This Spring has brought many respiratory disorders and allergies into the limelight

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This Spring has brought many respiratory disorders and allergies into the limelight. It is a good time to learn as much as we can about the different disorders and/or allergies that cause our difficulties.. So we will depict briefly a few of them here.

First a definition or two to help understand what the terms mean.

COPD Means Chronic Obstructive Pulmonary Disease. This can be secretions you can't remove with coughing, or fibrous tissue formed through years of irritation.

	Pneumothorax This occurs when a lung or a part of you lung collapses. Sometimes this can be spontaneous for no apparent reason or from a chest wound.
	Respiratory Failure The inability of the lungs and /or cardiac system to maintain an adequate exchange of Oxygen and Carbon Dioxide in the lungs.
	ARDS This is Acute Respiratory Distress Syndrome/
	Atelectasis This is when a small portion of the lung collapses.
	CPAP A machine that fits airtight around your nose at night. and causes a continuous positive airway pressure. this delivers a constant pressure throughout the respiratory cycle.

Asthma

This is one of the diseases that causes COPD. Many children and adults suffer from Asthma caused by allergies, sudden change in temperature, smoking, exercise. This is an acute reversible airway disease that occurs by bronchospasm .

Bronchospasm

Bronchospasm is a narrowing of the airways causing an increase in airway resistance and me be caused by many things

	breathing in toxic or irritating substances such as smoke, pollen, dust, and gases
	bronchitis
	severe coughing episodes
	extreme cold
	exercise

Although bronchospasm is usually associated with asthma the above items can precipitate bronchospasm in anyone.

Bronchospasm actually includes smooth muscle constriction, mucosal edema (swelling), and excessive mucus with plugging of the conducting airways in advanced stages. The potential severity of an asthma attack is frequently minimized by the use of bronchodilators. It is important that we continue to take these medications if ordered. Do not stop just because you feel better. Unless ordered to by your physician. ("Critical Care Nursing"-Hudak &Gallo, Lippincott , 1994)

Chronic Bronchitis

Chronic infection or irritation of the bronchi results in bronchitis. The mucus secreting glands of the tracheobronchial tree become thickened and make the diameter of the airway smaller. In addition there is increased mucus production, The most common cause is tobacco smoking. Exacerbation (increased seriousness) of chronic bronchitis with the resulting respiratory insufficiency is most often caused by an acute bacterial infection of the bronchial tree.

An essential measure in preventing an acute inflammatory process is rigorous bronchial hygiene to promote clearance of secretions that provide the medium for bacterial growth. In contrast to emphysema, chronic bronchitis can be reversed if the source of the infection or irritation is treated. ie stopping smoking, treating the allergen etc. ("Critical Care Nursing"-Hudak &Gallo, Lippincott , 1994)

Emphysema

This is an irreversible dilation of the alveoli (where the oxygen exchange takes place) accompanied by destructive changes of the alveoli walls, with resultant loss of elasticity of the lung. The most common cause of this destruction is cigarette smoking. In contrast to chronic bronchitis, the destruction process is slow and gradual The majority of people who have COPD have a mixture of chronic bronchitis and Emphysema rather than just one or the other. ("Critical Care Nursing"-Hudak &Gallo, Lippincott , 1994)

Pulmonary Edema

The accumulation of fluid in the extravascular spaces of the lung. Usually the result of arteriosclerosis, hypertension, or other cardiac disease.

Early symptoms of pulmonary edema are difficulty breathing on exertion, nighttime breathing difficulties, breathing relieved when in an upright position or leaning across a table, rapid breathing and coughing. When listening to a person with pulmonary edema. there is a sound that sounds something like when you rub strands of hair together by your ear. This is called rales. There most likely will be increased heart rate. Coughing will produce a frothy like material often blood tinged. Skin may be cold and clammy and cyanotic.

Treatment of Pulmonary edema is centered around reducing the fluid build up such as diuretics, and oxygen. If the blame is on difficulties with the heart, treatment will include such things as digoxin or pressor drugs to increase the ability of the heart to contract. Also possibility of such things as drugs to dilate and relax the veins. These drugs would be given only in an intensive care unit. You may be given Morphine IV to help reduce the anxiety and difficulty breathing. (Nurses Reference library, Springhouse Corporation,1985)

Sleep Apnea

People with COPD also seem to be more prone to have sleep disorders especially sleep apnea. This condition is more common in men than in women though the occurrence in women increases after menopause, suggesting that possible hormones have something to do with it.

The sleep partner will usually describe intermittent loud snoring followed by silence lasting 10-100 seconds. The classifications are:

	Obstructive....associated with absence of airflow despite ventilatory efforts
	Central..........associated with absence of both airflow and ventilatory efforts
	Mixed............during which there is an initial period of central apnea followed by obstructive apnea

The site of obstruction is the oropharynx (back of the mouth and throat) and is apparently related to an abrupt loss of tone in the muscles surrounding the oropharynx just before the onset of inspiration.

people with apnea often complain of headaches, insomnia, daytime drowsiness, difficulty concentrating, personality changes, reduced libido, and very restless sleep,

Treatment usually starts with a CPAP machine, and or nighttime Oxygen along with some simple surgeries.

images of the lungs

American Lung Association

Occupational disease of lung

Respiratory

Merck manual on lungs

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