Where do some infammatory and infectious disease affect?
- - URT
- - Lung parenchma (connective and supportive tissue) pneumonia, TB
What are some suppurative (puss) lung diseases?
- - Bronchiectasis
- - Lung abscess
What are the parts of the upper and lower respiratory
What is coryza?
- common cold
WHat is coryzal?
- like those of the common cold
Where does the common cold affect?
- the upper respiratory tract
How is the common cold transmitted?
- droplet transmission
What happens with the common cold?
- - infection and inflammation of the nasopharyngeal mucosa
- - extension of the infection beyonf the NP- pneumonia, bronchitis, otis media
What is influenza?
- highly infectious actue viral illness caused by the influenza virus
What are the characteristics of influenza?
- - pyrexia- fever
- - headache
- - myalgia- aches
- - malasie- feeling sick
- - fatigue and lethargy
What is the aetilogy of influenza?
- - highly infectious
- - droplet spread
- - still a major cause of morbidity and mortality
- - high risk- age, comorbidities, immune compromised, resp disease
What is the management of influenza?
- - supportive
- - preventative
What are other URT infections that occur. Note we dont deal with this
- - epiglottitis- inflammation of the supraglottic region
- - laryngotracheobronchitis- croup, inflam of the subglottic region
- - pertussis- whooping cough, viral infection, characteristic cough
How do you manage other URT
- - protect airway
- - humidification
- - antibiotics
- - inhaled adrenaline
- - corticosteroids
- - minimal handling
- - respiratory support as needed
- Physio- CI in acute phase but later only if there is specific lung pathology
What are some conditions of the lwer respiratory tract?
- - bronchiolitis
- - pneumonia
- - PCP- classic pneuonia of aids
- - lung abscess
- - bronchiectasis
- - TB
What is bronchiolitis?
- inflammation of the bronchioles
what is the aetiology of bronchiolitis?
- - most common LFT disease in childhood
- - usually caused by RSV (respsinovirus)
- - aerosol or direct transmission
What is the process of bronchiolitis?
- - inflamm of bronchioles by viral pathogen
- - necrosis of the epithelium- sloughs into airway
- - airway oedma
- - increased mucous production
- - obstruction to small airways- air trapping or collapse, pneumonia/ consolidation
What are the clinical signs and symptoms?
- - fever
- - resp distress
- - cough and secretions
- - ausc signs
- 0 CXR may show consolidation
What is the management of bronchiolitis?
- - humidification with or without O2
- - ventilatory support needed
- - ABs i f secondary infection
- - medications- antiviral
- - not indicated in acute stage
- - later in the disease course only if specific lung pathology and excessive secretions- only when u should handle them
What is pneumonia?
- - INFLAMMATORY PROCESS AFFECTING THE LUNG PARENCHYMA- GAS EXCHANGE portion of the lung
- - significant world wide cause of morbidity and mortality
What is pneumonia also known as?
- - Nosocomial/ Hospital acquired (HAP)
- - Community acquired (CAP)
- - Health associated (HCAP)
What are the different causes of pneumonia?
- - typical vs atypical
- - bacteria- streptococuss, staphylococcus, klebsiella, pseudomonas, haemophillus, legionella
- - viruses: influenz, RSV
- - mycoplasma pneumoniae: small organisms which escapes isolation by standard tests
- - chicken pox
- - rubella- measles
- - fungal- aspergillus (in soil), histoplasmosa, candida
- - aspiration- alcoholics, people with poor conciousness, foreign substances into resp tract, URT secretions, gastric secretions, often anaerobic microbes- abcess, arapneumonic effusions
- - repeated pneumonia- suggestes aspiration, obstruction of bronchus eg Ca, perm lung damage
who are at high risk of pneumonia?
- -poor resp defences
- - extremes of age- children and elderly
- - respdisease acute or chronic eg COPD
- - other chronic disease eg DM
- - debilitated
- - malnourished
- - immunocompromised
- - hospital pts
- - ETOH/ Drugs
What is the pathology of pneumonia?
- -infetion of lung parenchyma with pathogen
- -filling of alvoli- fluid, secretions, RBCs, white blood cells, macrophages
- - consolidation of lung- poor alveolar ventilation, VQ mismatch, hypoxaemia
what are the two stages of pneumonia?
- - cosolidation stage- initial stage
- - resoution stage- break up of alveolar consolidation, may become productive
pneumonia may effect pleura
- parapneumonic effects
What are the clinical signs and symptoms of pneumonia?
- - fever increase WCC
- - flu like symptoms- my/arthralgia, malaise, headache, N&V
- - pleural pain
- - cough- dry/ productive
- - increased RR and HR
- - ausc- BBS, crackles, reduced BS
- - CXR- vary, consol
- - ABGS- hypoxameia
- - sputum culture
what are the complications with pneumonia?
- - perm damage to lung
- - bronchiectasis, lung abscess
- - pleural effusion- parapneumonic (in pleural space), empyema (puss)
- - sepsis and multiorgan failure
- - resp failure
what is the management of pneumonia?
- - hospital admission
- - antibiotics
- - fluid management
- - analgesics
- - oxygen therapy to mantain PaO2
- - other supportive therapy as needed
- - percs and vibes postural drainage in the resolution phase
What is PCP?
- - classic pneumonia of AIDS
- - pneumocystis pneumonia
- - it is a fungus causiing infection in immunocompromised pts
- - diagnosed by analysis of sputum
How do u manage PCP?
- - supportive
- - pharmacological
- - usually non productive therefore often no need for physio
- a localised collection of pus withing a caviated necrotic lesion in the lung parenchyma
what causes a lung abscess?
- Anaerobic bacteria invading lung
- - bacteriodes
- - normally inhabit GIT and mouth
- - colonize gums (poor hygeine)
- - enter the lungs via aspiration
- Associated with
- - ETOH
- - Loss of consciousness
- - dysphagia
- - other bacteria invading lung eg E. coli
- - bronchial obstuction with secondary infection
- - vascular obstruction eg PE
- - interstitial lung disease
- - blood born infection- sepsis
- - infective bullae (bubble thing)
- - transdiaphragmatic spread
What is the pathology of a lung abscess?
- - as for pneumonia in the early stages- lung consolidation
- - progression to tissue necrosis and destruction of tissue- cavity formation
- - cavity filled with air and infected material
- - may be encapsulated in a yogenic membrane- fibrosis, inflammatory, granu;lation tissue
- - may rupture into a bronchus into the pleural cavity- bronchopleural fistula, empyema, drainage of fluid
- - compression of surrounding lung
What are the signs and symptoms of lung abcess?
- - as for pneumonia
- - systemic signs
- - cough with purulent secretions
- - hasmoptysis
- - loss of weight
- - CXR/ CT findings- cavity, airfluid levels
how do u manage lung abcess?
- - antibiotics
- - biopsy
- - supportive therapy
- - surgery
- - postural drainage may be required if abcess is draining
- - affected area uppermost- gravity assisted
What is bronchiectasis?
anatomically defined by chronic, irreversible dilation and distortion of the bronchi caaused by inflam destruction of the mm and elastic components of bronchial walls
what is the epidemiology of bronchiectasis?
- incidence in developed countrie unknow- low
- - less overcrowding
- - better hygiene
- - high immunisation rates
- - better nutrition
- - access health care
- - prevalance in indigenous aust and pacific isalnders- highest in the world
what is the aetiology of bronchiectasis?
- - idiopathic
- - acquired
- -chronic lung infection
- - pneumonia, CF
- - chronic aspiration
- - subsequent to childhood infections
- - immunodeficiency
- - may also occur distal to obstructed bronchus- foreign body, lymph node
- - congenital- kartagener's syndrome, primary ciliary diskinesia, hypogammaglobulinemia
- - associated with other diseases- often autoimmune- RA, chron's disease
What is the pathology of bronchiectasis?
- - initialinsult and then ongoing inflam response
- - damage and destruction to airway- cartilage, smooth mm, elastin, blood vessels
- - reduced effectiveness of MCC- pooling of secretions, further infection and lung damage
- - small airways closure- may lead to gas trapping or alveolar collapse
- - scarring of fibrosis of airways
- - both obstructive and restrictive
- - local or diffuse
what are the three anatomical variations of bronchiectaisis?
- - cylindrical
- - varicose
- - cystic/ saccular
what is the cylindrical bronchiectasis?
- dialated bronchi which fail to taper
what is varicose bronchiectasis?
- - irregular dilation
- - like varicose veins
what is cystic bronchiectasis?
- bronchi dialated and ending in cysts
what are the signs and symptoms of bronchiectasis?
- - cough with secretions
- - ausc- crackles and wheezes
- - ABGs, PFTS
- - CXR- tramlines, ring like shadows, outlines of thickened and dilated bronchi
- - CT- HRCT (high resp CT) gold standard diagnostic tool, dilated airways, no tapering
what are the signs and symptoms of acute exacerbation of bronchiectasis?
- - increased cough with more secretions, change colour
- - haemoptysis
- - signs of resp compromise
- - ausc crackles, wheezes
- - pleutric pain
- - cxr- increased consolidation, secretions in bronchi, cysts etc
- do tend to cough up blood due to erroded blood vessels
how do u mantain brochectasis?
- - secretion clearance
- - antibiotics
- - resp medications as appropriate
- - vaccinations
- - pulm rehab
- Acute- ABs- may be IV, other supportive treatment
- Surgery- remove affected lobes
How do physios manage bronchiectasis?
- - effective clearance- PD, P&V, ACBT, PEP< FLutter
- - self management and edu
- - exercise training and rehab
what is TB?
- - infectious disease caused by myocobacterium TB
- - particularly affects the lungs
- - one of the oldest disease known to affect human
- - old term consumption
- - > 5 mill new cases reported to WHO each yr
- - 95% from developing countries
- - under reported, 9 million estimated new cases per yr
- - 15-20million
- - 2 million die each
- - incidence stable or slightlydecling
Tb in the developed world
- - aerobic
- - thrive off areas of high O2
- - doesnt cahnge colour with acid stains
- - dropplet transmission
- - can remain in air for several hours
what are the clinical signs and symptoms