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| {{SI}} | | {{Respiratory disease}} |
| {{CMG}} | | {{CMG}} |
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| {{EH}}
| | ==[[Respiratory disease overview|Overview]]== |
| | | ==[[Respiratory disease historical perspective|Historical Perspective]]== |
| ==Overview==
| | ==[[Respiratory disease classification|Classification]]== |
| | | ==[[Respiratory disease pathophysiology|Pathophysiology]]== |
| '''Respiratory disease''' is an umbrella term for diseases of the lung, pleural cavity, bronchial tubes, trachea, upper respiratory tract and of the nerves and muscles of breathing. Respiratory diseases range from mild and self-limiting such as the common cold to life-threatening such as bacterial pneumonia or pulmonary embolism.
| | ==[[Respiratory disease causes|Causes]]== |
| | | ==[[Respiratory disease differential diagnosis|Differentiating Respiratory disease from other Diseases]]== |
| Respiratory diseases can be classified as either obstructive (i.e. conditions which impede the rate of flow into and out of the lungs, for example [[Asthma|asthma]]) or restrictive (i.e. conditions which cause a reduction in the functional volume of the lungs, for example [[Pulmonary fibrosis|pulmonary fibrosis]]).
| | ==[[Respiratory disease epidemiology and demographics|Epidemiology and Demographics]]== |
| | | ==[[Respiratory disease risk factors|Risk Factors]]== |
| Respiratory disease can be further classified as either [[Upper respiratory tract infections|upper]] or [[Lower respiratory tract infection|lower]] respiratory tract (most commonly used in the context of infectious respiratory disease), [[alveoli|parenchymal]] and [[Pulmonary circulation|vascular]] lung diseases. | | ==[[Respiratory disease screening|Screening]]== |
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| | ==[[Respiratory_disease_natural_history,_complications_and_prognosis|Natural History, Complications, and Prognosis]]== |
| They are a common and important cause of illness and death. In the US, people suffer 1 billion colds per year. One in seven people in the UK is affected by some form of chronic lung disease, most commonly chronic obstructive pulmonary disease and asthma.
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| Respiratory disease is responsible for over 10% of hospitalizations and over 16% of deaths in Canada. The study of respiratory disease is known as pulmonology. A doctor who specializes in respiratory disease is known as a pulmonologist, a chest medicine specialist, a respiratory medicine specialist, a respirologist or a thoracic medicine specialist.
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| == Chronic Obstructive Pulmonary Disease== | |
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| '''Chronic Obstructive Pulmonary Diseases''' (COPD) are characterised by an increase in [[Airway resistance|airway resistance]], shown by a decrease in Peak Expiratory Flow Rate (PEFR; measured in [[spirometry]]) and Forced Expiratory Volume in 1 Second (FEV1). The Residual Volume, the volume of air left in the lungs following full expiration, is greatly increased in COPD, while the total lung volume (TLC)is normal, leading to the clinical sign of chest over-inflation in patients with severe disease. Many individuals with COPD present with "barrel chest" - a deformity of outward rib displacement due to chronic over-inflation of the lungs,also, in severe COPD, a flattening of the [[diaphragm]] can be seen on chest [[radiograph]].
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| Examples of obstructive lung diseases include:
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| * [[Emphysema]]
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| * Acute & Chronic [[Bronchitis]]
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| * [[Asthma]]
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| * [[Bronchiectasis]]
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| * [[Bronchiolitis]]
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| ==Restrictive Lung Disease== | |
| '''Restrictive Lung Diseases''' (RLD) are characterized by a loss of [[Pulmonary compliance|airway compliance]] <ref name="emedicineRLD">{{cite web |url= http://www.emedicine.com/med/topic2012.htm|title= Restrictive Lung Disease|accessdate=2008-04-19 |author= Sharma, Sat|date= |work= |publisher=}}</ref> , causing incomplete lung expansion (i.e. via increased lung 'stiffness'). This change manifests itself in a reduced Total Lung Capacity, Inspiratory Capacity and Vital Capacity.
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| In contrast to OPD, RLD values for Tidal Volume, Expiratory Reserve Volume, Functional Residual Capacity and Respiratory Volume are unchanged. The FEV1 for a patient with RLD will either be normal or slightly increased, and thus the FEV1/FVC ratio will also be normal or increased for a RLD patient.
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| Notable restrictive lung diseases include:
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| * [[Fibrosis]]
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| * [[Sarcoidosis]]
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| * [[Pleural effusion]]
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| * [[Hypersensitivity pneumonitis]]
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| * [[Asbestosis]]
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| * [[Pleurisy]]
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| * [[Lung Cancer]]
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| * [[Infant respiratory distress syndrome]] (IRDS)
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| * [[Acute respiratory distress syndrome]] (ARDS)
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| * Neurologic diseases affecting the ability of the body to alter respiration rate, including [[spinal cord injury]]
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| * Mechanical diseases affecting pulmonary musculature, including [[myasthenia gravis]]
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| * [[Severe acute respiratory syndrome]] (SARS)
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| ==Parenchymal Lung Disease== | |
| The basic functional units of the lung, the [[alveoli]], are referred to as the lung '''''parenchyma'''''. Diseases such as [[COPD]] are characterised by destruction of the alveoli and are therefore referred to as parenchymal lung diseases.
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| Signs of parenchymal lung disease include, but are not limited to, [[hypoxemia]] (low oxygen in the blood), [[hypercapnoea]] (high carbon dioxide in the blood), and abnormal [[DLCO]] tests.
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| Chronic complications of parenchymal lung disease include reduced respiratory drive, [[right ventricular hypertrophy]], and [[right heart failure]] ([[cor pulmonale]]).
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| As can be seen from the overlap in categories, [[parenchyma]]l diseases can be either restrictive, obstructive or both.
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| Notable parenchymal diseases include:
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| * [[COPD]]
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| * [[Sarcoidosis]]
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| * [[Pulmonary fibrosis]]
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| * [[Emphysema]]
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| ==Vascular Lung Disease== | |
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| '''Vascular lung disease''' refers to conditions which affect the [[Pulmonary circulation|pulmonary capillary vasculature]]. Alterations in the vasculature manifest in a general inability to exchange blood gases such as oxygen and carbon dioxide, in the vicinity of the vascular damage (other areas of the lung may be unaffected).
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| Signs of vascular lung disease include, but are not limited to, [[hypoxemia]] (low oxygen in the blood) and [[hypercapnoea]] (high [[carbon dioxide]] in the blood).
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| Chronic complications of vascular lung disease include reduced respiratory drive, [[right ventricular hypertrophy]], and right [[heart failure]] ([[cor pulmonale]]).
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| Notable vascular lung diseases include:
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| * [[Pulmonary oedema]]
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| * [[Pulmonary embolism]]
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| * [[Pulmonary hypertension]]
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| ==Infectious Respiratory Disease==
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| '''Infectious Respiratory Diseases''' are, as the name suggests, typically caused by one of many infectious agents able to infect the mammalian respiratory system (for example the bacterium [[Streptococcus pneumoniae]]).
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| The clinical features and treatment options vary greatly between infectious lung disease sub-types as each type may be caused by a different infectious agent, with different pathogenesis and virulence. Features also vary between:
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| * [[Upper respiratory tract infection]], including [[Strep throat|strep throat]] and the [[Common cold|common cold]]; and
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| * [[Lower respiratory tract infection]], including [[Pneumonia|pneumonia]] and [[Tuberculosis|pulmonary tuberculosis]]
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| ==Respiratory Tumor== | |
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| "Respiratory tumor" can refer to either neoplastic (cancerous) or non-neoplastic masses within the lungs or lung parenchyma.
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| Neoplastic respiratory tumors : [[lung cancer|Respiratory neoplasms]] are abnormal masses of tissue within the lungs or parenchyma whose cell of origin may or may not be lung tissue (many other neoplasms commonly metastasize to lung tissue). Respiratory neoplasms are most often malignant, although there are non-malignant neoplasms which can affect lung tissue.
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| Non-neoplastic respiratory tumors : Tuberculosis cysts, other non-neoplastic masses.
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| Following is another classification of respiratory tumors:
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| ===Malignant tumors===
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| Malignant tumors, or cancers of the respiratory system, particularly lung cancers, are a major health problem responsible for 15% of all cancer diagnoses and 29% of all cancer deaths<ref name = "LungCa">{{cite web |url= http://www.lungcancer.org/reading/about.php|title= LungCancer.org|accessdate=2008-05-07 |format= |work= }}</ref>. The majority of respiratory system cancers are attributable to smoking [[tobacco]].
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| The major types of respiratory system cancer are:
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| * [[Small cell lung cancer]]
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| * [[Non-small cell lung cancer]]
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| ** Adenocarcinoma
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| ** Squamous cell carcinoma
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| ** Large cell undifferentiated carcinoma
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| * Other lung cancers ([[carcinoid]], [[Kaposi sarcoma]], [[melanoma]])
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| * [[Lymphoma]]
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| * [[Head and neck cancer]]
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| * [[Mesothelioma]], usually caused by exposure to asbestos dust.
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| In addition, since many cancers spread via the bloodstream and the entire cardiac output passes through the lungs, it common for cancer [[metastases]] to occur the lung. [[Breast cancer]] may invade directly through local spread, and through lymph node metastases. After metastasis to the [[liver cancer|liver]], [[colon cancer]] frequently metastasizes to the lung. [[Prostate cancer]], germ cell cancer and [[renal cell carcinoma]] may also metastasize to the lung.
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| Treatment of respiratory system cancer depends on the type of cancer. Surgery (usually removal of part of the lung, a [[lobectomy]] or an entire lung, a [[pneumonectomy]]), [[chemotherapy]] and [[radiotherapy]] are all used. The chance of surviving lung cancer depends on the cancer stage at the time the cancer is diagnosed and is only about 14-17% overall<ref name = "Canadalung">{{cite web |url= http://lung.ca/diseases-maladies/cancer-cancer/treatment-traitement/index_e.php|title= Canadian Lung Association – Lung Cancer|accessdate=2008-05-07 |format= |work= }}</ref>. In the case of metastases to the lung, treatment can occasionally be curative but only in certain, rare circumstances.
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| ===Benign tumors=== | |
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| Benign tumours are relatively rare causes of respiratory disease. Examples of benign tumours are:
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| * Pulmonary [[hamartoma]]
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| * Congenital malformations such as [[pulmonary sequestration]] and [[congenital cystic adenomatoid malformation]] (CCAM).
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| ==Disorders of breathing mechanics==
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| The brain co-ordinates breathing and sends messages via nerves to the muscles of respiration. The muscles produce the movements of breathing. Disorders of the brain’s control of breathing, the nerves or the muscles of respiration can affect the respiratory system.
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| Common disorders of breathing mechanics are:
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| * Obstructive [[sleep apnea]]
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| * Central [[sleep apnea]]
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| * [[Amyotrophic lateral sclerosis]]
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| * [[Guillian-Barre syndrome]]
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| * [[Myasthenia gravis]]
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| [[Obesity]] is often associated with [[sleep apnea]] and can cause either an obstructive or a restrictive pattern on [[spirometry]]. Obesity reduces the movement of the chest wall which can, in extreme cases, result in the obesity-hypoventilation syndrome, a cause of respiratory failure.
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| ==Pulmonary vascular diseases==
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| Pulmonary vascular diseases are conditions that affect the [[pulmonary circulation]]. Examples of these conditions are:
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| * [[Pulmonary embolism]], a [[Thrombosis|blood clot]] that forms in a vein, breaks free, travels through the heart and lodges in the lungs (thromboembolism). Large pulmonary emboli are fatal, causing sudden death. A number of other substances can also embolise to the lungs but they are much more rare: [[fat embolism]] (particularly after bony injury), amniotic fluid embolism (with complications of labour and delivery), [[air embolism]] (iatrogenic).
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| * [[Pulmonary arterial hypertension]], elevated pressure in the pulmonary arteries. It can be [[idiopathic]] or due to the effects of another disease, particularly COPD. This can lead to strain on the right side of the heart, a condition known as [[cor pulmonale]].
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| * [[Pulmonary edema]], leakage of fluid from capillaries of the lung into the [[alveoli]] (or air spaces). It is usually due to congestive heart failure.
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| * Pulmonary hemorrhage, inflammation and damage to capillaries in the lung resulting in blood leaking into the alveoli. This may cause blood to be coughed up. Pulmonary hemorrhage can be due to auto-immune disorders such as [[Wegener's Granulomatosis]] and [[Goodpasture's syndrome]].
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| ==Pleural cavity diseases== | |
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| Pleural cavity diseases include [[empyema]] and [[mesothelioma]] which are mentioned above.
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| A collection of fluid in the pleural cavity is known as a [[pleural effusion]]. This may be due to fluid shifting from the bloodstream into the pleural cavity due to conditions such as congestive heart failure and cirrhosis. It may also be due to inflammation of the pleura itself as can occur with infection, [[pulmonary embolus]], [[tuberculosis]], [[mesothelioma]] and other conditions.
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| A [[pneumothorax]] is a hole in the pleura covering the lung allowing air in the lung to escape into the pleural cavity. The affected lung “collapses” like a deflated balloon. A [[tension pneumothorax]] is a particularly severe form of this condition where the air in the pleural cavity cannot escape, so the pneumothorax keeps getting bigger until it compresses the heart and blood vessels, leading to a life threatening situation.
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| ==Other Respiratory diseases== | |
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| There are many other disorders that affect the lung and respiratory system. Auto-immune disorders such as [[vasculitis]],( [[Wegener's Granulomatosis]], [[Goodpasture's syndrome]], for example) attack the blood vessels in the lung, causing pulmonary[[ hemorrhage]]. Disorders in swallowing,or gastric refluxing can cause [[aspiration pneumonia]].
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Respiratory disease history and symptoms|History and Symptoms]] | [[Respiratory disease physical examination|Physical Examination]] | [[Respiratory disease laboratory findings|Laboratory Findings]] | [[Respiratory disease chest x ray|Chest X Ray]] | [[Respiratory disease CT|CT]] | [[Respiratory disease MRI|MRI]] | [[Respiratory disease ultrasound|Ultrasound]] | [[Respiratory disease other imaging findings|Other Imaging Findings]] | [[Respiratory disease other diagnostic studies|Other Diagnostic Studies]] |
| ===Symptoms===
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| The symptoms of respiratory disease differ depending on the disease. Common symptoms are:
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| * [[Shortness of breath]] or [[dyspnea]] which usually occurs with exercise and can interfere with daily activities. In severe cases, shortness of breath can occur while resting.
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| * [[Cough]] with or without the production of [[sputum]].
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| * Coughing blood ([[haemoptysis]]).
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| * [[Chest pain]]. This may or may not be pleuritic chest pain (that is pain that worsens with the movements of breathing).
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| * Noisy breathing, either [[wheeze]] or [[stridor]].
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| * [[Somnolence]].
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| * [[Loss of appetite]].
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| * [[Weight loss]].
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| * [[Cyanosis]], a bluish discoloration of the lips, tongue or fingers.
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| In some cases respiratory disease is diagnosed without symptoms in the investigation of another disease or through a routine check.
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| ===Diagnostic tests ===
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| Respiratory diseases may be investigated by performing one or more of the following tests
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| * [[Chest x-ray]]
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| * [[Pulmonary function test]]
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| * [[Computed tomography]]
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| * [[Microbiological culture|Culture of microorganisms]] from secretions such as [[sputum]]
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| * [[Bronchoscopy]]
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| * [[Biopsy]] of the lung or pleura
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| * [[Ventilation/perfusion scan|Ventilation - perfusion scan]]
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| * [[Medical ultrasonography|Ultrasound]] scanning can be useful to detect fluid such as [[pleural effusion]]
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| ==Differential Diagnosis==
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| * [[Asthma]]
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| * [[Bronchiolitis Obliterans Organizing Pneumonia]] (BOOP)
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| * [[Chronic Bronchitis]]
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| * [[Chronic Obstructive Pulmonary Disease]]
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| * [[Emphysema]]
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| * [[Interstitial lung disease]]
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| * Obstructive lung disease
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| * Oxygenation disorders
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| * [[Idiopathic pulmonary fibrosis|Pulmonary fibrosis]]
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| * Restrictive lung disease
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| * [[Sarcoidosis]]
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| == Histopathological Findings==
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| === [[Emphysema]]===
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| <youtube v=NyEwIVnzCwE/>
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| === [[Pulmonary tuberculosis]] ===
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| <youtube v=uxKoLtL_n3w/>
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| === [[Bronchiectasis]] ===
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| <youtube v=yISz4T1sp_8/>
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| === [[Lung]]: [[Silicosis]]===
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| <youtube v=8Zq4lhmHBiA/>
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| <youtube v=CJnM8py_wjI/>
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| === [[Diffuse alveolar damage]]: [[Adult respiratory distress syndrome]] ([[ARDS]])===
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| <youtube v=j7I-072vA9U/>
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| === [[Lung]]: [[Goodpasture syndrome]]===
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| <youtube v=805YGsF5jJ0/>
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| === [[Lung]]: [[Hyaline membrane disease]] ===
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| <youtube v=xNluoRABcIc/>
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| === [[Lung]]: [[Alveolar proteinosis]] ===
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| <youtube v=L9fVRzcPkEQ/>
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| === [[Lung]]: [[Blastomycosis]] ===
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| <youtube v=cLPwf1p21mE/>
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| === [[Lung]]: [[Aspergillosis]] ===
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| <youtube v=H9tw79BkGAs/>
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| <youtube v=iAyBGdMVqfE/>
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| === [[Lung]]: [[Adenocarcinoma]] ===
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| <youtube v=ZkvUodBSStQ/>
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| === [[Lung]]: [[Squamous cell carcinoma]] ===
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| <youtube v=sYQDldeboBk/>
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| === [[Lung]] & [[Bronchus]]: [[Cryptosporidium]] ===
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| <youtube v=NMtMgFU3M0w/>
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| === [[Lung]] & [[Lymph node]]: [[Asthma]] ===
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| <youtube v=WNX1GxNiE6c/>
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| ===[[Haemophilus influenzae]] [[laryngitis]] ===
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| <youtube v=ON2rkhQtz7w/>
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| ==Treatment== | | ==Treatment== |
| Treatment of respiratory disease depends on the particular disease being treated, the severity of disease and the patient. Lifestyle factors such as regular exercise and healthy nutrition are important in preventing and treating respiratory disease. Vaccination can prevent some respiratory diseases. In addition, the following treatments are often used for respiratory diseases:
| | [[Respiratory disease medical therapy|Medical Therapy]] | [[Respiratory disease surgery|Surgery]] | [[Respiratory disease primary prevention|Primary Prevention]] | [[Respiratory disease secondary prevention|Secondary Prevention]] | [[Respiratory disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Respiratory disease future or investigational therapies|Future or Investigational Therapies]] |
| * Medication, often given in an inhaled form
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| ** [[Glucocorticoid|Corticosteroids]]
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| ** [[Bronchodilators]]
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| ** [[Antibiotics]]
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| ** [[Anticoagulants]]
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| ** Cancer [[chemotherapy]]
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| ** Immune suppressants
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| * [[Physiotherapy]]
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| * [[Oxygen]]
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| * [[Mechanical ventilation]]
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| * Liquid ventilation (or [[Liquid breathing]])
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| * Surfactant Replacement Therapy
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| * [[Radiotherapy]]
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| * Surgery
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| ** Removal of a cancer e.g. lobectomy, pneumonectomy
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| ** [[Pleurodesis]]
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| ** Lung volume reduction surgery
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| ** [[Lung transplantation]]
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| ** Artificial lung
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| ==References==
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| {{Reflist|2}}
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| | ==Case Studies== |
| | [[Respiratory disease case study one|Case #1]] |
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| {{Medical conditions}} | | {{Medical conditions}} |
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| {{Certain conditions originating in the perinatal period}} | | {{Certain conditions originating in the perinatal period}} |
| {{Respiratory physiology}} | | {{Respiratory physiology}} |
| {{SIB}}
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| [[ja:呼吸器疾患]] | | [[ja:呼吸器疾患]] |