Respiratory Disorders
Obstructive Airway Disease
Alternate Names: Obstructive Airway Disease, Chronic Obstructive Lung Disease, COPD
Definition
A group of lung diseases characterized by limited airflow with varying degrees of air sack enlargement and lung tissue destruction. Emphysema, Chronic Bronchitis and Asthma are by far the commonest of the obstructive pulmonary diseases.
Emphysema
Emphysema is a lung disease that involves damage to the air sacs (alveoli). The air sacs are unable to completely deflate (hyperinflation) and are therefore unable to fill with fresh air to ensure adequate oxygen supply to the body.
Cigarette smoking is the most common cause of emphysema. Tobacco smoke and other pollutants are thought to cause the release of chemicals from within the lungs that damage the walls of the air sacs. This damage becomes worse over time, affecting the exchange of oxygen and carbon dioxide in the lungs.
Signs and Symptoms
- Usually thin
- Tachycardia
- Tachypnoea
- Dyspnoea
- Use of accessory muscles
- Pursed Lips on expiration
- Barrel chested
- Possible evidence of oedema
Bronchitis
Chronic bronchitis is an inflammation of the bronchi, the main air passages in the lungs, which persists for a long period or repeatedly recurs.
The condition is characterized by excessive bronchial mucus and a productive cough that produces sputum for three months or more in at least two consecutive years, without any other disease that could account for this symptom.
Signs and Symptoms
- Productive cough
- Usually cyanotic
- Tachycardia
- Tachypnoea
- Dyspnoea
- Rhonchi and wheezing
- Use of accessory muscles
- Oedema of legs and ankles
Asthma
Asthma is an inflammatory disorder of the airways, characterized by periodic attacks of wheezing, shortness of breath, chest tightness, and coughing.
Asthma is a disease in which inflammation of the airways causes airflow into and out of the lungs to be restricted. When an asthma attack occurs, the muscles of the bronchial tree become tight and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound. Mucus production is increased.
In sensitive individuals, asthma symptoms can be triggered by inhaled allergens (allergy triggers), such as pet hair, dust mites, moulds, or pollens. Asthma symptoms can also be triggered by respiratory infections, exercise, cold air, tobacco smoke and other pollutants, stress, food, or drug allergies. Aspirin and other non-steroidal anti-inflammatory medications (NSAIDS) provoke asthma in some patients.Signs and Symptoms
- Wheezing
- Usually begins suddenly
- Is episodic
- May be worse at night or in early morning
- Aggravated by exposure to cold air
- Aggravated by exercise
- Aggravated by heartburn (reflux)
- Resolves spontaneously
- Relieved by bronchodilators (drugs that open the airways)
- Cough with or without sputum (phlegm) production
- Shortness of breath that is aggravated by exercise
- Breathing that requires increased work
- Intercostal retractions (pulling of the skin between the ribs when breathing)
Emergency symptoms:
- Extreme difficulty breathing
- Bluish colour to the lips and face
- Severe anxiety
- Rapid pulse
- Sweating
- Decreased level of consciousness (severe drowsiness or confusion) during an asthma attack
Further Respiratory Conditions
Pneumonia
Pneumonia is an inflammation of the lungs caused by an infection. Many different organisms can cause it, including bacteria, viruses, and fungi.
Pneumonia is a common illness that affects millions of people each year
Pneumonia can range from very mild to very severe, even fatal. The severity depends on the type of organism causing pneumonia as well as your age and underlying health.
Signs and Symptoms
- Cough with greenish or yellow mucus; bloody sputum happens on occasion
- Fever with shaking chills
- Sharp or stabbing chest pain worsened by deep breathing or coughing
- Rapid, shallow breathing
- Shortness of breath
Pulmonary Embolism
Pulmonary emboli are caused by clots from the venous circulation, from the right side of the heart. Most are caused from clots originating in the lower extremities called deep vein thrombosis (DVT). The risk factors include prolonged bed rest or inactivity, oral contraceptive use, surgery and fractures of the hips or femur.
Signs and Symptoms
- Cough:
-
- begins suddenly
- may produce bloody sputum (significant amounts of visible blood or lightly blood streaked sputum)
- Sudden onset of shortness of breath at rest or with exertion
- Splinting of ribs with breathing (e.g., bending over or holding the chest)
- Light-headedness
- Fainting
- Dizziness
- Chest pain:
-
- under the breastbone or on one side
- sharp, stabbing, burning, aching or dull, heavy sensation
- may be worse at night
- may radiate to the shoulder, arm, neck, jaw, or other area
- may be worsened by breathing deeply, coughing, eating, bending, or stooping
- Sweating
- Anxiety
- Breathing, rapid
- Rapid heart rate (tachycardia)
*The signs and symptoms above are very similar to a patient who is having an acute myocardial infarct (AMI) but getting a good patient history will enable you to diagnose a possible PE. But definitive diagnosis will require hospital tests i.e. chest X-Rays.
General Management Techniques:
Administer O2 as per British Thoracic Guidelines; Assisted ventilations if needed, Patient positioning (Usually the PT will want to sit upright) Administer Salbutamol if indicated, In the case of Asthma consider the use of adrenaline in the case of failing respirations, Position in an Upright or semi-recumbent or whichever is comfortable for the patient, Be prepared to carry out BLS or assisted ventilations. As with all patients who suffer with COPD you must always be aware of Hypoxic Drive while administering O2
Continually monitor patient condition
Consider an ASHICE
Smooth and rapid journey to hospital
Professional handover to hospital staff