The Respiratory System
Dr Enmei Liu
Division of Respiratory Disorders
Children’s Hospital
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemoptysis
? Chest pain
? Breathlessness
? Wheeze
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Origin Common causes Nature/characteristics
Pharynx Post-nasal drip Usually persistent
Larynx Laryngitis,tumor Harsh,barking
Trachea Tracheitis Painful
Bronchi Bronchitis Dry or productive
Asthma Dry or productive,Worse
at night
Pneumonia Dry initially,productive
later
Bronchiectasis Productive.Changes in
posture induce sputum
production
Cough
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemoptysis
? Chest pain
? Breathlessness
? Wheeze
Type Appearance Cause
Serous Clear,watery,frot
hy,may be pink
Acute pulmonary
oedema
Mucoid Clear,grey,white,Chronic
bronchitis,
Asthma
Purulent Yellow,green,
brown
All types of
bacterial
infection
Sputum
Rusty Rusty,golden
yellow
Pneumococcal
pneumonia
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemoptysis
? Chest pain
? Breathlessness
? Wheeze
Causes of Haemoptysis
Common Uncommon Others
Pulmonary*
infarction
Mitral stenosis Foreign body
inhalation
Bronchial
carcinoma*
Aspergilloma Chest trauma
Tuberculosis* Bronchial
adenoma
Latrogenic
Lung abscess Metastatic
pulmonary
Bronchoscopy
Transbronchial
biopsy
Acute bronchitis Malignant disease
Chronic bronchitis Laryngeal
tumours
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Disorders--Causes of Chest Pain
Pleural
?Pneumonia
?Pulmonary infarction
?TB
?Malignant disease
Chest wall
?Rib fractures
?Direct invasion of chest by tumour
?Spinal nerve root involvement
Retrosternal
Tracheitis
Mediastinal tumours
Oesophageal disorders
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Increased Work of Breathing
Airflow obstruction
?Bronchial Asthma
?Chronic bronchitis and emphysema
?Tracheal obstruction
Decreased pulmonary compliance
?Pulmonary oedema
?Pulmonary fibrosis
?Extrinsic allergic alveolitis
Restricted chest expansion
?Ankylosing spondylitis
?Respiratory muscle paralysis
?Kyphoscoliosis
Causes of Breathlessness
Physiological
?Exercise
?High altitude
Pathological
?Obesity
?Anaemia
?Respiratory disorders
?Cardiac disorders
Pharmacological
?Drug-induced respiratory disorders
?Drug-induced cardiac disorders
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Case Study
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.
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.
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).
Clinical Course
After several days of supportive
measures including
intravenous hydration and oxygen
She made an uneventful recovery.
Questions
This child probably has,
A,recurrent brochiolitis
B,bronchial asthma
C,asthmatic bronchitis
D,wheezy bronchitis
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
Answer this question true or false
The isolation of RSV helps distinguish
bronchiolitis from asthma.
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
The most useful therapeutic
Modalities for this child’s
immediate problem include
A,adequate hydration
B,humidified oxygen
C,antibiotics
D,bronchodilators
E,steroids
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
Summary
Bronchial Asthma
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
In 1994,17 countries in WHO
GINA
Global Initiative for Asthma
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.
What is Asthma?
A disease that:
? Is chronic
? Produces recurring episodes of
breathing problems
? Coughing
? Wheezing
? Chest tightness
? Shortness of breath
Environmental factors Genetic predisposition
Bronchial Inflammation
Bronchial
Hyperreactivity+trigger factors
Oedema
Bronchoconstriction
Mucus Production
Airways Narrowing
Symptoms
Upper respiratory tract
infection
Allergens
Exercise
Emotional upset
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)
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
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)
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
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
Investigation
?Eosinophil-eosinphilia
?Serum IgE
?Skin test
?Chest X-ray:hyperinflation
?Lung function:FEV1,peak expiratory
flow rate(PEFR with peak flow meter)
Differential Diagnosis
?Brochiolitis
?Inhaled foreign body
?Tuberculosis
?Congenital abnormality of lung,
airway or heat idiopathic
Causes of Recurrent Wheezing
?Aspiration (i.e.,gastroesophageal
reflux)
?Asthma
?Bronchiolitis
?Bronchopulmonary dysplasia
?Cardiac disease
?Cystic fibrosis
?Foreign-body aspiration
?Mediastinal masses
Is There A Cure For Asthma?
Asthma cannot be cured,
but it can be controlled.
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
Drugs in Asthma
Type of Drug Drug
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
How Is Asthma Controlled?
? Monitor response to treatment
? Symptoms
? Peak flow
? Get regular follow-up care
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
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
Dr Enmei Liu
Division of Respiratory Disorders
Children’s Hospital
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemoptysis
? Chest pain
? Breathlessness
? Wheeze
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Origin Common causes Nature/characteristics
Pharynx Post-nasal drip Usually persistent
Larynx Laryngitis,tumor Harsh,barking
Trachea Tracheitis Painful
Bronchi Bronchitis Dry or productive
Asthma Dry or productive,Worse
at night
Pneumonia Dry initially,productive
later
Bronchiectasis Productive.Changes in
posture induce sputum
production
Cough
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemoptysis
? Chest pain
? Breathlessness
? Wheeze
Type Appearance Cause
Serous Clear,watery,frot
hy,may be pink
Acute pulmonary
oedema
Mucoid Clear,grey,white,Chronic
bronchitis,
Asthma
Purulent Yellow,green,
brown
All types of
bacterial
infection
Sputum
Rusty Rusty,golden
yellow
Pneumococcal
pneumonia
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemoptysis
? Chest pain
? Breathlessness
? Wheeze
Causes of Haemoptysis
Common Uncommon Others
Pulmonary*
infarction
Mitral stenosis Foreign body
inhalation
Bronchial
carcinoma*
Aspergilloma Chest trauma
Tuberculosis* Bronchial
adenoma
Latrogenic
Lung abscess Metastatic
pulmonary
Bronchoscopy
Transbronchial
biopsy
Acute bronchitis Malignant disease
Chronic bronchitis Laryngeal
tumours
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Disorders--Causes of Chest Pain
Pleural
?Pneumonia
?Pulmonary infarction
?TB
?Malignant disease
Chest wall
?Rib fractures
?Direct invasion of chest by tumour
?Spinal nerve root involvement
Retrosternal
Tracheitis
Mediastinal tumours
Oesophageal disorders
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Increased Work of Breathing
Airflow obstruction
?Bronchial Asthma
?Chronic bronchitis and emphysema
?Tracheal obstruction
Decreased pulmonary compliance
?Pulmonary oedema
?Pulmonary fibrosis
?Extrinsic allergic alveolitis
Restricted chest expansion
?Ankylosing spondylitis
?Respiratory muscle paralysis
?Kyphoscoliosis
Causes of Breathlessness
Physiological
?Exercise
?High altitude
Pathological
?Obesity
?Anaemia
?Respiratory disorders
?Cardiac disorders
Pharmacological
?Drug-induced respiratory disorders
?Drug-induced cardiac disorders
Symptoms of Respiratory
Disease
? Cough
? Sputum
? Haemopysis
? Chest pain
? Breathlessness
? Wheeze
Case Study
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.
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.
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).
Clinical Course
After several days of supportive
measures including
intravenous hydration and oxygen
She made an uneventful recovery.
Questions
This child probably has,
A,recurrent brochiolitis
B,bronchial asthma
C,asthmatic bronchitis
D,wheezy bronchitis
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
Answer this question true or false
The isolation of RSV helps distinguish
bronchiolitis from asthma.
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
The most useful therapeutic
Modalities for this child’s
immediate problem include
A,adequate hydration
B,humidified oxygen
C,antibiotics
D,bronchodilators
E,steroids
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
Summary
Bronchial Asthma
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
In 1994,17 countries in WHO
GINA
Global Initiative for Asthma
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.
What is Asthma?
A disease that:
? Is chronic
? Produces recurring episodes of
breathing problems
? Coughing
? Wheezing
? Chest tightness
? Shortness of breath
Environmental factors Genetic predisposition
Bronchial Inflammation
Bronchial
Hyperreactivity+trigger factors
Oedema
Bronchoconstriction
Mucus Production
Airways Narrowing
Symptoms
Upper respiratory tract
infection
Allergens
Exercise
Emotional upset
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)
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
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)
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
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
Investigation
?Eosinophil-eosinphilia
?Serum IgE
?Skin test
?Chest X-ray:hyperinflation
?Lung function:FEV1,peak expiratory
flow rate(PEFR with peak flow meter)
Differential Diagnosis
?Brochiolitis
?Inhaled foreign body
?Tuberculosis
?Congenital abnormality of lung,
airway or heat idiopathic
Causes of Recurrent Wheezing
?Aspiration (i.e.,gastroesophageal
reflux)
?Asthma
?Bronchiolitis
?Bronchopulmonary dysplasia
?Cardiac disease
?Cystic fibrosis
?Foreign-body aspiration
?Mediastinal masses
Is There A Cure For Asthma?
Asthma cannot be cured,
but it can be controlled.
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
Drugs in Asthma
Type of Drug Drug
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
How Is Asthma Controlled?
? Monitor response to treatment
? Symptoms
? Peak flow
? Get regular follow-up care
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
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
