Respiratory System:

Diseases and Disorders

Y OUR RESPIRATORY SYSTEM functions

without you even thinking about it.
You breathe in and out all day long
without a care: it’s effortless. However
there are times when breathing can
become difficult due to a disease or a
medical condition. This unit explores
common disorders and diseases of the
respiratory system.

Objective:

þ Describe diseases and disorders of the lungs and upper respiratory system.

Key Terms:

Ñ alveoli
anorexia
dyspnea
emphysema
pneumonia
pulse oximetry
aspiration hemoptysis radiation therapy
asthma laryngitis respiratory system
atelectasis lobar pneumonia rhinitis
bronchoscopy lobes sinusitis
chest x-ray (CXR) lobectomy spirometry
chronic disease lung cancer sputum
chronic bronchitis lungs tachypnea
chronic obstructive malignancy thoracentesis
pulmonary disease mediastinum upper respiratory
(COPD) metastasized infection (URI)
common cold nosocomial pneumonia wheezing
cryoablation orthopnea
cyanosis pneumonectomy

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 Diseases and Disorders:
Lungs and Upper Respiratory System
The respiratory system is a set of organs and accessory structures that allow the body to
bring oxygen in and then exchange the oxygen for carbon dioxide. Oxygen is carried through-
out the body and carbon dioxide
is released from the body. The
lungs are a pair of organs in the
chest that supply the body with
oxygen and remove carbon diox-
ide from the body. Lungs sit on
each side of the chest and are sep-
arated by the mediastinum. The
mediastinum is the area
between the lungs in the center of
the chest. The organs in this area
include the heart, the trachea, the
esophagus, the thymus, and
lymph nodes. Lungs are cone-
shaped and are made of spongy
tissue. The apex is the narrow top
FIGURE 1. This image depicts the airways within the respiratory system.
portion of the lung. The base is Diseases and disorders of the lungs include COPD, pneumonia, asthma, and
the wide bottom of the lung. cancer. Diseases and disorders of the upper respiratory system include
rhinitis, sinusitis, laryngitis, and the common cold.
Lobes are the sections of the
lung.

DISEASES AND DISORDERS OF THE LUNGS

COPD
Chronic obstructive pulmonary disease (COPD) is a persistent lung disease that
includes bronchitis, emphysema, or both. COPD occurs when there is persistent airflow
obstruction through the bronchial tubes and lungs. A chronic disease is a condition that
lasts one year or more, gradual in onset, and requires ongoing medical attention. There are two
main types of COPD: emphysema and chronic bronchitis. Both can be caused by smoking or
by exposure to irritating gases.

t TYPES, CAUSES, AND RISKS:

• Emphysema is a condition in which the alveoli lose their elastic property. Alveoli are
tiny air sacs in the lungs that resemble grape clusters located at the end of the bronchi-
oles. It is within the alveoli that oxygen is exchanged for carbon dioxide. In emphysema

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 FIGURE 2. COPD is a persistent lung disease that includes bronchitis, emphysema, or both. COPD occurs when
there is persistent airflow obstruction through the bronchial tubes and lungs. Both are caused by smoking or by
exposure to irritating gases.

the alveoli sacs do not deflate with expiration. This leads to the inability of the person
to fully exhale the carbon dioxide in the lungs. Causes and risks include:
– Causes of emphysema include smoking. (There is a strong link between smoking and
emphysema.) Constant over inflation of the lungs causes the ribs to remain slightly
expanded leaving the person with a barrel-like appearance to the chest. (Because the
alveolar sacs do not deflate, air remains in the lungs.)
– Risks when emphysema is diagnosed include increased respiratory infections and
heart disease. A person with emphysema may exhibit tachypnea (fast breathing
above the rate of 20 breaths per minute). The person may also have a cough, espe-
cially in the morning. There is a strong link between smoking and the development
of emphysema.
– Chronic bronchitis is the long-term irritation of the bronchial tubes leading into
the lungs. The bronchial tubes are responsible for carrying the air to and from the
alveoli. Cause and risk of chronic bronchitis is:
– Cause is a narrowing of the tubes due to irritation or inflammation.
– Risk is that the lungs produce mucous which may block these narrowed airway pas-
sages.

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 t SIGNS AND SYMPTOMS:
• Dyspnea is difficulty breathing, especially with exertion.
• Chronic persistent cough.
• Productive cough of mucous. Mucous may be clear, white, yellow, or green.
• Cyanosis is a blue tinge around the lips and in the fingernail beds.
• Lack of energy or fatigue.
• Chest tightness.
• Swelling in feet and ankles.
t DIAGNOSIS: To diagnose COPD, a health care practitioner takes a detailed history of
the person’s symptoms and performs a physical examination. Then, lung (pulmonary)
function tests determine how much air is being inhaled and exhaled and also measures
the amount of oxygen in the blood stream. Diagnostic tests include:
• Spirometry is a common pulmonary function test in which a person exhales into a
tube connected to an instrument that measures the air capacity of the lungs: a
spirometer. The lung volume is measured, as well as how fast the air was blown out of
the lungs.
• Pulse oximetry is a measure of the percentage of oxygen concentration in the blood
stream. A small probe is placed on a fingertip or earlobe to measure the percentage of
oxygen in the blood stream.
• Chest x-rays help to diagnose emphysema.
• Computerized tomography (CT) of the lungs may help to diagnose emphysema. A CT
scan produces computer generated cross-sectional images of the organs for diagnosis.
t TREATMENT: COPD treatments are determined by the symptoms and the diagnostic
results of performed tests. It’s recommended that a person with COPD or other respira-
tory infections:
• Quit smoking. This is the most important treatment for COPD (if the person is a
smoker).
• Remove them self from exposure to irritating materials at work. Irritating materials
negatively affect lung function.
• Receive medication from a healthcare provider for any respiratory infection.
• Use bronchodilators (in the form of inhalers) to relax the bronchial tubes. Inhaled ste-
roids may also be used to decrease inflammation.
• Increase the blood oxygen content via oxygen therapy.
• Follow exercise, nutrition, and lifestyle changes to enhance respiratory function.
• Elevate the head and torso to make it easier to breathe. [NOTE: Orthopnea (ortho-
meaning straight and -pnea meaning breathing) is a condition that makes breathing dif-
ficult when lying down. It occurs in many disorders of the respiratory and cardiac sys-
tems.]

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 Pneumonia
Pneumonia is an acute infection or inflammation of the alveoli in one or both lungs
caused by viruses or bacteria. The alveoli fill with pus or fluid and become solid and may col-
lapse. The collapse is called atelectasis: commonly called a collapsed lung.

t TYPES, CAUSES, AND LOCATIONS:

• Community-acquired pneumonia is the most common type of pneumonia and is
caused by viruses and bacterial infections. This type of pneumonia spreads by an
infected person coughing and spreading droplets that contain the bacteria or virus to
others.
• Lobar pneumonia is acute pneumonia that involves the entire lobe of a lung. Lobes
are the sections of the lung: the right lung has 3 lobes and the left lung has 2 lobes.
• Aspiration is inhaling
something into the lungs
other than air: often water,
vomit, or food. Aspiration
pneumonia is an infection
that develops when a per-
son inhales foreign mate-
rial. This is a concern for
people who have difficulty
swallowing and for those
who are elderly or have
dementia.
• Nosocomial pneumo-
nia is a hospital-acquired
disease picked up during a
hospital stay or visit to a
physician office or clinic.
The person may have been
admitted to the hospital
for an unrelated injury or FIGURE 3. This chest x-ray belongs to a patient who has pneumonia on the
disease and acquired pneu- right side. The location is marked with a red arrow. The pneumonia is in the
right lower lobe of the lung.
monia during the stay.
t SIGNS AND SYMPTOMS:
• Fever, sweating or shaking, and chills (when an infection is present).
• Dyspnea or shortness of breath.
• Cough, which may be productive.
• Chest pain with coughing or exertion.
• Confusion or a lower than normal body temperature due to a poor immune system
(symptomatic with some older adults).
t DIAGNOSIS:
• A health history noting any complaints of the above signs and symptoms.

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 • Use of a stethoscope to listen for crackling, rumbling, or other abnormal sounds when
breathing.
• A chest x-ray obtained and reviewed by the radiologist. A chest x-ray (CXR) is a pro-
cedure that uses a small amount of radiation to produce an image for evaluation of the
organs and structures in the chest.
• A pulse oximetry test. (Pneumonia can prevent the lungs from supplying the body with
sufficient oxygen.)
• Collection of a sputum (mucus from the lungs) sample. To collect the sample, the
patient performs a deep cough. The sputum is then examined for bacteria or other
abnormal cells.
• A bronchoscopy is a surgical procedure in which the airways of the lungs are exam-
ined by passing a tube through the mouth and into the lungs. A bronchoscopy may be
performed if further diagnosis or a biopsy is needed from the lungs.
t TREATMENT: Pneumonia treatment focuses on eliminating the cause and rehabilitat-
ing the person back to good respiratory health. Treatments include:
• Drinking plenty of fluids to help “mobilize” the mucus making it easier to cough it out.

FURTHER EXPLORATION…
ONLINE CONNECTION:
E-Cigarettes: Know the Risks
E-cigarettes, or vaping, is becoming very popular
among young people, as well as those who are
attempting to quit tobacco smoking. E-cigarettes
are made in a wide variety of flavors, which may
make it appear more like a ‘harmless’ activity. As
an activity or as an alternative to cigarette smok-
ing, studies are reporting that vaping does have an
effect on the body.
As with anything you do, it is essential that you
understand the risks and the benefits of what you
are considering. This is especially important when
your health may be at risk.
Learn more about the use of e-cigarettes and
the effects they have not only on your respiratory
system but on other body systems as well on the
U.S. Surgeon General’s website at [Link]
[Link]/[Link]
and on the Center on Addiction website at
(Image courtesy Wikipedia at
[Link] [Link]
about-e-cigarettes/10-surprising-facts-about-e- File:Adverse_effects_of_vaping_(raster).png)
cigarettes.

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 • Taking medications to reduce fever and fight infection as directed by the physician.
• Resting. Resting is key as rest allows the lungs to heal.
• Using cough suppressants under the direction of the physician. Coughing is the body’s
“plan” for clearing the airways.

Asthma
Asthma is a chronic inflam-
mation disease of the airways
leading to the lungs. A person
having an asthma attack has dif-
ficulty-moving air in and out of
the lungs. The disease seems to
run in families or be genetic and
can begin at any age. With
proper treatment, the person can
live a healthy life. There is no
cure for asthma however it can
be treated. Asthma is caused by
various triggers which make the
airways constrict or narrow.
Asthma is no longer considered FIGURE 4. You see a healthy bronchial tube on the left and a constricted
a single disease. It is treated bronchial tube on the right that represents an asthma flare up.
based on the identified trigger.

t COMMON ASTHMA TRIGGERS:

• Cold weather.
• Exercise.
• Allergens, including animals, mold, dust, food, or smoke.
• Medications, such as aspirin, can induce asthma.
t SIGNS AND SYMPTOMS: The following indicators are likely to bring a person to the
doctor for a diagnosis.
• Chest tightness, especially during cold weather or exercise.
• Difficulty breathing or shortness of breath. The person may feel as if they are unable to
get enough air into their lungs.
• Wheezing is a high-pitched whistling sound as one takes a deep breath.
• Frequent cough, especially at night.
• Tachypnea (rapid breathing).
t DIAGNOSIS: Asthma diagnostics are conducted by a health professional and may
include:
• A complete health history including symptom occurrences and triggers.
• Listen to the air exchange within the lungs with a stethoscope.

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 • Spirometry testing to measure the amount and the rate at which air is moved out of the
lungs.
• Allergy testing to eliminate or confirm asthma flare-up triggers.
t TREATMENT: The treatment of asthma depends upon the trigger and controlling that
trigger. Asthma treatment focuses on living a normal life with asthma. Once the trigger is
identified, health professionals assist the patient and family in creating an asthma treat-
ment plan to help limit flare-ups. Asthma treatments may include:
• Avoidance of the triggers.
• Quick relief medication used during a flare-up. This medication is likely given through
an inhaler and taken as soon as symptoms worsen. Inhaled medications help relax the
airways so breathing becomes easier.
• Long-term medication taken daily. These medications are often steroids taken daily
regardless of how well the person feels.

Lung Cancer
Lung cancer is a malignant disease that begins in the lungs. A malignancy is a condition
dangerous to health: a term often used interchangeably with the term ‘cancer.’

t RELATED FACTORS AND RISKS: Although the cause of lung cancer is unclear, there
are several factors that may increase the risk of developing lung cancer. For example:
• Smoking increases the risk
for lung cancer although the
risk does decrease when the
person stops smoking.
• Being elderly.
• A family history of lung can-
cer.
• Exposure to chemicals, such
as asbestos, either at work or
in the home.
t SIGNS AND SYMPTOMS:
Typically, there are no early
signs or symptoms of lung can-
cer. However, the following
occurrences should be reported
to the doctor:
• A cough that does not go
away and worsens over time
• Hemoptysis is spitting up
or coughing up blood.
FIGURE 5. Lung cancer is a malignant disease that begins in the lungs. This PET
• Anorexia is the loss of scan film of lung cancer is from different body angles. The cancerous tumor
appetite. absorbs the radiation and shows up brighter than the surrounding tissue.

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 • Pain in the chest or side that does not go away.
• Shortness of breath or wheezing.
• Tiredness or fatigue.
t DIAGNOSIS: The diagnosis of lung cancer begins with the health professional and may
include several steps. For example, a health professional would:
• Take a comprehensive health history and perform a physical examination.
• Order radiological or imaging tests to provide pictures of the lungs. There are several
types of imaging tests used in the diagnosis of lung cancer.
– A computerized tomography (CT) scan.
– A positron emission tomography (PET) scan uses radioactive tracers that are
absorbed by the cancer cells. Then, a special camera takes a picture of the areas of
radioactive uptake by the cancer cells.
• Obtain and examine a sputum specimen microscopically for the presence of cancer
cells.
• Conduct a bronchoscopy to get direct visual examination of the internal structures of
the respiratory system.
• Perform a thoracentesis when fluid is found around the lungs. Thoracentesis is a
surgical procedure in which a needle is inserted between two ribs to extract any fluid.
Then, the fluid is examined for cancer cells.
t TREATMENT: Lung cancer treatment options include surgical and non-surgical tech-
niques.
• Lobectomy is the surgical removal of the affected lobe of the lung. This procedure
leaves the person with a partial lung.
• Pneumonectomy is the surgical removal of an entire lung. This procedure leaves the
person with one lung.
• Cryoablation is a non-surgical treatment in which a needle inserted into the tumor
injects a cold gas to freeze the cancer cells.
• Radiation therapy is a non-surgical treatment using high-power energy beams to
destroy the cancer cells. The therapy can be used for lung tumors as well as cancer cells
that may have metastasized (spread) to other body parts, such as to the brain or to
bones.

DISEASES AND DISORDERS OF

THE UPPER RESPIRATORY SYSTEM
An upper respiratory infection (URI) is a disease of the nose, sinuses, larynx, or throat:
the structures of the upper respiratory system. A URI is commonly called a cold. The com-
mon cold is a contagious viral infection of the upper respiratory tract transmitted by airborne
droplets or by direct contact with infected secretions.

t SYMPTOMS: Symptoms of a URI depend upon the structure that is inflamed or

infected. General symptoms include cough, sore throat, sneezing, and runny nose.

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 FIGURE 6. This image depicts healthy and inflamed sinuses.

• Rhinitis is drainage through the nose (a runny nose). The drainage is normally clear
and thin. A physician should be contacted if the drainage becomes thick or colored
(green or yellow).
• Sinusitis is an inflammation of the facial sinuses. The symptoms may include fullness
in the face and pain or tenderness below the eyes. A person could also experience
increased nasal drainage and fever.
• Laryngitis is inflammation of the larynx that results in hoarseness or loss of voice and
a sore throat. (The larynx is an upper respiratory system structure commonly known as
the voice box.)
t DIAGNOSIS: Diagnosis of an URI includes a comprehensive physical examination that
considers the patient’s history and symptoms. A sample of nasal drainage or a throat swab
may be obtained and submitted for laboratory when there is a question of bacterial infec-
tion.
t TREATMENT: URI treatment depends upon the physical findings.
• Fluids are encouraged to thin the drainage thin and to keep it flowing.
• Medications may be ordered for pain or fever relief.
• Rest is encouraged to allow the body to heal.

Summary:

2 Your respiratory system provides vital oxygen to cells and removes carbon dioxide
as a waste product. When the respiratory system becomes compromised by disease
or illness it affects daily life. Suddenly, we become very aware of our breaths and
any struggles that occur with those breaths. Respiratory diseases and disorders can
happen to anyone at any age. Keeping your respiratory system healthy and recogniz-
ing any change in breathing is very important to your wellbeing.

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 Checking Your Knowledge:

´ 1. Differentiate the COPD disorders.

2. Explain the importance of a complete health history and physical examination
to respiratory health.
3. Compare lung cancer treatments including the benefits of one treatment over
another.
4. Play the “Respiratory Disorder Quizlet” at [Link]
Report your score.
5. List the respiratory system structures are impacted by lung and upper respira-
tory diseases and disorders.

Expanding Your Knowledge:

L We have all had a respiratory disease at one time. With care, some of the respiratory
diseases and disorders may be prevented or controlled. Research how infectious
respiratory diseases are spread and how chronic diseases can be controlled. Design a
respiratory health awareness poster to share with your school that includes preven-
tion of respiratory diseases and the care of the disease. Begin your research with the
Web Links resources.

Web Links:

: Lung Cancer
[Link]
syc-20374620

Pulmonary Rehabilitation
[Link]

Smoking and Respiratory Diseases

[Link]
fs_smoking_respiratory_508.pdf

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