LESSON PLAN ON
RESPIRATORY
DISORDERS
GENERAL OBJECTIVES
SPECIFIC OBJECTIVES
S.NO TIME OBJECTIVE CONTENT TEACGHING AV AIDS EVALUATION
AND
LEARNING
ACTIVITY
1 INTRODUCTION:
The World Health Organization defines
occupational health as: "an area of work in
public health to promote and maintain
highest degree of physical, mental and social
well-being of workers in all occupations."
Respiration is the sequence of events that
results in the exchange of oxygen and carbon
dioxide between the atmosphere and the
body cells. Every 3 to 5 seconds, nerve
impulses stimulate the breathing process, or
ventilation, which moves air through a series
of passages into and out of the lungs
Respiratory diseases may be caused by
infection, by smoking tobacco, or by
breathing in secondhand tobacco smoke,
radon, asbestos, or other forms of air
pollution. Respiratory diseases include
asthma, chronic obstructive pulmonary
disease (COPD), pulmonary fibrosis,
pneumonia, and lung cancer..
bronchitis, byssinosis, asthma and
COPD
BRONCHITIS
Definition:
Bronchitis is a condition that develops when
the airways in the lungs, called bronchial
tubes, become inflamed and cause coughing,
often with mucus production
-National Institute of health
TYPES OF BRONCHITIS:
ACUTE BRONCHITIS: Acute bronchitis
is a shorter illness that commonly follows a
cold or viral infection, such as flu which
usually lasts a few days or weeks
CHRONIC BRONCHITIS:
Chronic bronchitis is characterized by a
persistent, mucus producing cough on most
days of the month, three months of a year for
two successive years in absence of a
secondary cause of the cough
CAUSES:
Viruses. Viruses that cause bronchitis
include influenza (the
flu), respiratory syncytial virus
(RSV), adenovirus, rhinovirus (the
common cold) and coronavirus.
Bacteria. Bacteria that cause
bronchitis include Bordetella
pertussis, Mycoplasma
pneumonia and Chlamydia
pneumonia.
Pollution.
Smoking cigarettes or marijuana
(cannabis).
Low resistance
Exposure to irritants in job
Gastric reflux
CLINICAL MANIFESTATIONS:
Inflammation and swelling of the
bronchi
Shortness of breath (dyspnea).
Fever and chills
Runny nose.
Tiredness (fatigue).
Cough
Chest pain or discomfort
Wheezing
Blocked or runny nose
DIAGNOSTIC TESTS
History collection
Physical examination
Nasal swab
Chest X-ray
Blood tests
Sputum tests
Pulmonary function tests
MANAGEMENT
Antiviral medications: for viral
infections
Bronchodilators : to open the
bronchial tubes and clear out mucus
Anti-inflammatory medications- to
reduce the inflammation and
swelling
Antibiotics: for bacterial infections
Cough suppressants
Mucolytics: to thin or loosen the
mucus in the airways making it
easier to cough out sputum
BYSSINOSIS
DEFINITION:
Byssinosis is a lung disease caused by
occupational exposure to cotton dust. It is
characterized by symptoms like chest
tightness, wheezing, and cough that typically
worsen on Mondays or after periods away
from work.
RISK FACTORS:
Textile workers
Smoking
Impaired lung function
History of respiratory allergy
Bronchitis
Asthma
Infections
Exposure > 20 years
CLINICAL MANIFESTATIONS
Tightness in the chest
Wheezing
Cough
Dyspnea
Fever
Muscle and joint pain
Shivering
Tiredness
DIAGNOSTIC TESTS
Detailed history collection
Physical examination
Chest x ray
Pulmonary function tests
CT
MANAGEMENT
In acute settings patients are
encouraged to consider alternate
occupations or at least reduce the
exposure in the work environment.
Smokers should be encouraged to
stop smoking.
Physical activity and breathing
exercises may help in management.
Bronchodilators help to relax and
dilate the airways.
Bronchodilators include beta-
adrenergic drugs (both those for
quick relief of symptoms and those
for long-term control),
anticholinergics, and
methylxanthines.
Corticosteroids are given only in
severe cases.
Immunomodulators and
Antihistamines can also be used.
Oxygen therapy is given in case of
hypoxia - diminished blood oxygen
levels (oxygen saturation levels of
<92%).
Nebulizers used in chronic
byssinosis.
Enclosure of processing of cotton.
Avoid smoking.
Wear protective masks.
Increase ventilation.
Avoiding long term exposure.
Byssinosis is generally not serious.
But if left untreated it can lead to
chronic illnesses such as emphysema and
chronic bronchitis.
ASTHMA
DEFINITION:
Asthma is a chronic inflammatory disorder
of the airways which causes an increase in
the airway hyper-responsiveness that leads
to recurrent episodes of wheezing,
breathlessness, chest tightness and cough,
particularly at night or early in morning.
TRIGGERING FACTORS
a) Allergen inhalation:
- Animal
- House dust
- Cockroaches
- Pollens
b) Air pollutants
- Exhaust fumes
- Perfumes
- Oxidants
- Cigarette smoke
c) Viral upper respiratory
infection
- Sinusitis
- Stress
d) Drugs
- Aspirin
- NSAIDS
- β- adrenergic blockers
e) Occupational exposure:
- Metal salts.
- Wood and vegetable
dusts
- Industrial chemicals
and plastics
f) Gastroesophageal reflux
disease
CLINICAL MANIFESTATIONS
• Wheezing.
• Dyspnea.
• Cough.
• Chest tightness.
• Expiration may be prolonged.
• Secretions may be white, thick,
tenacious, gelatinous mucus
DIAGNOSTIC TESTS
• History
• Physical examination.
• PFT
• Peak expiratory flow rate.
• Chest X-ray.
• ABG or oximetry.
• Allergy skin testing.
• Blood level of eosinophils and IgE.
MANAGEMENT
Long term control medicines to achieve and
maintain control of persistent asthma.
• Anti-inflammatory drugs
• Corticosteroids
• Bronchodilators
• Long acting β2 – adrenergic agonists
• Theophylline
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE:
COPD is a progressive, non reversible
process of airway narrowing and loss of
supporting tissue.
Three separate process are typically
involved:
• Chronic bronchitis with persistent
air way, edema excessive mucous
production, and impaired airway
clearance
• Emphysema with loss of alveolar
walls capillary bed and airway
support tissue resulting in airway
collapse and reduction in gas
exchange.
• Small airways disease with broncho
constriction
CAUSES:
Cigarette smoking is the primary
cause. smokers are 12-13 times more
likely to die from COPD than non
smokers.
(smoke impairs ciliary movement,
inhibit the function of alveolar
macrophages, and cause mucus
secreting glands to hypertrophy.
Smoking constricts smooth muscle,
increasing airway resistance
OTHER FACTORS INCLUDE:
• Air pollution
• Occupational exposure to noxious
dust and gases
• Airway infection, and familial and
genetic factors.
• Genetic factors include severe alpha
–antitrypsin deficiency.
RISK FACTORS:
• Common among whites than blacks
• Common among men than women
MANIFESTATIONS RELATED TO
CHRONIC BRONCHITIS
Productive cough lasting three or
more months in two consecutive
years
Congestion and edema of bronchial
mucosa and mucus gland
enlargement leads to thick tension
mucus in large amounts at least half
cup for day
Difficult in cleaning the mucus due
to changes in bronchial wall.
These excess secretion narrows
airway and obstruct air flow, that is
expiration is affected first then
inspiration .
As ciliary function is impaired
normal defense mechanisms are
unable to clean the mucus and any
inhaled pathogens
MANIFESTATIONS RELATED TO
EMPHYSEMA:
It is characterized by obstruction of
the walls of the alveoli resulting in
enlargement of abnormal air space.
Alveolar wall destruction causes
alveoli and air spaces to enlarge
with loss of corresponding position
of the pulmonary capillary bed
reduction in surface area for alveolar
capillary diffusion affecting gas
exchange.
Exercise intolerance
Cough typically occurs in the
morning
Initially dyspnea occurs in extreme
exertion but on the condition activity
intolerance is reduced, gradually
dyspnea occurs even at rest .
Cyanosis
Evidence of right heart failure
including distended neck veins
edema liver enlargement and
enlarged heart
Ventilation sounds including loud
rhonchi possible wheeze in
prominent and auscultation
Air trapping and hyper inflation
increase the anterio-posterior chest
diameter causing barrel chest
DIAGNOSTIC TESTS
1. ABG ANALYSIS:
Mild hypoxemia, later marked
hypoxemia
Normal or low CO2 tension
Respiratory alkalosis due to
increased respiratory rate
Hypercapnia
2. OXYGEN SATURATION less than
95%
3. EXHALED
CO2(CAPNOGRAM) :
Normal ETCO2 reading is 35-45mm
Hg.
It is elevated when ventilation is
inadequate and decreased , when
pulmonary infusion is impaired.
4. CBC:
CBC with WBC shows increased
RBC`s and hematocrit (as chronic
hypoxia stimulates increased
erythropoiesis to increase the oxygen
carrying capacity)
Polycythemia, increased number of
all blood cells may be evident.
Increased WBC indicates bacterial
infection
5. CHEST X-RAY:
It shows flattening of the diaphragm
due to hyperventilation
6. SERUM ALPHA ANTITRYPSIN
LEVELS:
It may be drawn to screen for
deficiency
Normal range is from 80-260mg/dl
7. PULMONARY FUNCTION
TESTING:
The total lung capacity is increased
Residual volume is decreased
Forced expiratory volume(FEV1) is
decreased
Forced vital capacity are decreased
due to narrowed airways and
resistance to airflow
8. VENTILATION PERFUSION
SCANNING:
It helps to determine the extent of
ventilation perfusion mismatch
TREATMENT
1. SMOKING CESSATION
It can prevent COPD and improve lung
function , FEV1 improves and survival is
prolonged
2. MEDICATIONS
a) Broad spectrum antibiotics
Doxycycline
Amoxicillin
b) Brochodilators:
It improves airflow and reduce air
trapping in COPD
It may be given through meter dosed
inhaler, dry powder inhaler ,
nebulizer or orally
Theophylline :
It stimulates respiratory drive,
strengthens diaphragmatic
contraction and improves cardiac
output
c) Corticosteroids :
Corticosteroids may be used
Prednisolone is used initially
ALPHA ANTITRYPSIN
REPLACEMENT THERAPY:
It is available for the patients with
genetic deficiency
PULMONARY HYGIENE
MEASURES :
It includes hydration, effective
cough, percussion and postural
drainage are used to improve
clearance of airway secretions
PULMONARY
REHABILITATION:
It includes exercises , education and
psychological support
These improve functional capacity
and quality of life
BREATHING EXERCISES:
Pursed lip breathing slows the
respiratory rate and open airways
during exhalation
Abdominal breathing exercises
relieves the work of accessory
muscles of respiration
OXYGEN THERAPY:
Long term oxygen therapy is used for
severe and progressive hypoxemia
It may be used at night or
continuously
3. SURGERY:
When medical therapy is not useful,
LUNG TRANSPLANTATION may
be done
Either single or bilateral transplant
have been performed with 2 years
survival rate of 75% operated
Lung reduction surgery is still in an
experimental stage.
4. COMPLEMENTARY THERPAY
Herbal tea made with pepperiment
may acts as expectorant.
Acupuncture may helps in patient
with smoking cessation
Hypnotherpay, guided imagery helps
to stop smoking, control anxiety and
breathing pattern
SUMMARY
We have dealt with the main
respiratory disorders like bronchitis,
byssinosis, Asthma and chronic obstructive
pulmonary diseases definition, causes, risk
factors, clinical manifestations, diagnostic
tests and their management.
CONCLUSION
Hundreds, thousands and millions of
people suffer from respiratory diseases and
chronic obstructive pulmonary disease is the
leading respiratory problem among all. We
can control these risk factors by adopting a
healthy lifestyle. Try eating healthily and
indulge in physical activities like walking
and exercising. Make sure to quit smoking
immediately to avert any risk of any kind of
respiratory problems.
BIBLIOGRAPHY
