RESPIRATORY DISEASES

TABLE OF CONTENTS
 (click on the links below to view more details)

bullet   PART I - Author’s Comments

bullet   PART II - Learning Objectives

bullet   PART III - Assigned Readings

bullet   PART IV - Content Outline

bullet   PART V - Instructional Content
                Unit 1 - Introduction
                Unit 2 - Chronic Obstructive Pulmonary Disease
                              Chronic Bronchitis
                              Pulmonary Emphysema
                              Bronchiectasis
                              Asthma
                              Small Airway Disease
                              Cor Pulmonale
                              Cystic Fibrosis
                Unit 3 - Restrictive Pulmonary Disease
                              Interstitial Pneumonia
                              Pnuemoconioses
                              Sarcoidosis
                              Thoracoskeletal Diseases
                              Neuromuscular Disorders
                              Pickwickian Syndrome
                              Pneumothoriax
                              Pleural Effusion
                              Adult Respiratory Distress Syndrome (A.R.D.S)
                              Pulmonary Edema
                Unit 4 - Infectious Pulmonary Disease
                              Pneumonia
                              Pulmonary Fungal Infection
                              Pulmonary Tuberculosis
                Unit 5 - Pulmonary Embolic Disease
                Unit 6 - Pulmonary Pathology Due to Trauma Burns/Smoke                               Inhalation
                              Penetrating Chest Wounds
                              Flail Chest/ Rib Fractures
                              Gastric Aspiration
                              Near- Drowning
                              Hypothermia
                              Bibliography

bullet   PART VI - Clinical Procedures

bullet   PART VII - Case Studies

bullet   PART VIII- Glossary

bullet   PART IX- Post Test

bullet   RESPIRATORY DISEASES

Part I. AUTHOR’S COMMENTS

Chronic respiratory disease has emerged as a major nationwide health problem. Chronic obstructive pulmonary diseases have increased to epidemic proportions and are currently significant causes of morbidity and mortality in this country. These conditions have revolutionized the practice of pulmonary medicine and have promoted the emergence of the allied health specialties, such as respiratory therapy and pulmonary nursing.

There has also developed increasing recognition of the dangers of occupational lung diseases and much has been done to prevent them and promote early diagnosis. Despite these new developments, tuberculosis remains a significant worldwide health problem. Many advances, however, have made treatment much easier (more available drugs and shorter treatment programs).

Lung disease is not restricted to any age group. Each year tens of thousands of children under the age of five die from various pulmonary causes and even more adult deaths occur annually due to chronic lung disease.

As is true in many other organ diseases, prevention and early diagnosis are the keys to ultimate control and cure. Respiratory therapists can play a very important role in assisting physicians in gathering clues in the clinical history, examination and physiologic measurements that may lead to early detection and treatment. To accomplish this end, respiratory therapists must learn about lung disease. Learning involves not only reading and studying didactic information, but devoting time to clinical rounds with a teacher well versed in the spectrum of lung disease.

bullet   RESPIRATORY DISEASES

PART II. LEARNING OBJECTIVES

Upon completion of this module, the student will:
1.Differentiate between the various chronic obstructive pulmonary    diseases.
2.Differentiate between the various restrictive pulmonary diseases.
3.Describe the pathophysiology of the infectious respiratory disease    processes.
4.Discuss the pathophysiology of pulmonary embolic disease.
5.Summarize the effects of pulmonary pathology due to trauma.

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PART III. ASSIGNED READING

As there are no clinical procedures to perform for this module, the student is expected to spend more time on assigned readings. Because of the wide array of disease states the therapist encounters, familiarity obtained by these readings will aid in proper diagnosis and treatment.

For your own benefit, we highly recommend reviewing the supplemental reading, however it is not required.

Burton and Hodgkin, Respiratory Care - A Guide to Clinical Practice. Philadelphia: J.B. Lippincott Company.

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PART IV. CONTENT OUTLINE

Unit 1. Introduction

Unit 2. Chronic Obstructive Pulmonary Disease:
            Chronic Bronchitis
            Pulmonary Emphysema
            Bronchiectasis
            Asthma
            Small Airways Disease
            Cor Pulmonale
            Cystic Fibrosis

Unit 3. Restrictive Pulmonary Disease:
            Interstitial Pneumonia
            Pneumoconiosis
            Sarcoidosis
            Thoracoskeletal Disease of the Chest Wall
            Neuromuscular Disorders
            Pickwickian Syndrome
            Pneumothorax
            Pleural Effusion
            ARDS
            Pulmonary Edema

Unit 4. Infectious Pulmonary Disease:
            Pneumonia
            Pulmonary Fungal Infection
            Pulmonary Tuberculosis

Unit 5. Pulmonary Embolic Disease

Unit 6. Pulmonary Pathology Due to Trauma:
            Burns/Smoke Inhalation
            Penetrating Chest Wounds
            Flail Chest/Rib Fractures
            Gastric Aspiration
            Near Drowning
            Hypothermia

bullet   RESPIRATORY DISEASES

PART V. INSTRUCTIONAL CONTENT

Unit 1. Introduction:

To cover the entire topic of pulmonary diseases in a single module is a difficult if not impossible task. In order to provide the respiratory therapy student with a sound general concept of the pathophysiology of the majority of pulmonary disease, this module has been broken down into several major categories:
      1. Chronic obstructive pulmonary disease
      2. Restrictive pulmonary disease
      3. Infectious pulmonary disease
      4. Pulmonary embolic disease
      5. Pulmonary pathology due to trauma

Before beginning the discussion of the individual diseases, it is important for the student to be able to differentiate between obstructive and restrictive disease and acute and chronic disease states. Obstructive pulmonary disease is generally defined as a state in which there is an obstruction to expiratory air flow. This disorder can be determined by simple spirometry. On the other hand, restrictive pulmonary disease is defined as disease processes in which there is a restriction to inspiratory air flow. Both obstructive and restrictive diseases can occur acutely and chronically.

Acute pulmonary disease is defined as one in which the onset of symptoms is rapid and severe. An acute disease usually will follow a shorter course than chronic disease states. Chronic disease is defined as any disease with a long, drawn-out course. Acute and chronic are antonyms.

Each adult pulmonary disease will be further discussed according to certain major characteristics. The following terms will be used in the discussion:

1. Etiology: The cause of the disease.
2. Incidence: The frequency of occurrence of the disease in relation to      the population.
3. Pathogenesis: The origin and development of the disease.
4. Pathology: The conditions produced by the disease.
5. Clinical Manifestations: Those manifestations which can be clinically      observed by actual patient observation.
6. Radiographic Examination: Data obtained by x-ray.
7. Sputum Examination: Data obtained from sputum collection.
8. Laboratory Findings: Data obtained from laboratory tests.
9. Pulmonary Function Studies: Data obtained from PFT’s.
10. Diagnosis: Establishing the name of the disease by evaluation of the        above data.
11. Management: How the disease is treated.
12. Disease Course: The progression of the disease.
13. Prognosis: Prediction of the final outcome of the disease.

An attempt will be made to cover each of these aspects of the individual pulmonary diseases. A great deal of additional information may be obtained from the resource readings and it will be most important for the student to study these sources to obtain in-depth knowledge of pulmonary pathology.

Unit 2. Chronic Obstructive Pulmonary Disease:

Chronic obstructive pulmonary disease (COPD) is a title given to a number of disease entities that are all similar and often difficult to distinguish from one another. This is due in part to the fact that they often overlap; the patient may well have more than one of the disease entities.

Generally, COPD includes chronic bronchitis, pulmonary emphysema and asthma. Closely associated with these diseases are bronchiectasis, cystic fibrosis, bronchiolitis and small airway disease. Bronchiolitis and cystic fibrosis are predominantly pediatric disorders and should be covered at length in a pediatric module.

The chronic obstructive pulmonary diseases have much in common. They tend to be chronic illnesses and exhibit an obstructive component in pulmonary function studies. Because of these similarities, treatment is often much the same for each of the COPD states.

Chronic Bronchitis:

Chronic bronchitis is best defined as a chronic productive cough for at least three months of the year for two successive years. The patient with “asthmatic bronchitis” suffers from chronic bronchitis accompanied by frequent bouts of bronchospasm.

Incidence
Chronic bronchitis is found in 10 to 20% of the adult population. It is more common in men than women (a 10:1 ratio).

Etiology
The key factor in the etiology of chronic bronchitis is cigarette smoking. There is also an increased incidence of the disease in areas associated with air pollution. Infection can cause exacerbation of the bronchitis into an acute state. Anything causing prolonged irritation of the bronchial mucosa can cause chronic bronchitis.

Pathology and Pathogenesis
The primary pathological feature of chronic bronchitis is inflammation of the airways. This inflammation leads to hypertrophy of the bronchial mucosal glands and an increase in the number of goblet cells. Increased amounts of mucus are produced. The bronchial mucosa becomes edematous.

The increased mucus production, mucus gland hypertrophy and edematous tissues cause increased airway resistance. This is the cause of the obstructive component of chronic bronchitis.

The above changes are accompanied by mucociliary impairment and some actual loss of cilia. Phagocytic activity is decreased by the increase in mucus production and decreased mucus infection.

Often, chronic bronchitis is accompanied by vascular changes due to the hypoxia that it causes. Pulmonary hypertension and an increase in pulmonary vascular resistance ma