Download Respiratory System in a Breath

Respiratory System in a Breath
June 21, 2012
Anna Spirkina, B.Sc.Pharm, ACPR
Objectives

By the end of this presentation the
participants should be able to…



Name the different anatomical structures that
make up the respiratory system
Describe the primary and secondary functions of
the respiratory system
Identify the main causes, symptoms, and
mechanisms of disease for COPD and Asthma
Anatomy

Respiratory System



Respiratory airways – tubes carrying air between
the atmosphere and lungs
Lungs
Structures of the chest involved in producing air
movement
Anatomy
http://www2.estrellamountain.edu/faculty/farabee/biobk/biobookrespsys.html
Anatomy


Nasal Passages
Pharynx

“Throat”


Passage for respiratory and digestive systems


Tonsils – lymphoid tissue (part of immune system)
Trachea and esophagus
Larynx



Cartilage structure connecting pharynx and trachea
Protects air passages
Contains vocal folds


Produce sound through vibration
Prevent air entry when fully closed
Anatomy

Trachea and Bronchi


Rigid, non-muscular
tubes
Cartilage-like rings



Keep airways open
Subdivide into smaller
bronchioles
Alveoli


Thin-walled, inflatable air
sacs
Smallest working units
http://www.nlm.nih.gov/medlineplus/ency/imagepages/8675.htm
Anatomy

Lungs




Branched airways, alveoli, blood vessels, elastic
connective tissue
Volume – mostly air, weight – mostly blood
No muscle to inflate/deflate during breathing
 Done through dimension changes of the chest
cavity
Diaphragm



Separates chest cavity from abdominal cavity
Main muscle involved in breathing
Downward movement=inhalation, upward
movement=exhalation
Physiology



Respiration
 Exchange of oxygen (O2) and carbon dioxide (CO2) between
the external environment and the cells of the body
Four steps
 Breathing – moving air in and out of lungs
 Exchange of O2 and CO2 between air in the alveoli and blood
in the lung blood vessels
 Blood transport or O2 and CO2 between lungs and body
 Exchange of O2 and CO2 between body tissues and blood
Respiratory System – first 2 steps
Physiology



Primary Function of Respiratory
System
 Brings O2-rich air and O2-poor
blood into close proximity
Gas exchange by passive
movement of O2 and CO2
 Move from higher to lower
concentrations
Carried to and from lungs by red
blood cells
 Contain haemoglobin

Easily reversible bond to O2 and
CO2
http://www.goldiesroom.org/Note%20Packets/13%20Human%20Other/00%20Human%20Other%20Systems--WHOLE.htm
Physiology

Non-respiratory Functions of Respiratory
System






Water loss and heat elimination
Acid-base balance maintenance
Speech, signing, vocalization
Defence against inhaled foreign material
Sense of smell
Removal, modification or activation of materials
added to blood by body tissues
Common Disease States

Chronic Obstructive Pulmonary Disease
(COPD)



Chronic bronchitis
Emphysema
Asthma
COPD

Chronic and recurrent obstruction of airflow


Progressive disease
Mostly preventable
 Most common cause – smoking




Also chronic irritation by polluted air, allergens
Some people – genetic component
Lack of pronounced symptoms until advanced disease
Increasing mortality (deaths) over past three
decades


Fourth leading cause of death – U.S.
Combination of asthma, COPD and sleep apnea – 4th
leading cause of death in Canada
COPD

Two types

Emphysema


Bronchitis



destruction of walls between
alveoli
obstruction of small airways
by mucus and changes in
lining
Both types usually
overlapping
Diagnostic tests

Spirometry – measures the
amount of air entering and
leaving lungs
http://www.nhlbi.nih.gov/health/health-topics/topics/copd/
COPD


Symptoms
 Chronic cough
 Sputum production
 Difficulty breathing – shallow, more frequent breaths
 Barrel chest, pursed lips during expiration
Symptoms of rapidly worsening COPD (x 48 hours)
 Increase in sputum production; change in colour of sputum
 Chest tightness
 Increasing difficulty breathing
 Decreased exercise tolerance
 Fever
 Requires timely medical attention
COPD

Treatment



No cure, only symptom management
Smoking cessation – the only strategy to slow
progression of COPD
Treatment approaches depend on disease
severity
COPD Severity
Symptoms
Treatment
Mild
Shortness of breath when
hurrying on the level or
walking up a slight hill
Short-acting
bronchodilators (eg.
Ventolin® ± Atrovent® )
Moderate
Shortness of breath
causing the patient to stop
walking after ~100m on
the level
Short-acting
bronchodilators (eg.
Ventolin®) + Long-acting
bronchodilators (eg.
Serevent® or Spiriva®)
Severe and Very Severe
Patient too breathless to
leave the house,
breathless after dressing;
heart failure due to COPD
Short-acting
bronchodilators (eg.
Ventolin®) + Combination
steroid/bronchodilator (eg.
Advair® or Symbicort®) ±
Theophylline ± Oxygen
Asthma

Reversible episodic airway inflammation and obstruction
 Triggered by variety of stimuli


Genetic component
 Childhood asthma
The number of people diagnosed with asthma have been
increasing over several decades
 Over 2 million Canadians reported history of asthma in 2010
 No proportional increase in mortality (deaths) or
hospitalizations over the past years


Allergens
Cold air, exercise, drugs, air pollution, respiratory infections
Asthma

Pathogenesis (how it
happens)




Thickening of airway walls
due to inflammation
Excessive secretion of
thick mucus
Constriction of the smaller
airways
Diagnostic tests

Spirometry - measures the
amount of air entering and
leaving lungs
http://www.asthmacuretoday.com/wp-includes/images/522asthma.jpg
Asthma


Symptoms
 Episodes of dry hacking coughing, chest tightness, wheezing,
whistling sound when breathing
 Often associated with exercise or known allergens, but may
be spontaneous
Severe asthma attack
 Progresses over days or hours
 Severe presentation of the usual symptoms





Can only speak few words at a time
Non-responsive to rescue inhaler
Pale or ash-coloured skin
Increased heart rate
Requires immediate medical attention
Asthma

Characteristic
Frequency or
Value
Daytime symptoms
<4 days/week
Night-time
symptoms
<1 night/week
Physical activity
Normal
Asthma attacks
Mild, infrequent
Absence from
school or work
None
Need for rescue
inhaler
<4 doses/week
Treatment



Varies depending on how
well symptoms are
controlled
Asthma education
Action plans
Asthma
Dispensing Medications for Asthma
and COPD
Class of Medication
Examples
Mechanism of
Action
Things to
Remember
Short-acting
Bronchodilators
Ventolin®
Bricanyl®
Relax muscle lining of
bronchi quickly but
short term
Ventolin® - Shake
inhaler before use
Long-acting
Bronchodilators
Serevent®
Oxeze®
Relax muscle lining of
bronchi long term
Inhaled steroids
Flovent®
Pulmicort®
Decrease
inflammatory
response
Rinse mouth after use
to prevent thrush
Combination products
Symbicort®
Advair®
Relax bronchi,
decrease
inflammation
Rinse mouth after use
to prevent thrush
Anticholinergics
Atrovent®
Spiriva®
Inhibit chemical
receptors responsible
for bronchocostriction
and mucus
production
Spiriva® - capsules
not for oral ingestion;
expire 5 days after foil
opened
Atrovent® - Shake
inhaler before use
Summary



Respiratory system consists of respiratory
airways, lungs, and structures of the chest
cavity that are involved in air movement
The primary function of the respiratory
system is to facilitate gas exchange between
oxygen-rich atmosphere and oxygen-poor
blood
Asthma and COPD are two of the common
disease states of the respiratory system
References








“Asthma, by age group and sex”. Summary Tables. 11 June 2011. Statistics Canada. 18
December 2011. http://www40.statcan.gc.ca/l01/cst01/health49a-eng.htm
“Centre for Chronic Disease Prevention and Control”. Chronic Disease. 25 October 2011.
Public Health Agency of Canada. 18 December 201. http://www.phac-aspc.gc.ca/ccdpccpcmc/index-eng.php
Kelly, William., Sorkness, Christine. “Asthma” Pharmacotherapy: A Pathophysiologic
Approach. 7th Ed. Ed.Joseph Dipiro et al. China: The McGraw-Hill Companies, Inc., 2008.
463-95. Print.
Moore, Keith L., Agur, Anne M.R. “Thorax” Essential Clinical Anatomy. 3rd Ed. Baltimore,
MD:Lippincott Williams and Wilkins, 2007. 70-80. Print.
Moore, Keith L., Agur, Anne M.R. “Neck” Essential Clinical Anatomy. 3rd Ed. Baltimore,
MD:Lippincott Williams and Wilkins, 2007. 611-20. Print.
Porth, Carol. “Disorders of Ventilation and Gas Exchange” Essentials of Pathophysiology:
Concepts of Altered Health States. 2nd Ed. Philadelphia, PA: Lippincott Williams & Wilkins,
2007. 491-505. Print.
Sherwood, Lauralee. “The Respiratory System” Human Physiology: From Cells to
Systems. 6th Ed. Ed. Peter Adams. Belmont,CA: Thomson Brooks/Cole, 2007. 451-99.
Print.
Williams, Dennis., Bourdet, Sharya. “Chronic Obstructive Pulmonary Disease”
Pharmacotherapy: A Pathophysiologic Approach. 7th Ed. Ed.Joseph Dipiro et al. China:
The McGraw-Hill Companies, Inc., 2008. 495-518. Print.