Respiratory System Pathologies 2 Flashcards
What is acute bronchitis?
An acute infection of the bronchial tree causing inflammation of medium and large-sized bronchi and trachea.
What are the key pathological effects of acute bronchitis?
• Bronchial mucosal irritation, hyperemia, and edema.
• Diminished bronchial mucociliary function.
• Airways blocked or clogged by debris.
• Increased mucus secretion leading to coughing.
What are common causes of acute bronchitis?
• Bacterial infection (most common).
• Viral infection.
• Allergic reactions.
• Exposure to toxins or pollutants.
• Smoking.
• Immunosuppression (young children, advanced age).
How long does acute bronchitis typically last?
Approximately 10 days; if bacterial, it can be effectively treated with antibiotics.
What can happen if inflammation extends into the bronchioles and alveoli?
Bronchopneumonia may result.
What are the long-term effects of recurrent acute bronchitis?
• Damage to mucosa and mucociliary elevator.
• Impairment of mucus and particle removal.
• Potential contribution to bronchial epithelial metaplasia (cancer).
What are the signs and symptoms of acute bronchitis?
• Productive intense cough with clear, yellow, green, or occasionally blood-tinged sputum.
• General malaise, extreme fatigue, muscle aches.
• Chest pain (severe cases, due to coughing).
• Dyspnea and cyanosis (if underlying COPD is present).
• Sore throat, stuffy nose, headache.
• Wheezing and use of accessory muscles (severe cases).
• Fever is rare; if present, flu or pneumonia is more likely.
What is COPD?
A term encompassing lung diseases associated with an abnormal reaction of the lungs to inhaled noxious particles/gases, leading to progressive, chronic, or recurrent airflow limitation.
What are the three main types of COPD?
• Emphysema
• Bronchiectasis
• Chronic Bronchitis
What are the key characteristics of COPD?
• Prolonged forced exhalations.
• Predominantly irreversible lung damage.
What are the primary causes of COPD?
• Cigarette smoking (most common; many patients are pack-a-day smokers for 20+ years).
• Secondhand smoke exposure.
• Potential relationship with air pollution and environmental factors.
Where do pathological changes in COPD primarily occur?
• Large airways.
• Small bronchioles.
• Lung parenchyma (in some cases).
What are the pathological features of COPD?
• Inflammation and edema of lung mucosa.
• Thickened basement membrane.
• Mucus gland hypertrophy.
• Goblet cell hyperplasia.
• Bronchial smooth muscle hypertrophy/constriction.
• Airway wall remodeling (chronic inflammation causes thickening of mucosa).
What is emphysema?
Emphysema is the destruction of alveolar walls and capillary beds supplying the alveoli, leading to abnormal, permanent enlargement of air spaces distal to the terminal bronchioles. This results in distention and expansion of alveoli into larger air sacs, making gas exchange inefficient.
What happens to lung elasticity in emphysema?
Damage to elastic fibers that hold airways open leads to loss of lung elastic recoil and impaired gas exchange.
Why do small airways collapse in emphysema?
Why do small airways collapse in emphysema?
How does emphysema affect lung compliance and recoil?
Lung compliance increases, meaning the lung becomes easier to distend, but recoil decreases, so airways empty slowly.
How does emphysema impact exhalation?
As the patient exhales, airways collapse before all the air is expelled, leading to chronic lung over-inflation.
How does emphysema affect the diaphragm?
Over-inflation of the lungs can impair diaphragm function, making it harder for the patient to expand an already over-expanded thorax.
What are bulla in emphysema?
Abnormal enlargements of air spaces distal to the terminal bronchioles.
What happens when bulla grow larger than 1 cm?
They can compress adjacent healthy lung tissue, further impairing ventilation and perfusion.
They can compress adjacent healthy lung tissue, further impairing ventilation and perfusion.
To reduce compression and prevent them from bursting, which could lead to pneumothorax.
What are the causes of emphysema?
• Smoking (primary and secondary)
• Genetic defects in the structure of the respiratory unit (small percentage)
• Repeated respiratory infections (especially chronic bronchitis)
• Atmospheric pollution
What are the two types of emphysema?
- Centriacinar (Centrilobular) and
- Panacinar (Panlobular)
Describe Centriacinar emphysema.
• Focal destruction of the respiratory bronchiole and central portions of the acinus.
• Associated with edema, inflammation, and thickening of the bronchiolar wall.
• Most common in upper lobes.
• Rare in non-smokers; almost exclusively seen in smokers.
• Begins at the alveolar duct.
Describe Panacinar emphysema.
• Destructive enlargement of the entire alveoli distal to the terminal bronchiole.
• Can occur throughout the entire lung, but more severe in the lower lung.
• Most commonly found in smokers, but also has a genetic correlation.
What are the key signs and symptoms of emphysema?
• Slow, insidious onset of dyspnea
• Tachypnea – rapid, shallow breathing
• Orthopnea – difficulty breathing except when upright
• Labored inhalation
• Forced exhalation due to loss of lung elastic recoil
• Hyperventilation in advanced stages to maintain normal blood oxygen levels
• Pursed-lip breathing with audible exhalation
• Prominent use of accessory respiratory muscles
• Pink Puffers – patients with advanced emphysema who hyperventilate to compensate for oxygen loss
How does emphysema affect musculoskeletal posture?
• Typical forward-seated posture (tripod position), hands on knees, shoulders elevated.
• Over-recruitment of accessory muscles of inspiration (linked to TOS, head-forward posture, headaches).
• Barrel chest due to lung hyper-inflation and flattened diaphragm.
• Thoracic hyperkyphosis and compression of abdominal contents (including liver in advanced stages).
• Compensatory lumbar and cervical hyperlordosis.
• Thoracic hypomobility, rib fixation, increased risk of osteoarthritis.
How does emphysema affect the cardiovascular system?
• Increased risk of hypertension and heart failure.
• Cor Pulmonale – right-side heart failure due to increased resistance in the lungs, forcing the right heart to work harder.
What emotional and psychological effects can emphysema have?
• Fear due to dyspnea and complications.
• Fatigue due to chronic hypoxia limiting activities of daily living (ADLs).
• Frustration, anger, and low self-esteem.
How does emphysema affect tissue health?
• Increased tissue fragility and poor healing.
• Nail bed changes.
• Severe emphysema may cause significant weight loss due to lack of energy to eat, leading to immune suppression and muscle atrophy.
What is pursed-lip breathing, and why is it beneficial?
A technique that prolongs exhalation, increasing back pressure in the airways to prevent airway collapse.
How do you perform pursed-lip breathing?
- Sit comfortably, relax shoulders and neck.
- Inhale through the nose for 1, 2.
- Pucker lips (as if blowing on a hot drink or about to whistle).
- Exhale and count 1, 2, 3, 4.
What is the definition of chronic bronchitis?
A chronic, persistent cough with sputum production for 3 months in at least 2 consecutive years, with other causes of cough excluded.
Where are the pathological changes of chronic bronchitis found?
In the bronchi and/or bronchioles.
What are the three types of chronic bronchitis?
- Simple chronic bronchitis – no airway obstruction
- Chronic asthmatic bronchitis – increased wheezing and hyperactive airway
- Obstructive chronic bronchitis – abnormal airflow
What are the key pathological changes in the airways in chronic bronchitis?
• Squamous metaplasia of bronchiolar epithelium
• Ciliary dysfunction & loss of ciliated cells
• Thickened bronchiolar mucosa
• Hyperplasia & hypertrophy of goblet cells and mucous glands
• Hyperplasia of airway smooth muscle
• Inflammation & disrupted mucociliary blanket
• Increased thick mucus secretion → airway narrowing & chronic cough
• Airway scarring → remodeling → thickening → airflow limitation (↑ resistance)
What are the causes of chronic bronchitis?
• Idiopathic (persistent inflammation of bronchial walls)
• Long-term smoking (10x increased incidence)
• Exposure to irritants/environmental pollution
• History of recurrent acute bronchitis
What are the signs and symptoms of chronic bronchitis?
• Thick, tenacious, purulent sputum
• Chronic cough
• Tachypnea (↑ respiratory rate; accessory muscle use)
• Worsens with concomitant infections
• Advanced stages: failure to maintain normal O2/CO2 → cyanosis
• ↓ QOL: withdrawal from activity → obesity
• Known as “Blue Bloaters”
What musculoskeletal changes are associated with chronic bronchitis?
• Overuse of accessory respiratory muscles → TOS, TrPs, FHP, headaches
• Barrel chest, ↑ thoracic hyperkyphosis
• Compensatory lumbar/cervical hyperlordosis
• Thoracic hypomobility (especially posterior/inferior) → OA risk
• Fatigue/weakness of diaphragm and accessory muscles → weak cough
What cardiovascular issues may develop with chronic bronchitis?
• ↑ risk of hypertension and heart failure (from ↑ resistance in lungs/pulmonary vessels)
• Chronic hypoxia from mucous → ↑ heart stress
• ↑ heart rate to meet O2 demands
• Sedentary lifestyle → rapid weight gain, diabetes, HBP
What self-care and exercises are helpful for chronic bronchitis?
• Facial steams with essential oils (e.g. Eucalyptus, Tea Tree, Chamomile, Thyme, Oregano)
• Deep coughing exercise:
- Hands on lower chest
- Deep breath
- Open mouth
- Exhale forcefully using abdominal muscles while saying “Ha Ha Ha”
What is bronchiectasis?
A chronic obstructive pulmonary disease involving abnormal, permanent dilation of medium-sized bronchi due to damage of their muscular and elastic walls.
What usually causes bronchiectasis?
Previous chronic necrotizing infection that weakens the bronchial walls → dilation.
How can bronchiectasis present?
• Focal (one lobe/segment)
• Diffuse (both lungs; common in systemic illnesses like cystic fibrosis)
What cycle contributes to bronchiectasis progression?
Vicious cycle of bronchial damage → dilation → recurrent infection
Describe how bronchiectasis develops.
• Mucosa becomes edematous & ulcerated
• Elastic tissue and smooth muscle damaged → dilation & scarring
• Hyperplasia of bronchiolar walls → non-ciliated mucus-secreting cells replace ciliated ones
• Loss of mucociliary blanket → retained mucus
• Dilated airways + pockets of stretched mucosa → infected secretion pooling
• Possible abscess formation
• Distal lung damage from persistent infection/pneumonia
• Pulmonary resistance ↑ → may lead to Cor Pulmonale
What are common causes of bronchiectasis?
• Post-infection (e.g., pneumonia, TB – most common worldwide cause)
• Childhood illness → permanent scarring
• Bacteria/viruses: S. aureus, TB, Mycoplasma, measles, pertussis, influenza, HSV, adenovirus
• Foreign body obstruction
• Smoking → chronic bronchitis/emphysema → bronchiectasis
• Inherited immunodeficiency (→ recurrent lung infections)
• HIV/AIDS → repeated infections → bronchial damage
• Autoimmune/inflammatory disorders:
• IBD, RA, Ankylosing spondylitis, SLE
What are the clinical symptoms of bronchiectasis?
• Chronic, violent, disabling mucoid cough (can last years)
• Dyspnea (80%), worse with comorbid illness
• Chronic sinusitis (30%)
During exacerbations:
• Purulent sputum with offensive odor
• Fever
• Hemoptysis (60%) from dilated vessels and damage
Additional:
• Difficulty breathing, fatigue, weakness, weight loss
• Pleuritic chest pain, crackles, wheezing
• Cor Pulmonale, peripheral edema, hepatomegaly, hypoxia, respiratory failure
What should massage therapists consider with bronchiectasis patients?
• Contraindicated if infection is present
Patients may be on:
• Antibiotics
• Bronchodilators, corticosteroids
• Oxygen therapy
• Dietary supplementation
• Recent or upcoming surgery
• Also likely receiving physical therapy
What type of cough is commonly seen in COPD, and when is it often worse?
A productive cough, often worse in the morning.
What type of breathing difficulty do COPD patients experience?
Dyspnea; the patient may be breathless after minimal exertion.
What causes wheezing and prolonged expiration in COPD?
Increased effort and the sound of air being forced through the narrowed lumens due to increased resistance.
What happens during acute exacerbations of COPD?
COPD can present with acute exacerbations that become more frequent and severe as the disease progresses.
What is a “barrel chest” in COPD?
It refers to hyper-inflated lungs and flattening of the diaphragm.
How does tachypnea relate to COPD severity?
It is proportional to disease severity; patients with severe disease can experience tachypnea and respiratory distress during simple activities like bending down or reaching up.
Why does fatigue occur in COPD?
Breathing takes more energy—inhale is difficult due to air trapping, and exhale is forced due to loss of lung elastic recoil and increased respiratory rate.
What signs may be seen in advanced COPD?
Cyanosis and pitted peripheral edema.
What muscular pattern is commonly overused in COPD?
The accessory muscles of respiration.
Name some systemic manifestations of COPD.
• Anemia
• Muscle weakness
• Osteoporosis
• Depression
• Pulmonary hypertension
• Cor pulmonale (enlargement and failure of the right ventricle due to increased pulmonary vascular resistance)
What are the key components of pulmonary rehab in COPD?
• Physical therapy and exercise for aerobic endurance and reduced dyspnea
• Breathing retraining (e.g., diaphragmatic breathing)
• Patient and family education to improve QOL and prevent symptoms
• Smoking cessation, the most important therapeutic intervention
What medications might a COPD patient use to help with dyspnea or exercise tolerance?
Bronchodilators:
• Short-acting (episodic use)
• Long-acting (taken regularly)
Beta-agonists: relax smooth muscle to relieve symptoms
Other drugs:
• Anticholinergics
• Anti-inflammatory drugs
• Mucolytic agents (reduce sputum viscosity)
• Antibiotics (due to common chronic infections)
What questions should you ask a COPD patient about their medications before treatment?
“Are you on any medications? Which ones and do you have them with you here (e.g., puffer)?”
What are some manual therapy treatment goals for a COPD patient?
• Maintain thoracic ROM, mobility, and joint health
• Normalize respiratory function by addressing compensatory structures
• Promote drainage of secretions via postural drainage and percussion/tapotement
• Promote general relaxation
What should you assess in terms of respiratory muscles in COPD?
Tone, length, and strength of respiratory muscles.
What positional modifications may be necessary for COPD patients during treatment?
Avoid positions that inhibit diaphragm function, such as prone or excessive pillowing.
What educational components can support a COPD patient’s self-care?
• Smoking cessation
• Diaphragmatic breathing techniques
• Deep coughing (to increase effectiveness of cough and clear secretions)
What kind of exercise modifications might be needed for COPD patients?
Modified therapeutic exercises that accommodate their respiratory limitations.
