen via nasal cannula or mask to assure sufficient oxygen is available in the bloodstream. It may also be necessary to place the individual on a mechanical ventilator to assist with breathing. ALLERGIC RHINITIS Allergic rhinitis is an allergic reaction that occurs when an individual breathes in particles called allergens to which that he/she is allergic. Common allergens include dust, mold, animal dander, or pollen. Allergic rhinitis resulting from pollen is commonly called hay fever or seasonal allergy. Symptoms occur shortly after exposure to the allergen and include itchy nose, mouth, eyes, and throat; runny nose; sneezing; watery eyes; and problems with smell. Later symptoms can include stuffy nose, coughing, sore throat, headache, puffy eyes, irritability, and fatigue. The symptoms of allergic rhinitis are caused by the release of histamine and other chemical substances from the cells fighting the immune response of antibodies reacting with the allergen. Antihistamines such as Claritin and Allegra are used to inhibit the symptoms caused by histamine. 8

9 ASTHMA Asthma is a chronic long-term disease causing inflammation and narrowing of the airways. Symptoms of asthma include recurring periods of wheezing, shortness of breath, chest tightness, and coughing. The airways of an individual with asthma are inflamed and often swollen which narrows the airways. When certain substances called triggers are inhaled, the muscles around the airways tighten making the airways even narrower. The flow of air to the lungs is restricted. Cells in the airways begin to make more mucus than normal and the sticky mucus also narrows the airways. Asthma triggers can include dust, animal dander, pollen, mold, pollution, smoke, spray products such as hairspray, and sulfites in foods. Upper respiratory illnesses and exercise can also trigger asthma. Asthma symptoms may be mild and go away without treatment. However, symptoms can get worse leading to acute asthma attacks. Treating symptoms early is important. Without treatment, symptoms can quickly worsen and require emergency care. Asthma attacks can also be fatal. The cause of asthma is unknown. Many researchers believe there are both genetic and environmental factors that result in the development of asthma early in life. Treatment of asthma is three-fold. Avoid triggers as much as possible. Use long-term medications. This includes inhaled corticosteroids, and drugs that prevent airway inflammation, open airways, and prevent the body from reacting to asthma triggers. Use quick-relief or rescue drugs. Inhaled rescue drugs work to provide immediate relief when asthma is causing acute symptoms. These medications relax the tight muscles around the airways so they open up and allow air to flow into the respiratory tract. BRONCHITIS Bronchitis is inflammation of the mucous membranes that line the bronchial tubes. It can be either acute or chronic. Acute bronchitis is very common and often develops from a cold or other respiratory infection. Chronic bronchitis results from constant irritation of the mucous membranes, often as a result of smoking. Chronic bronchitis is more serious than acute bronchitis. Signs and symptoms of both acute and chronic bronchitis can include cough, production of mucus, fatigue, and chest discomfort. A slight fever with chills may also be present. In acute bronchitis, the cough persists for several weeks after the bronchitis ends. The presence of a productive cough (one that brings up mucus) for at least three months in two consecutive years is a diagnosis of chronic bronchitis. Acute bronchitis is treated with rest, over-the-counter pain medications, breathing in warm moist air, increased fluid intake, and sometimes a cough medication. Acute 9

10 bronchitis is usually caused by a viral infection so antibiotics are not given. However, if the cough and discomfort persist or the symptoms worsen, this may be an indication that a secondary bacterial infection is present and antibiotics may then be prescribed. Chronic bronchitis treatment may include all of the treatments for acute bronchitis plus breathing treatment and medications that reduce inflammation and open the airways. Chronic bronchitis can progress to emphysema and can also be a symptom of chronic obstructive pulmonary disease. CANCER Cancer can occur throughout the respiratory system, beginning at the lips and continuing to the lung. Tumors can be benign or malignant and can be in the soft tissues, bones, and cartilage. Most of the upper respiratory tract cancers are squamous cell carcinomas. The presence of these malignancies can result in disfiguring and life-altering surgeries to remove the tumors or prevent the spread of the cancer. It may be necessary to remove all or part of the tongue, the roof or floor of the mouth, teeth, bones, larynx, and more. Cancer of the lung is generally divided into two types: small cell lung cancer and nonsmall cell lung cancer. Non-small cell carcinoma includes squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. Small cell carcinoma is found almost exclusively in individuals who smoke and those who are exposed to secondhand smoke. As with other types of cancer, treatment of respiratory system cancers depends on the location, type of malignancy, and metastases to other sites. Treatment can include surgery, radiation, and chemotherapy. CHRONIC OBSTRUCTIVE PULMONARY DISEASE Chronic obstructive pulmonary disease (COPD) is a group of diseases that make breathing difficult by blocking the airflow. The two most common diseases that cause COPD are emphysema and chronic bronchitis. COPD is almost always caused by long-term exposure of irritants such as smoke (cigarette, pipe, and cigar), air pollution, or chemical fumes/dust from the workplace or environment. In the United States, smoking is the most common cause of COPD. Symptoms of COPD include shortness of breath, frequent cough, cough that produces mucus, wheezing, and chest tightness. COPD cannot be cured but it can be treated with inhaled bronchodilators and corticosteroids to help ease the symptoms. COMMON COLD The most common respiratory tract disease is the common cold. Almost everyone, including healthy children and adults, will have at least one cold every year. Symptoms include runny nose, sneezing, cough, watery eyes, sore throat, and congestion. 10

11 Symptoms do not include fever and significant fatigue. Symptoms may last for up to two weeks. More than 100 different viruses can cause the common cold. The most common viruses involved are the rhinovirus (25-80%), coronavirus (5%), and adenovirus (5%). Within each virus group there can be many subtypes. Treatment for the common cold can include use of over-the-counter decongestants, cough suppressants, and pain relievers. As colds are caused by viruses, treatment does not include antibiotics. Antibiotics are not effective for viral infections. If symptoms last for more than two weeks, begin to include fever, earaches, wheezing, or sinusitis, treatment by a physician may be needed. The viral infection may have spread to the eye canal or sinuses, or a secondary bacterial infection may have developed. At this time treatment with prescription decongestants and antibiotics may be indicated. CYSTIC FIBROSIS Cystic fibrosis (CF) is a life-threatening genetic disease that severely damages the lungs and digestive system. The cells that produce sweat, mucus, and digestive enzymes become diseased and produce thick sticky substances that plug up the ducts and passageways of primarily the lungs and pancreas. Symptoms of CF include difficulty breathing, persistent cough with thick sputum, frequent respiratory infections, foul smelling greasy stools, intestinal blockages, and poor growth/weight gain. Newborn screening for CF is now state-mandated in all fifty states. As a result, the disease can be identified within one month of life and treatment can begin before symptoms are present. In the past, the life expectancy of an individual with CF was in the teens. Now with earlier diagnosis and treatment, individuals are living into their 20s and 30s, some even into their 50s. Treatment of CF includes preventing and controlling lung infections, loosening and removing mucus from the lungs, and preventing and treating intestinal blockages. Prescription drugs such as antibiotics, mucus-thinning drugs, bronchodilators, pancreatic enzymes are used, as well as physical therapy to assist with removal of mucus from the lungs. DIPHTHERIA Diphtheria is a highly infectious respiratory infection caused by the bacteria Corynebacterium diphtheriae. Due to vaccination, it is rarely seen in the United States. The symptoms of diphtheria include sore throat, fever, and the presence of a grayish color membrane attached to the tonsils, pharynx, or nose. The membrane can block the airway making it difficult to swallow and breathe. The throat can become extensively involved with the presence of a barking cough and hoarseness. Diphtheria is potentially life-threatening and requires immediate medical attention. The bacterium produces a toxin that can lead to heart failure, blood disorders, paralysis, and coma. Severe swelling of the lymph nodes in the respiratory tract can close the airway 11

12 and stop respiration. Diphtheria is treated with antibiotics such as penicillin or erythromycin, and the administration of diphtheria antitoxin to neutralize the toxin produced by the bacteria. In the United States, almost all children are vaccinated for diphtheria. It is part of the DtaP, Td, and Tdap vaccine. DtaP given to children 6 years and younger; protects against diphtheria, tetanus, and pertussis Td given to individuals 7 years or older; protects against tetanus and diphtheria; boosters recommended every 10 years Tdap given to individuals 7 years or older; protects against tetanus, diphtheria, and pertussis; given one time only EMPHYSEMA Emphysema is a disease caused by the breakdown of the alveoli in the lungs. As the alveoli are where the exchange of oxygen takes place, decreased quantities of oxygen are delivered to the bloodstream. Symptoms include shortness of breath, cough, and difficulty breathing. Emphysema, one of the causes of chronic obstructive pulmonary disease, develops over time. Smoking is the leading cause of emphysema in the United States. Emphysema cannot be cured or reversed but treatment can minimize the progression. Treatment incudes the use of both short-acting and long-acting inhaled bronchodilators. The treatments are available as inhalers or as a solution placed in a nebulizer. FUNGAL INFECTION Fungal infections of the lung are much less common than infections caused by bacteria or viruses. Most pulmonary fungal infections are opportunistic. This means that the fungus lives in the environment (usually soil or decomposing organic materials) and does not cause disease in individuals with fully functioning immune systems. Therefore, fungal infections of the lung are seen most often in immunocompromised individuals such as those with organ/bone marrow transplants, receiving chemotherapy, or with an inherited or acquired immunodeficiency. Once an infection is established in the lungs, the fungus can spread to the bloodstream and be fatal. Fungal organisms and the diseases they cause follow. Organism Histoplasma capsulatum Found in soil Associated with bird and pigeon droppings Blastomyces dermatidis Found in moist soil and in decomposing organic matter such as wood and leaves Coccidioides immitis Found in dry soil Disease Histoplasmosis Blastomycosis Coccidiomycosis; often called Valley Fever or San Joaquin Valley Fever 12

13 Organism Cryptococcus neoformans Found in soil Aspergillus species Found in soil, on plants, and in decaying organic matter Also found in household dust and building materials Disease Cryptococcosis Aspergillosis INFLUENZA Influenza or flu is a respiratory tract infection that affects millions of people every year. Influenza is highly contagious and occurs mainly in the late fall, winter, or early spring. Influenza is spread from person-to-person through respiratory secretions caused by coughing and sneezing. Every year about 20,000 Americans die because of influenza or influenza-related complications. There are three influenza virus types: influenza A, influenza B, and influenza C. The influenza A virus is identified by the presence of the H (hemagglutinin) and N (neuraminidase) protein spikes on the virus cell membrane. There are 15 subtypes of the H protein and 9 subtypes of the N protein. Therefore, an influenza A virus will be named based on the H and N spikes; e.g. influenza A(H3N2). Influenza A and B both cause significant respiratory illness with increased rates of hospitalization and death. Influenza A may cause epidemics and pandemics; influenza B may cause epidemics. Influenza C causes a very mild respiratory illness with little or no symptoms. Symptoms of influenza occur 1-2 days after exposure to the virus. Common symptoms include sudden fever often as high as 104º F, shaking chills, moderate to severe muscle and joint aches and pains, sweating, a dry cough, nasal congestion, sore throat, moderate to severe malaise and fatigue, and headache. The illness can last up to 1-2 weeks, although fever generally lasts only 3-8 days. The most severe complication of influenza is secondary bacterial pneumonia. Influenza damages the lining of the respiratory tract and allows for certain types of bacteria to establish an infection. Streptococcus pneumoniae and Staphylococcus aureus are two common species of bacteria that can cause pneumonia resulting from influenza. Pneumonia caused by the influenza virus itself is less common. The very young, the elderly, and the immunocompromised are most likely to get a secondary bacterial infection and require hospitalization. Most deaths from influenza occur in these risk groups. LARYNGITIS Laryngitis is swelling and/or inflammation of the larynx that causes the voice to be hoarse or raspy. Usually laryngitis comes on quickly and lasts no more than two weeks. If laryngitis lasts more than two weeks the individual should seek medical attention to assure the laryngitis is not caused by a more severe problem. 13

14 Laryngitis is caused most often by a cold or influenza virus. Other causes of laryngitis include acid reflux, irritation from allergies or smoke, or overuse of the voice. NEONATAL RESPIRATORY DISTRESS SYNDROME Neonatal respiratory distress syndrome (RDS) is most often seen in premature infants. It occurs when an infant is born whose lungs are not yet fully developed and lack a substance called surfactant. Surfactant is needed to help the lungs fill with air and to keep the alveoli from deflating. Surfactant is generally present in sufficient quantities at about 38 weeks of gestation. Therefore, an infant born earlier than 38 weeks will most likely develop RDS. Symptoms of RDS can appear at time of birth or within several hours. They include cyanosis, periods of apnea, rapid breathing, shallow breathing, and shortness of breath. Treatment for some infants may include the administration of artificial surfactant. Other treatments include administration of oxygen, and if needed, mechanical respiration. Some infants are treated with continuous positive airway pressure (CPAP) as an alternative to mechanical breathing. CPAP uses a device that sends air into the nose to help keep the airways open. Oxygen and carbon dioxide levels must be closely monitored on infants with RDS to assure toxic levels of these substances are not reached. Too much oxygen can lead to problems with the infant s brain and eyes. If RDS is severe enough, infants may die. Others may have complications such as bleeding into the brain, pulmonary hemorrhage, pneumothorax, problems with eyesight including blindness, and delayed mental development. PERTUSSIS Pertussis is also known as whooping cough. It is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Pertussis most commonly affects children and it is most serious in infants who are too young to have received the DTaP (diphtheria-tetanus-pertussis) vaccine. It can be fatal in infants less than one year of age. Twenty-five percent of infants with pertussis need to be hospitalized to prevent the development of pneumonia. Pertussis begins as a regular cold with sneezing, runny nose, and a slight cough. Within 1-2 weeks violent uncontrollable coughing begins making it hard for the individual to breathe. After a bout of coughing, the individual may need to take in deep breaths which result in a characteristic whooping sound. Antibiotics recommended to treat pertussis include azithromycin, clarithromycin, and erythromycin. Trimethoprim-sulfamethoxazole can also be used. PLEURAL EFFUSION A pleural effusion is the presence of abnormal excessive amounts of fluid in the double lining of the membrane surrounding each lung. Normally a small amount of fluid is present in the membrane to allow for lubrication. Excessive quantitates of fluid can 14

15 accumulate in disease states such as congestive heart failure, blocked blood vessels, inflammation, infection, lung injury, blocked lymph vessels, and tumors. Symptoms of pleural effusion include cough, chest pain, fever, and shortness of breath. Treatment involves removal of the fluid via a procedure called thoracentesis, identification of the cause of the fluid buildup, and prevention of further fluid buildup. PNEUMONIA Pneumonia is a serious lung infection. It can be caused by a virus, bacteria, or fungus. Most people with pneumonia can be treated at home and the disease resolves itself with appropriate treatment within two weeks. Others become sufficiently ill to be hospitalized for more intensive treatment. Symptoms of pneumonia include cough with sputum, fever, shortness of breath, chills, chest pain, tachycardia, nausea, vomiting, diarrhea, and extreme fatigue. Common causes of pneumonia follow. Bacteria o Streptococcus pneumoniae o Haemophilus influenzae o Chlamydia pneumoniae o Mycoplasma pneumoniae o Legionella pneumophila Viruses o Adenovirus o Influenza o Parainfluenza o Respiratory syncytial virus Fungal o Histoplasma capsulatum o Blastomyces dermatidis o Coccidioides immitis o Cryptococcus neoformans o Aspergillus species If the cause of the pneumonia is bacterial or fungal, appropriate antibiotics and antifungal drugs can be given. For viral pneumonia, pneumonia caused by influenza virus can be treated with certain antiviral drugs. In cases of viral pneumonia, antibiotics may be given to prevent the development of a secondary bacterial infection. Respiratory therapy is almost always used to assure adequate oxygen is received by the bloodstream and sputum is removed from the lungs. PNEUMOTHORAX A pneumothorax is commonly known as a collapsed (deflated) lung. It occurs when a buildup of air in the space between the lung and the chest wall occurs. The air in this space puts pressure on the lung and the lung can then collapse. When a pneumothorax occurs, the individual s lung cannot expand appropriately when inhaling air and this results in sharp chest pain and shortness of breath. A pneumothorax can 15

16 be life-threatening if the pressure is great enough to prevent oxygen from reaching the blood stream. The most common cause of a pneumothorax is a chest injury such as a puncture wound or broken rib. It can also be caused by lung conditions such as cystic fibrosis, pneumonia, COPD, or asthma. A pneumothorax can also spontaneously occur. Individuals who smoke are at higher risk of developing a pneumothorax than those who do not smoke. To treat a pneumothorax, it may be necessary to insert a needle or a chest tube into the chest cavity to relieve the pressure on the lung. Removing the pressure allows the lung to re-expand. In some cases, the administration of oxygen via a mask or nasal cannula is sufficient to allow the lung to re-expand. PULMONARY EMBOLISM A pulmonary embolism (PE) is the blockage of one or more of the arteries that go to the lungs with a blood clot. Most commonly, the blood clot has developed in another part of the body and moved upwards towards the lungs. While a pulmonary embolism can occur spontaneously, most commonly it is a complication of deep vein thrombosis (DVT) in the lower extremities. Symptoms of PE include chest pain, sudden shortness of breath, and a cough that may bring up sputum tinged with blood. PE can be life-threatening. It is treated with anticoagulants such as heparin or warfarin. PULMONARY FIBROSIS Pulmonary fibrosis is the scaring and thickening of lung tissue that surround the alveoli. This condition makes it difficult for oxygen to get into the bloodstream. There is a variety of causes of pulmonary fibrosis, including the following. Radiation to the lung or breast as a treatment for cancer Use of certain chemotherapy drugs, antibiotics, and heart medications Diseases such as pneumonia, tuberculosis, systemic lupus erythematosus In some instances, pulmonary fibrosis occurs in an otherwise healthy individual. This is termed idiopathic pulmonary fibrosis. Pulmonary fibrosis can lead to respiratory failure, pulmonary hypertension, and rightsided cardiac failure. Individuals with pulmonary fibrosis are also at high risk for the development of lung cancer. The damage done by pulmonary fibrosis cannot be reversed. Treatments for this condition are given to make it easier for the individual to breathe and to stop the progression of the disease. Treatment includes pulmonary therapy, oxygen supplementation, and use of medications such as corticosteroids. 16

17 PULMONARY HYPERTENSION Pulmonary hypertension is a serious condition that occurs when the blood vessels that carry blood from the heart to the lung become hard and narrow. This results in high blood pressure in the arteries to the lungs. Over time, heart failure develops. Symptoms include shortness of breath during routine activities, racing heartbeat, fatigue, chest pain, and pain on the upper right side of the abdomen. Pulmonary hypertension is often related to another heart or lung condition. It can also appear in an otherwise healthy individual. There is no cure for pulmonary hypertension. Treatments such as oxygen, heart, and lung disease medications are used to minimize the symptoms. In certain cases, lung transplantation is recommended. RESPIRATORY SYNCYTIAL VIRUS Respiratory syncytial virus (RSV) is a respiratory virus. Infection in healthy adults results in a limited upper respiratory infection. However, in infants, young children, and older adults, RSV can cause a serious infection. In the United States, RSV is the most common cause of pneumonia and infection of the bronchioles (bronchiolitis) in children under one year of age. Per the Centers for Disease Control and Prevention (CDC) 75,000 to 125,000 children aged one year or less are hospitalized due to RSV infection every year. Symptoms of RSV generally begin with a runny nose. About 1-2 days later a fever accompanied by coughing and sneezing develops. Difficulty breathing may occur. Most infants infected with RSV do not need to be hospitalized. Even in those hospitalized, the infection resolves itself within 1-2 weeks. For those hospitalized with RSV, treatment may include administration of an antibiotic to prevent a secondary bacterial infection, oxygen, suctioning of mucus from the airways, and, in severe cases, mechanical ventilation. Inhaled bronchodilator drugs may be administered as well as inhaled ribavirin, an antiviral drug. Complications of RSV include pneumonia, middle ear infections, and bronchiolitis. SINUSITIS Sinusitis is the presence of inflamed sinuses, specifically the paranasal sinuses. Symptoms of sinusitis include the following. Cough Pain and pressure in areas of the paranasal sinuses Production of thick yellowish mucus Fatigue Pain in the upper jaw and teeth Earache 17

18 Other less common symptoms such as decreased sense of smell, bad breath, and fever may occur. Sinusitis is classified into four types. Acute lasts up to four weeks Subacute lasts four to twelve weeks Chronic lasts for more than 12 weeks; can continue for months to years Recurrent several attacks within a year Sinusitis can result from anything that causes swelling in the nasal cavities. This includes viral infections such as the common cold, allergic conditions such as hay fever, and bacterial infections. These conditions block the openings between the nasal cavities and the paranasal sinuses resulting in pain and the development of thickened mucus. Treatment for sinusitis includes use of decongestants, pain relievers, and antibiotics if bacterial infections are present. Chronic sinusitis may require the use of nasal steroid sprays, saline washes, and oral corticosteroid medications. In some cases, surgery is needed to enlarge the openings of the sinuses and to correct any significant structural problems of the nose and/or sinus cavities that may be contributing to an obstruction. STREP THROAT Strep throat is a bacterial infection of the throat and tonsils. Many types of the bacterium Streptococcus can cause strep throat but the most common is Group A β-hemolytic Streptococcus pyogenes. The symptoms of strep throat include fever, sore throat, enlarged lymph nodes, and pustular exudates on the tonsils. Even without antibiotics, strep throat usually resolves itself within a few days. However, it is recommended that antibiotics be given as strep throat can cause complications such as rheumatic fever and kidney inflammation. Even with antibiotic treatment, complications can occur. Antibiotics also reduce the risk of spreading the infection from one individual to another. TUBERCULOSIS Tuberculosis (TB) is caused by a bacteria called Mycobacterium tuberculosis. TB is a highly infectious disease spread through the air from one individual to another. Close contacts (people with prolonged, frequent, or intense contact such as family members, friends, and coworkers) are at highest risk of becoming infected. Others at risk for infection follow. Foreign-born individuals from areas where TB is common Immunocompromised patients (such as those with HIV/AIDS, bone marrow/organ transplants) Residents and employees of high-risk settings such as nursing homes, prisons and healthcare facilities Homeless people 18

19 People who inject illegal drugs Medically underserved, low-income populations While highly infectious, TB is slow growing. About 5% of infected individuals with a normal immune system will develop TB disease within the first two years, and another 5% will develop the disease later in life. In all, about 10% of infected individuals with normal immune systems will develop TB disease in their lifetime. When the body is unable to stop the bacteria from growing, the bacteria begin to multiply and destroy tissue. This is called active TB disease. Some people develop active TB soon after becoming infected. Others may get sick months to years later. Persons with active TB disease have symptoms such as the following. Productive prolonged cough of more than three weeks (productive = brings up sputum from the lungs) Chest pain Hemoptysis (coughing up blood) Fever, chills, night sweats Appetite loss Weight loss Fatigue Certain medical conditions increase the risk of developing TB disease to about 10% each year. This includes the high risk groups listed above and individuals with leukemia, Hodgkin s disease, malabsorption syndromes, end-stage renal disease, head and neck cancers, diabetes mellitus, prolonged corticosteroid therapy, and more. TB most often infects the lungs, where it causes pulmonary TB. The bacteria destroy tissue in the lungs eventually causing permanent damage. In many patients, the infection waxes and wanes. Tissue destruction is balanced by tissue healing. As the disease progresses, acute respiratory inflammations develop leading to lesions and fluid in the lungs. These lesions often create masses of dead tissue that harden forming tubercles. In more serious cases, the organisms spread to other areas of the body infecting bones, the brain, and reproductive, urinary, and digestive organs. Without treatment, death is inevitable. Most people who become infected with TB are able to fight off the bacteria and stop them from growing. The bacteria become inactive but remain alive in the body. The bacteria can become active later. This is called latent TB infection. People with latent TB do not have symptoms, do not feel sick, and cannot spread TB to others. Many people with latent TB never develop active TB. In other people, the bacteria become active and cause TB disease. Antibiotic treatment for TB is prolonged taking 6-9 months. Common treatments include the use of more than one drug and these include isoniazid, rifampin, ethambutol, and pyrazinamide. 19

20 REFERENCES Anatomy of the Respiratory System. DeAnza College. Accessed 4 September 2013 Diphtheria. Medline Plus. January Accessed 15 November 2013 Introduction to the Respiratory System. National Cancer Institute November Accessed 4 September Respiratory System. Inner Body. Accessed 9 November 2013 Respiratory System. Rutgers University. Accessed 9 November 2013 Sinusitis. National Institutes of Health. January Accessed 15 November 2013 The Respiratory System. National Heart, Lung, and Blood Institute. Accessed 4 September 2013 The Respiratory System Major Zones and Divisions. Accessed 9 November 2013 QUESTIONS A Review of the Respiratory System # Directions: Before taking this test, read the instructions on how to complete the answer sheets correctly. If taking the test online, log in to your User Account on the NCCT website Select the response that best completes each sentence or answers each question from the information presented in the module. If you are having difficulty answering a question, go to and select Forms/Documents. Then select CE Updates and Revisions to see if course content and/or a test questions have been revised. If you do not have access to the internet, call Customer Service at Which of the following is NOT a function of the respiratory system? a. Helps with blood ph regulation b. Inspires carbon dioxide into the lungs c. Produces sounds and speech d. Rids the body of some excess heat 2. Which of the following is considered part of the respiratory system conducting zone? a. Alveolar duct b. Alveoli c. Respiratory bronchiole d. Larynx 20

21 3. Which of the following is considered part of the lower respiratory tract? a. Nose b. Larynx c. Pharynx d. Trachea 4. Where are the turbinates located? a. Nares b. Nasal conchae c. Paranasal sinuses d. Respiratory mucosa 5. Which of the following is NOT part of the paranasal sinuses? a. Auditory b. Ethmoidal c. Maxillary d. Spheroidal 6. In which part of the pharynx does only air pass through? a. Esophagus b. Laryngopharynx c. Nasopharynx d. Oropharynx 7. Which of the following is essential for speech? a. Larynx b. Oropharynx c. Pharynx d. Trachea 8. The Adam s apple is composed by which of the following cartilages? a. Arytenoid b. Cricoid c. Cuneiform d. Thyroid 9. Which of the following is responsible for producing sound in the larynx? a. Cricoid cartilage b. Epiglottis cartilage c. Inferior ligaments d. Superior ligaments 21

22 10. Which of the following structures branches into two smaller tubes, with one tube going to each lung? a. Bronchi b. Larynx c. Pharynx d. Trachea 11. Alveoli are located at the end of the. a. Left lung b. Trachea c. Terminal bronchioles d. Tertiary bronchi 12. The lungs are separated from each other by the. a. Bronchi b. Mediastinum c. Pleura d. Thymus gland 13. Which of the following statements is TRUE? a. The left lung has three lobes. b. The left lung is broader than the right lung. c. The right lung has three lobes. d. The right lung is longer than the left lung. 14. Which structure has an indentation called the cardiac notch? a. Left primary bronchus b. Left lung c. Right lung d. Right primary bronchus 15. Which blood vessel carries de-oxygenated blood from the right side of the heart? a. Aortic artery b. Aortic vein c. Pulmonary artery d. Pulmonary vein 16. Which blood vessel carries oxygenated blood to the left atrium of the heart? a. Aortic artery b. Aortic vein c. Pulmonary artery d. Pulmonary vein 22

23 17. Which of the following is a FALSE statement about acute respiratory distress syndrome? a. ARDS occurs when the bronchioles fill up with fluid. b. Complications can include memory and cognitive problems. c. It most often occurs in critically ill individuals. d. Mechanical ventilation may be necessary. 18. The symptoms of allergic rhinitis are due to. a. a bacterial infection that causes the nasal passages to be congested b. a viral infection that causes the nasal passages to be congested c. release of antihistamines from cells involved in the immune reaction d. release of histamine from cells involved in the immune reaction 19. Quick-relief or rescue drugs used for asthma work by. a. eliminating substances that are triggers b. increasing the production of mucus c. relaxing muscles around the airways d. suppressing inflammation of the airways 20. Chronic bronchitis can progress to. a. cancer b. cystic fibrosis c. emphysema d. respiratory distress syndrome 21. Most upper respiratory tract cancers are. a. adenocarcinomas b. large cell carcinomas c. small cell carcinomas d. squamous cell carcinomas 22. Which of the following is the virus most likely to cause the common cold? a. Adenovirus b. Coronavirus c. Influenza A d. Rhinovirus 23. In cystic fibrosis, what organs are primarily infected by the disease? a. Larynx and pancreas b. Lungs and pancreas c. Lungs and trachea d. Pharynx and pancreas 23

24 24. In which of the following respiratory illnesses can a membrane develop that blocks the airway? a. Cystic fibrosis b. Diphtheria c. Histoplasmosis d. Influenza 25. In the United States, which of the following is the leading cause of emphysema? a. Chronic obstructive pulmonary disease b. Pollution c. Pertussis d. Smoking 26. Which of the following microorganisms is known to cause an opportunistic infection in someone who has a compromised immune system? a. Bordetella pertussis b. Corynebacterium diphtheriae c. Cryptococcus neoformans d. Streptococcus pyogenes 27. Which of the following infections is associated with bird and pigeon droppings? a. Blastomycosis b. Coccidiomycosis c. Cryptococcosis d. Histoplasmosis 28. Which of the following influenza viruses may cause a pandemic? a. Influenza A b. Influenza B c. Influenza C d. All can cause pandemics 29. In which season are influenza infections NOT generally seen? a. Early spring b. Late fall c. Mid-summer d. Winter 30. Neonatal respiratory distress syndrome results from. a. a lack of positive airway pressure b. a lack of surfactant c. immature alveoli d. too much surfactant 24

25 31. Which of the following microorganisms causes whooping cough? a. Bordetella pertussis b. Corynebacterium diphtheriae c. Mycobacterium tuberculosis d. Streptococcus pyogenes 32. The treatment for a pleural effusion that removes excess fluid from the linings that surround the lung is called a/an. a. CPAP b. DTaP c. pneumothorax d. thoracentesis 33. For which of the following causes of pneumonia would antibiotics NOT be effective as a treatment for the primary microorganism? a. Cryptococcus neoformans b. Haemophilus influenzae c. Respiratory syncytial virus d. Streptococcus pneumoniae 34. Which of the following disorders are treated with anticoagulants? a. Pneumonia b. Pneumothorax c. Pulmonary embolism d. Pulmonary hypertension 35. Which one of the following viruses is responsible annually for the hospitalization of 75, ,000 children aged one year or less? a. Adenovirus b. Influenza C c. Respiratory syncytial virus d. Rhinovirus 36. Which one of the following is a TRUE statement about tuberculosis? a. People with latent TB can spread the disease. b. Schools are a high risk-setting. c. TB can spread from the lungs throughout the body. d. TB is minimally infectious. *End of Test* 25