Obstructive pulmonary and respiratory diseases

Overview

Lung disorders are classified as either obstructive or restrictive by doctors. Obstructive lung illnesses are conditions that make it difficult to expel all of the air from the lungs. People suffering from restrictive lung disease have trouble fully inflating their lungs with air.

What is Obstructive Lung Disease?

Obstructive Lung Disease

Obstructive lung disease causes shortness of breath because it is difficult to expel all of the air from the lungs. Exhaled air moves more slowly than usual due to injury to the lungs or restriction of the airways inside the lungs. An excessively large volume of air may still remain in the lungs after a thorough expiration.

The most common causes of obstructive lung disease are:

Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis
Asthma
Bronchiectasis
Cystic fibrosis

Although COPD and all other obstructive lung illnesses have symptoms such as coughing and wheezing, they are unique disorders in terms of disease onset, frequency of symptoms, and reversibility of airway blockage.

Asthma

Asthma

Asthma is a respiratory disorder that damages your lungs. It causes wheezing, shortness of breath, chest tightness, and nocturnal or early morning coughing. Asthma may be managed by taking medication and avoiding factors that can provoke an attack. You must also eliminate the irritants in your surroundings that might aggravate your asthma.

The overall etiology is complex and not fully understood, particularly when it comes to predicting which children with pediatric asthma will develop asthma as adults (up to 40% of children have a wheeze, whereas only 1% of adults have asthma), but it is agreed that it is a multifactorial pathology influenced by both genetics and environmental exposure.

What are the Symptoms of Asthma?

Patients frequently describe a wheeze or cough that is aggravated by allergies, exertion, or a cold. There is frequently diurnal fluctuation, with symptoms stronger at night. Patients may describe different types of atopy, such as eczema and hay fever. With acute exacerbations, there may be some modest chest discomfort. Many asthmatics experience nighttime coughing bouts yet seem fine during the day.

The results of the physical exam will depend on whether the patient is currently undergoing an acute exacerbation. A slight tremor in the hands and modest tachycardia may occur during an acute exacerbation due to salbutamol administration. Patients will exhibit some breathing difficulty and will frequently sit forward to splint expand their airways. A bilateral, expiratory wheeze will be noted on auscultation. The chest may be quiet in life-threatening asthma because air cannot enter or exit the lungs, and there may be indicators of systemic hypoxia.

How is Asthma Diagnosed?

Asthma Diagnosis

Pulse oximetry can be used to determine the intensity of an asthma episode or to monitor for worsening. Because of the physiological reserve of many patients, a declining pO2 on pulse oximetry is a late discovery, suggesting a critically ill or peri-arrest patient.

Peak flow measurements can also be used to evaluate asthma, but they should always be compared to a nomogram as well as the particular patient's normal baseline function. The severity of acute asthma episodes is connected with a peak flow measurement, which is reported as a percentage of projected peak flow.

Laboratory

If the patient receives a large dosage or repeat salbutamol, urea and electrolytes (kidney function) should be taken, as one of the adverse effects of salbutamol is that it causes potassium to transfer into the intracellular space transiently, which can produce transient, iatrogenic hypokalaemia. Eosinophilia is frequent but not unique to asthma. Recent research suggests that sputum eosinophil levels may help guide treatment. Furthermore, some individuals may have an increase in serum IgE.

Hypoxemia and respiratory acidosis may be revealed by arterial blood gas analysis. Periostin may be a marker for asthma, according to research, although its clinical relevance is unknown. An ECG will show sinus tachycardia caused by asthma, albuterol, or theophylline.

Imaging

A chest x-ray is a useful exam, especially if the patient has a history of foreign body or infection risk. Patients with persistent symptoms who do not respond to treatment are given a chest CT scan.

Special Tests

Spirometry is the preferred diagnostic approach, revealing an obstructive pattern that is partially or totally relieved by salbutamol. To establish the severity of the disease, spirometry should be performed prior to therapy. A lower FEV1 to FVC ratio indicates airway blockage, which can be reversed with therapy. Reversibility testing is performed by administering inhaled short-acting beta 2 agonists to the patient, followed by a repeat spirometry test. If FEV1 improves by 12% or 200ml from the prior figure, it indicates reversibility and is diagnostic for bronchial asthma. Peak expiratory flow monitoring is now widespread and allows one to document therapeutic response. This test has the drawback of being effort dependent.

A methacholine/histamine challenge may be necessary in some individuals to evaluate if airway hyper-reactivity exists. Only trained personnel should do this exam.

What is the Treatment for Asthma?

Treatment for Asthma

Conservative Measures

Calming the patient to get them to relax, relocating the person outside or away from the likely source of allergen, and cooling the individual are all measures to take. It is occasionally done to remove clothing and wash the face and mouth to eliminate allergies, however this is not supported by research.

Environmental management is critical if recurring episodes are to be avoided. Avoiding allergens can dramatically enhance one's quality of life. This includes staying away from cigarettes, dust mites, animals, and pollen. Obese asthmatics who lose weight have better control. Allergen immunotherapy is still debatable. Large-scale trials have found no substantial effect, and the method is extremely costly.

Patients with moderate to severe asthma who have a positive skin test should get monoclonal antibody treatment. The medication can reduce IgE levels, which reduces histamine production. However, the injections are expensive. Bronchial thermoplasty is a relatively recent treatment that applies heat energy to the airway wall to restrict it. Several studies have shown that it can minimize emergency room visits and school days lost.

Medical

Bronchodilators such as beta-2 agonists and muscarinic antagonists (salbutamol and ipratropium bromide, respectively) and anti-inflammatories such as inhaled steroids are used in medical therapy. Chronic asthma management consists of five phases; therapy is initiated based on severity and subsequently escalated or de-escalated based on response to treatment.

Step 1: The Preferred controller is as needed low dose inhaled corticosteroid and formoterol.
Step 2: The preferred controllers are daily low dose inhaled corticosteroid plus as-needed short-acting beta 2 agonists.
Step 3: The preferred controllers are low dose inhaled corticosteroid and long-acting beta 2 agonists plus as-needed short-acting beta 2 agonists.
Step 4: The preferred controller is a medium-dose inhaled corticosteroid and long-acting beta 2 agonist plus as-needed short-acting beta 2 agonists.
Step 5: High dose inhaled corticosteroid and long-acting beta 2 agonist plus long-acting muscarinic antagonist/anti-IgE.

High-flow oxygen inhalation, systemic steroids, back-to-back nebulizations with short-acting beta 2 agonists and short-acting muscarinic antagonists, and intravenous magnesium sulfate are used to treat patients with life-threatening asthma. The early engagement of the intensive care team consultation aids in the reduction of mortality. Early intubation and mechanical breathing are required in cases with near-fatal asthma.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a lung condition that causes difficulty breathing over time. Millions of Americans are affected by the illness, which is a primary cause of disability and mortality in the United States. The good news is that COPD is frequently avoidable and treated.

COPD is caused by long-term exposure to toxic particles or gases. Cigarette smoking is the leading cause of COPD globally. Other potential reasons include secondhand smoking, environmental and occupational exposures, and a lack of alpha-1 antitrypsin (AATD).

COPD is a chronic inflammatory disease that affects the airways, lung parenchyma, and pulmonary vasculature. It is believed that the process involves oxidative stress and protease-antiprotease imbalances. Emphysema represents one of the structural changes found in COPD, in which the alveolar air sacs (gas-exchanging surfaces of the lungs) are destroyed, resulting in obstructive physiology. An irritant (for example, smoking) triggers an inflammatory reaction in emphysema.

Neutrophils and macrophages are activated, releasing a variety of inflammatory mediators. Excess proteases and oxidants cause the deterioration of the air sacs. The degradation of elastin by proteases results in a lack of elastic rebound and airway collapse during exhale.

COPD Symptoms

COPD often manifests in maturity, frequently during the winter months. Patients often complain of persistent and increasing dyspnea, coughing, and sputum production. Wheezing and chest tightness are other possible symptoms. While a smoking history is evident in the majority of cases, many do not. They should be asked about their second-hand smoking exposure, occupational and environmental exposures, and family history.

Those with a confirmed COPD diagnosis should be questioned regarding prior exacerbations, nightly awakenings, inhaler use, and the disease's influence on activity level. Patients should be asked about their medical history for disorders including asthma, allergies, and childhood respiratory infections. Those who have liver illness, basilar emphysema, or a family history of emphysema should be tested for alpha-1 antitrypsin deficiency. Acute COPD exacerbations are characterized by increased dyspnea, productive cough, and wheezing.

How is COPD diagnosed?

COPD diagnosis

Spirometry

A basic test called spirometry should be performed to accurately diagnose COPD. This entails blowing into a machine that tests your lung capacity hard and quickly. This is the total volume of air you can expel, as well as the rate at which you can empty your lungs. In the first second of a strong blow out, a healthy person may empty at least 70% of the air from their lungs.

Spirometry measures only one element of your lung function. People with the same spirometry result may feel more or less breathless depending on their degree of fitness, any other medical issues, and how their lungs have been affected by COPD.

Chest X-ray and blood test

Spirometry is the only way for most patients to get a definitive diagnosis of COPD. It will not be made just on the basis of a chest X-ray. However, your doctor should arrange for a chest X-ray or scan as well as a blood test to rule out other possible explanations of your symptoms.

BMI calculation

To determine if you are a healthy weight, your doctor will calculate your body mass index (BMI). This is significant because you can better control your COPD if you are not underweight or overweight.

Other tests

Your health care professional may want to get a better picture of your condition and how it affects you, including:

Tests to find out how well your lungs are functioning
Tests to see if the oxygen level in your blood is significantly reduced
Carrying out general tests, including measuring heart rate, blood pressure, and temperature
Asking how often you have symptom flare-ups or chest infections
Finding out how short of breath you feel during everyday activities.

What are the treatments for COPD?

treatments for COPD

1. Don’t smoke

Stopping smoking is the most effective COPD therapy. Your doctor and pharmacist can advise you on how to make things simpler for yourself. With the assistance of support services and medicines, you are approximately three times more likely to quit.

2. Get vaccinated

Make sure you receive your flu shot every year to protect yourself against the flu viruses that are expected to circulate this winter. Getting vaccinated minimizes your chances of suffering serious consequences from the flu, such as pneumonia and heart issues. It is provided free of charge by the NHS to those suffering from long-term diseases such as COPD.

You should also ensure that your coronavirus immunizations are up to date. Your doctor should also offer you a pneumococcal infection vaccination, which is a bacterial infection that can cause pneumonia and other ailments. This is only required once.

You may avoid infections by avoiding persons with colds, flu, sinus infections, or sore throats, particularly youngsters. If you do have an infection, make sure you treat it as soon as possible.

3. Pulmonary rehabilitation

Pulmonary rehabilitation (PR) is an exercise and education program developed for persons with COPD. It is one of the most effective COPD therapies available. Request a referral from your doctor or nurse.

A course typically lasts six to eight weeks and you will be part of a group. You'll spend around half of each session doing physical activity. This will be carefully developed to offer you with the appropriate degree of activity. You'll also get information and recommendations on topics such as:

Breathing techniques and positions to help you when you’re out of breath
How to manage stress
Healthy eating
How to use your inhalers and other medicines
What to do when you’re unwell.

PR is all about assisting you in better managing your COPD. It's not a cure, but it will make you feel better, more confident, and in charge. After you've finished your course, it's critical that you continue to exercise consistently, stay active, and apply the principles you've learned.

What’s the difference between COPD and asthma?

COPD causes your airways to become permanently constricted; inhaled medicine can help to open them up, but only to a certain amount. Asthma causes intermittent constriction of the airways. It frequently occurs after being exposed to a trigger, which is something that irritates your airways, such as dust, pollen, or cigarette smoke. Inhaled medicine can completely expand your airways and reduce symptoms by relaxing them.

So, if you experience symptoms such as shortness of breath, coughing, wheezing, or a tight chest that improve on some days but worsen on others, or if you frequently wake up in the night with symptoms, you may have asthma.

Because the symptoms are similar and because persons with asthma might acquire COPD later in life, it can be difficult to distinguish between the two disorders. Furthermore, some patients have both COPD and asthma.

Bronchiectasis

Bronchiectasis

Bronchiectasis is a chronic illness in which the bronchial walls thicken due to inflammation and infection. Exacerbations are periodic flare-ups of breathing problems in people with bronchiectasis.

When you breathe, air moves via bronchi within your lungs. Bronchiectasis is a disorder in which the airway walls (bronchi) thicken and become irreparably damaged. As the bronchial walls scar, the bronchi can no longer adequately discharge regular secretions, causing mucus to pile up and serve as a breeding ground for viruses. This causes a vicious cycle of inflammation and infection, resulting in abnormal airway pockets and, finally, loss of lung function. The illness can affect the entire lung or just particular airways. The sickness becomes more serious as the damage spreads.

What Causes Bronchiectasis?

Bronchiectasis is frequently caused by lung injury from another ailment. Even a noncancerous tumor or development in the airway can cause bronchiectasis. Though it is most commonly associated with cystic fibrosis, bronchiectasis can be caused by a variety of diseases, including:

Autoimmune disease
Immunodeficiency disorders, such as HIV or diabetes
Chronic obstructive pulmonary disease (COPD), and alpha-1 antitrypsin deficiency which can cause COPD in some people
Diseases that affect the cilia, the small, hair-like structures that line your airways and whose main function is to clear mucus
Inflammatory bowel disease, including Crohn’s and ulcerative colitis
Allergic bronchopulmonary aspergillosis which is a type of allergic lung inflammation of the airways
Chronic pulmonary aspiration, problems with swallowing that causes food or fluids to get into the lungs and leads to inflamed airways

What are the Symptoms of Bronchiectasis?

Symptoms of Bronchiectasis

Bronchiectasis symptoms can develop over months or years and worsen progressively. Coughing and mucus production on a daily basis are the two prominent symptoms (sputum). Other common symptoms include:

Coughing up yellow or green mucus daily
Shortness of breath that gets worse during flare-ups
Fatigue, feeling run-down or tired
Fevers and/or chills
Wheezing or whistling sound while you breathe
Coughing up blood or mucus mixed with blood, a condition called hemoptysis
Chest pain from increased effort to breathe
Clubbing, or the thickening of the skin under nails

How is Bronchiectasis Diagnosed?

Bronchiectasis chart

Bronchiectasis is a disorder that is frequently misdiagnosed. Whether bronchiectasis is suspected, your doctor will first ask for a full family history and blood testing to see if you have an underlying illness that might cause bronchiectasis. These blood tests can also inform your doctor whether you have a deficiency in infection-fighting blood cells.

Because it is a lung condition, your doctor will want to assess your lung function as well. They will begin by listening to your lungs to look for obstructions and abnormalities. Lung function tests can tell you how well your lungs perform. A sputum culture can also inform your doctor whether you have germs in your lungs.

Once other explanations of your symptoms have been ruled out, the most frequent technique to diagnose bronchiectasis is via a chest X-ray or CT scan. Both tests produce comprehensive pictures of your lungs, heart, or airways, providing your doctor with a complete view of your situation.

When bronchiectasis is severe and not responding to therapy, physicians may consider a bronchoscopy. This flexible, thin tube is placed into the airways to aid in the detection of obstructions and infection sources.

How is Bronchiectasis Treated?

Bronchiectasis Treatment

The purpose of bronchiectasis therapy is to keep infections and flare-ups at bay. This is accomplished by the use of medicine, fluids, and chest physical therapy. To increase low blood oxygen levels, oxygen treatment may be indicated. Surgery may be indicated in severe cases if the bronchiectasis is limited to a specific area of the lung or there is extensive bleeding.

The most frequent therapy for bronchiectasis is antibiotics. Most infections are treated with oral antibiotics, but more difficult infections may need intravenous (IV) medicines. Macrolides are a class of antibiotics that not only kill bacteria but also decrease inflammation in the bronchi. Though they may be useful to certain people, they are only utilized in the most severe cases due to their significant negative effects.

Mucus Thinning Medication may be recommended to assist individuals with bronchiectasis cough up phlegm. These drugs are frequently administered through nebulizer, when they are combined with hypertonic saline solution, misted, and breathed deep into the lungs. They are frequently used in conjunction with a decongestant.

Airway Clearance Devices: To assist break up mucus, some patients exhale through a hand-held device. Oscillating Positive Expiratory Pressure (PEP), Intrapulmonary Percussive Ventilation (IPV), and Postural Drainage are some of these devices. Chest Physical Therapy (CPT), also known as chest physiotherapy, is a common respiratory therapist method that entails clapping on the chest in a certain manner to assist release mucus from the lungs so that it may be removed. Electronic chest clappers or vests are now available to help with CPT at home.

How to Manage Bronchiectasis?

Bronchiectasis management

Bronchiectasis is a chronic illness with symptoms that must be addressed over time. Patients should work closely with their doctors to develop healthy practices that will help them avoid flare-ups. Here are some ideas:

Quit smoking and avoid secondhand smoke.
Maintain a healthy diet, low in sodium, added sugars, saturated fats and refined grains.
Stay hydrated, drinking plenty of water to help prevent mucus build-up.
Be diligent about taking oral and inhaled medications and performing mucus clearance techniques daily.
Staying up to date on vaccinations.
Take antibiotics for one to two weeks during flare-ups.

Despite leading a healthy lifestyle, flare-ups are possible. This is frequently caused by a new respiratory infection or bacterial overgrowth. Increased mucus (sputum) production that is bloody or a different color, fever, exhaustion, weight loss, and increasing shortness of breath may indicate a flare-up. In these cases, you should call your doctor right away.

Conclusion

Obstructive lung disease makes breathing more difficult, especially during increased exercise or activity. Asthma, chronic bronchitis, emphysema, cystic fibrosis, and bronchiolitis are examples of obstructive airway illnesses that cause decreased expiratory airflow and affect airways distal to the carina.

Treatment for Obstructive Lung Diseases

Obstructive pulmonary and respiratory diseases

Overview

What is Obstructive Lung Disease?