Respiratory Introduction

Question 1

What do I need to know about the respiratory context?

Answer 1

• You need to know the basic anatomy and physiology of the respiratory system
• The differences in vulnerability to disease of the different areas of the respiratory
  system
• The different factors that can impact on the development of respiratory disease,
  noting the socioeconomic implications this may have on individual patients.

Question 2

How does breathing work?

Answer 2

The respiratory system reflects our natural world in its broad resemblance to a tree – the
branching bronchi descending into smaller bronchioles are in fact sometimes called the
bronchial tree.

Just as trees ‘inhale’ carbon dioxide and ‘exhale’ oxygen, so our respiratory system inhales oxygen and exhales carbon dioxide.

The system is divided into two main sections, or tracts – the upper respiratory
and lower respiratory.

What might be the differences in how pathological factors affect each tract? It is exposed to the outside world overall. It also need robust defensive measures.

Thinking point – what other part of human anatomy resembles a tree? Nerves for example.

Question 3

What are the respiratory system functions?

Answer 3

Fundamental functions of the respiratory system are:
* Pulmonary ventilation – in other words breathing in and out
* External respiration – the exchange of gases between the airways and the bloodstream
* Internal respiration – the exchange of gases between the blood and tissues and ultimately the exhalation of carbon dioxide
* Olfaction – the ability to smell - secondary functions are really important too in this system
* Creation of sound via air vibration over the vocal cords

What clinical tool is used to examine the function of the respiratory system? Breath strength test - spirometry. Also listening device - stethoscope
Thinking point – what respiratory conditions may affect the vocal cords?

Question 4

What makes up the Upper Respiratory Tract and Lower Respiratory Tract?

Answer 4

URT, the conducting zone: Key structures are nasal cavity, pharynx, larynx - which contain tough epithelium and mucus, with cilia
* Additional clinically relevant structures – paranasal sinuses, glottis and epiglottis - sunisitis and inflammation
* Most vulnerable to – environmental pathogens, changes in temperature and moisture

Consider how inflammation might affect the membranes of the URT – what signs and symptoms might you see? Swelling, red, colour, warmth

LRT, the respiratory system: The air passages in the lower respiratory tract branch to form increasingly smaller airways, from bronchi (still belong to the conducting zone really), to bronchioles, ultimately terminating in the alveoli where gas exchange occurs.

Vulnerable to things that pool and hang around as very thin membranes down here.

Thinking point – what respiratory condition causes bronchoconstriction?

Question 5

How can diet affect respiratory disease?

Answer 5

Beneficial:
Aiming to prevent oxidative stress and inflammation encourage healthy cell development and optimal airway function
* Vitamins A, C and E
* Beta carotene
* Selenium - Brazil nuts
* Magnesium
Key foods – dark green leafy and orange fruits and vegetables (apricots and carrots are useful here), seeds, wheatgerm, cold pressed oils

Detrimental:
Dietary factors which promote inflammation, allergenic foods if the patient has an atopic tendency or frank allergy, and overall poor diet leading to deficiency
* Zinc deficiency
* Iron deficiency
* Refined carbohydrates and sugars
Key foods to avoid – white bread, pasta and rice, sweets and cakes, fizzy drinks, undiluted fruit juice - wheat, dairy and/or egg in case of allergy

Question 6

How does the environment impact on lung health?

Answer 6

• Air pollution – car exhaust fumes, particulate from burning solid fuel (e.g. wood stoves) leads to hyperreactivity of airways and inflammation of respiratory membranes
• Workplace contaminants – asbestos, chemical exposure (e.g. farm workers), coal leads to asbestosis, mesothelioma, pneumoconiosis
• Damp and/or mouldy living spaces – for example exposure to Aspergillus mould leads to Aspergillosis; damp can trigger asthma and allergic responses such as rhinitis, and can increase predisposition to developing colds and flu.

Consider:
* What protective measures against unavoidable exposure can patients take? - stay away from hazard, wear masks
* Can you think of a protective herbal approach to minimise damage? Herbs that protect and build up the lungs - are mucus, cilia and immuneprotective.

Question 7

How does someone’s socioeconomic status impact on
respiratory health?

Answer 7

Thinking back to the previous slides and looking at different factors that can affect respiratory health, these can all be affected by the socioeconomic status of the patient.

Respiratory disease can be affected by:
* Exposure to pollutants in potentially unsafe workplaces
* Poor or inappropriate diet
* Damp or mouldy living conditions
* Exposure to air pollution near schools

Consider how different incomes, cultural factors and levels of education might affect these factors.

The holistic perspective – it can be especially challenging to advise a patient to
implement changes across their lifestyle; essential to balance the ideal with the
realistic; look for where the most therapeutic benefit can be achieved. Sometimes diet alone can be enough.