introduction to respiratory medicine

1. Introduction to
RESPIRATORY
MEDICINE
Dr.Bilal Natiq Nuaman,MD.
C.A.B.M.,F.I.B.M.S.,D.I.M.
2016-2017
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2. BASIC HUMAN SURVIVAL NEEDS:
Oxygen : HUMAN CANNOT SURVIVE
FOR MORE THAN 10 MINUTES
WITHOUT OXYGEN
Water : HUMAN CANNOT SURVIVE FOR
MORE THAN 100 HOURS WITHOUT
WATER
Food : HUMAN CANNOT SURVIVE FOR
MORE THAN 1000 HOURS WITHOUT
FOOD
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3. The primary function of the lungs is gas exchange. This requires
the movement of O2 into the blood to support aerobic respiration
in the mitochondria and the removal of the metabolic by-product
CO2 from the blood.
To achieve this, an integrated system of external respiration
(lungs), circulatory system (cardiovascular and hematology
systems) and cellular respiration (internal respiration) must
function harmoniously.
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4. Respiratory system
Composed from :
1-Respiratory tracts
2- ventilatory pump
3- Gas exchanger
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5. 1-Respiratory tracts
1-upper respiratory tract : nasopharynx,larynx,p.n.sinuses .
2-lower respiratory tract : trachea, main bronchi ,down to
terminal bronchioles.
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6. 2- ventilatory pump
consists of the following:
1-Brainstem centers (respiratory centers) that control the
respiratory muscles.
2- The respiratory muscles (internal/external intercostal muscles ,
diaphragm) , which expand and contract the thoracic cavity.
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7. 3-Gas exchanger
Consists of thousands of lung alveoli where O2 and CO2
exchanged through respiratory membrane proportional to the
difference in partial pressure.
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8. MAIN FUNCTIONS OF RESPIRATORY SYSTEM
1-Provides an extensive area for gas exchange
between air & circulating blood
2-Assists in the control of acid-base balance
3-Produce sounds involved in speaking.
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9. Respiratory disease is defined
any deviation from or interruption of the normal
structure or function of any components of
respiratory system (Respiratory tracts,
ventilatory pump ,and Gas exchanger),
manifested by a characteristic set of symptoms
and signs; and may affect the main functions of
respiratory system .
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10. The Burden of Respiratory Disease
Respiratory disease is responsible for a major burden of morbidity
and mortality, with conditions such as tuberculosis, pandemic
influenza and pneumonia the most important in world health
terms.
The increasing prevalence of allergy, asthma and chronic
obstructive pulmonary disease (COPD) contributes to the overall
burden of chronic disease in the community.
By 2025, the number of cigarette smokers worldwide is anticipated
to increase to 1.5 billion, ensuring a growing burden of tobacco-
related respiratory conditions.
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11. • 20% of people consulted a physician for a respiratory
complaint
• TB infect 1/3 of population
• Respiratory diseases are among the leading causes of death
worldwide. Lung infections (mostly pneumonia and
tuberculosis), lung cancer and chronic obstructive pulmonary
disease (COPD) together accounted for one-sixth of the global
total.
• The World Health Organization estimates that the same four
diseases accounted for one-tenth of the disability-adjusted life-
years (DALYs) lost worldwide in 2008
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12. • Most of emerging infectious diseases (diseases that appear
in the last 30 years) are of respiratory origin like
SWINE FLU (H1N1) ,
SARS ,
AVIAN FLU( H5N1),
MIDDLE EAST RESPIRATORY SYNDROME
CORONAVIRUS (MERS-COV)
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13. Diagnosis
1-
•HISTORY
2-
• EXAMINATION
3-
• INVESTIGATIONS 13

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15. EXAMINATION OF RESPIRATORY SYSTEM
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17. Pulmonary Function Tests
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➢Basic tests for preliminary assessment and for
monitoring disease progression include :-
1-spirometry, which is a record of exhaled
volume versus time during a forced
exhalation (with or without determination of
the response to an inhaled bronchodilator
for possible reversible airflow).

19. • Among the most helpful spirometric values are
1-Forced vital capacity ( FVC ),
2-Forced expiratory volume in the first second of
exhalation (FEV1), and
3-Ratio (FEV1 / FVC).
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20. NORMAL LEVELS
FEV1 > 80%
FVC >80 %
FEV1/FVC >70%
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21. 2-Diffusion capacity, which measures the
transfer of carbon monoxide to indicate how
well inspired gases cross the alveolar-
interstitial-capillary endothelial interface into
blood. diffusion capacity of the lung for
carbon monoxide (Dlco)
3-Lung volumes , which include TLC,VC,RV.
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22. INTERPRETATION OF SPIROMETRY
PULMONARY FUNCTION TESTS HELP TO IDENTIFY AND
QUANTIFY ABNORMALITIES OF PULMONARY SYSTEM ,
WHICH USUALLY ARE CATEGORIZED AS
OBSTRUCTIVE OR RESTRICIVE .
❖OBSTRUCTIVE LUNG DISEASE:
➢FEV1 ↓ <80%
➢FVC normal 80%
➢FEV1/ FVC ↓ <70%
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23. ❖ RESTRICTIVE LUNG DISEASE:
FEV1 ↓ <80%
FVC ↓ < 80%
FEV1/ FVC NORMAL >70%
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24. Interpretation of transfer factor
➢LOW DLCO:
Causes
Emphysema ,
Interstitial lung disease-idiopathic pulmonary
fibrosis
Anemia.
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25. ➢HIGH DLCO:
Causes
ASTHMA,
POLYCYTHEMIA
➢NORMAL DLCO: :
CHRONIC BRONCHITIS
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26. Pulmonary Function Tests
Indications
1. Detect the presence of lung dysfunction classified
as obstructive or restrictive lung disease.
2. Quantify severity of known lung disease
3. evaluation of response to various treatments
including bronchodilators for asthma and
corticosteroids for interstitial lung disease
4. monitoring pulmonary side effects of treatment
(e.g., methotrexate, amiodarone)
5. Assess the risk for surgery (preoperative
assessment)
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27. Categories of respiratory diseases
• 1-obstructive lung disease :
partial or complete obstruction of the airways due to
anatomic narrowing or loss of elastic recoil.
Causes
Asthma,
emphysema,
chronic bronchitis ,
bronchiectasis,and
cystic fibrosis
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28. • 2-Restricive lung disease:
Reduced expansion of the lung parenchyma due to
restrictive disease of lung,pleura,and chest wall.
Causes
Interstitial lung disease,
Pleural effusion,
Pneumothorax,
Pleural fibrosis and tumor ,
Pulmonary embolism,
Kyphoscoliosis,
Ankylosing spondylitis,
Neuromuscular disease,
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29. • 3-Combination of obstructive and restrictive
Due to mixed pathology
Causes
Lung Infection: TB , Pneumonia.
Lung malignancy
Sarcoidosis
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30. Thanks for listening
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