Respiratory disease

Respiratory diseases, or lung diseases,[1]

are pathological conditions affecting the
organs and tissues that make gas
exchange difficult in air-breathing animals.
They include conditions of the respiratory
tract including the trachea, bronchi,
bronchioles, alveoli, pleurae, pleural cavity,
the nerves and muscles of respiration.
Respiratory diseases range from mild and
self-limiting, such as the common cold,
influenza, and pharyngitis to life-
threatening diseases such as bacterial
pneumonia, pulmonary embolism,
tuberculosis, acute asthma, lung cancer,[2]
and severe acute respiratory syndromes,
such as COVID-19.[3] Respiratory diseases
can be classified in many different ways,
including by the organ or tissue involved,
by the type and pattern of associated
signs and symptoms, or by the cause of
the disease.

The study of respiratory disease is known

as pulmonology. A physician who
specializes in respiratory disease is known
as a pulmonologist, a chest medicine
specialist, a
Respiratory disease
respiratory medicine
specialist, a
respirologist or a
thoracic medicine Micrograph of an
specialist. emphysematous
lung; emphysema is
Obstructive a rare respiratory
lung disease disease, strongly
associated with
Asthma, chronic smoking. H&E stain.
bronchitis, Specialty Pulmonolog
bronchiectasis and
chronic obstructive pulmonary disease
(COPD) are all obstructive lung diseases
characterised by airway obstruction. This
limits the amount of air that is able to
enter alveoli because of constriction of the
bronchial tree, due to inflammation.
Obstructive lung diseases are often
identified because of symptoms and
diagnosed with pulmonary function tests
such as spirometry. Many obstructive lung
diseases are managed by avoiding triggers
(such as dust mites or smoking), with
symptom control such as bronchodilators,
and with suppression of inflammation
(such as through corticosteroids) in severe
cases. One common cause of COPD
including emphysema, and chronic
bronchitis, is tobacco smoking, and
common causes of bronchiectasis include
severe infections and cystic fibrosis. The
definitive cause of asthma is not yet
known.[4]

Restrictive lung diseases

Age-standardised disability-adjusted
life year (DALY) rates from respiratory
diseases by country (per 100,000
inhabitants).

Restrictive lung diseases are a category of

respiratory disease characterized by a loss
of lung compliance,[5] causing incomplete
lung expansion and increased lung
stiffness, such as in infants with
respiratory distress syndrome. Restrictive
lung diseases can be divided into two
categories: those caused by intrinsic
factors and those caused by extrinsic
factors. Restrictive lung diseases yielding
from intrinsic factors occur within the
lungs themselves, such as tissue death
due to inflammation or toxins. Conversely,
restrictive lung diseases caused by
extrinsic factors result from conditions
originating from outside the lungs such as
neuromuscular dysfunction and irregular
chest wall movements.[6]

Chronic respiratory disease

Chronic respiratory diseases (CRDs) are

long-term diseases of the airways and
other structures of the lung. They are
characterized by a high inflammatory cell
recruitment (neutrophil) and/or destructive
cycle of infection, (e.g. mediated by
Pseudomonas aeruginosa). Some of the
most common are asthma, chronic
obstructive pulmonary disease, and acute
respiratory distress syndrome. CRDs are
not curable; however, various forms of
treatment that help dilate major air
passages and improve shortness of breath
can help control symptoms and increase
the quality of life.[7]

Telerehabilitation for chronic respiratory

disease
The latest evidence suggests that primary
pulmonary rehabilitation and maintenance
rehabilitation delivered through
telerehabilitation for people with chronic
respiratory disease reaches outcomes
similar to centre-based rehabilitation.[8]
While there are no safety issues identified,
the findings are based on evidence limited
by a small number of studies.[8]

Respiratory tract infections

Infections can affect any part of the

respiratory system. They are traditionally
divided into upper respiratory tract
infections and lower respiratory tract
infections.

Upper respiratory tract infection

Classic steeple sign indicating croup

The upper airway is defined as all the

structures connecting the glottis to the
mouth and nose.[9] The most common
upper respiratory tract infection is the
common cold. However, infections of
specific organs of the upper respiratory
tract such as sinusitis, tonsillitis, otitis
media, pharyngitis and laryngitis are also
considered upper respiratory tract
infections.

Epiglottitis is a bacterial infection of the

larynx which causes life-threatening
swelling of the epiglottis with a mortality
rate of 7% in adults and 1% in children.[10]
Haemophilus influenzae is still the primary
cause even with vaccinations. Also
Streptococcus pyogenes can cause
epiglottitis. Symptoms include drooling,
stridor, difficulty breathing and swallowing,
and a hoarse voice.[11]
Croup (Laryngotracheobronchitis) is a viral
infection of the vocal cords typically
lasting five to six days. The main symptom
is a barking cough and low-grade fever. On
an X-ray, croup can be recognized by the
"steeple sign", which is a narrowing of the
trachea. It most commonly occurs in
winter months in children between the
ages of 3 months and 5 years. A severe
form caused by bacteria is called bacterial
tracheitis.[12]

Tonsillitis is swelling of the tonsils by a

bacterial or viral infection. This
inflammation can lead to airway
obstruction. From tonsillitis can come a
peritonsillar abscess which is the most
common upper airway infection and
occurs primarily in young adults. It causes
one swelling of one of tonsils pushing the
uvula to the unaffected side.[9] Diagnosis
is usually made based on the presentation
and examination. Symptoms generally
include fever, sore throat, trouble
swallowing, and sounding like they have a
“hot potato” in their mouth.[13]

Lower respiratory tract infection

The most common lower respiratory tract

infection is pneumonia, an infection of the
lungs which is usually caused by bacteria,
particularly Streptococcus pneumoniae in
Western countries. Worldwide,
tuberculosis is an important cause of
pneumonia. Other pathogens such as
viruses and fungi can cause pneumonia,
for example severe acute respiratory
syndrome, COVID-19 and pneumocystis
pneumonia. Pneumonia may develop
complications such as a lung abscess, a
round cavity in the lung caused by the
infection, or may spread to the pleural
cavity.

Poor oral care may be a contributing factor

to lower respiratory disease, as bacteria
from gum disease may travel through
airways and into the lungs.[14][15]

Upper and lower respiratory tract

infection

Primary ciliary dyskinesia is a genetic

disorder causing the cilia to not move in a
coordinated manner. This causes chronic
respiratory infections, cough, and nasal
congestion. This can lead to
bronchiectasis, which can cause life-
threatening breathing issues.[16]
Tumors

Malignant tumors

Malignant tumors of the respiratory

system, particularly primary carcinomas of
the lung, are a major health problem
responsible for 15% of all cancer
diagnoses and 30% of all cancer deaths.
The majority of respiratory system cancers
are attributable to smoking tobacco.

The major histological types of respiratory

system cancer are:

Small cell lung cancer

 Non-small cell lung cancer
Adenocarcinoma of the lung
Squamous cell carcinoma of the
lung
Large cell lung carcinoma
Other lung cancers (carcinoid, Kaposi’s
sarcoma, melanoma)
Lymphoma
Head and neck cancer
Pleural mesothelioma, almost always
caused by exposure to asbestos dust.

In addition, since many cancers spread via

the bloodstream and the entire cardiac
output passes through the lungs, it is
common for cancer metastases to occur
within the lung. Breast cancer may invade
directly through local spread, and through
lymph node metastases. After metastasis
to the liver, colon cancer frequently
metastasizes to the lung. Prostate cancer,
germ cell cancer and renal cell carcinoma
may also metastasize to the lung.

Treatment of respiratory system cancer

depends on the type of cancer. Surgical
removal of part of a lung (lobectomy,
segmentectomy, or wedge resection) or of
an entire lung pneumonectomy), along with
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 to some
extent on the histology, and is only about
14–17% overall. In the case of metastases
to the lung, treatment can occasionally be
curative but only in certain, rare
circumstances.

Benign tumors

Benign tumors are relatively rare causes of

respiratory disease. Examples of benign
tumors are:

Pulmonary hamartoma
 Congenital malformations such as
pulmonary sequestration and congenital
cystic adenomatoid malformation
(CCAM).

Pleural cavity diseases

Pleural cavity diseases include pleural

mesothelioma which are mentioned above.

A collection of fluid in the pleural cavity is

known as a pleural effusion.[17] This may
be due to fluid shifting from the
bloodstream into the pleural cavity due to
conditions such as congestive heart failure
and cirrhosis.[17] It may also be due to
inflammation of the pleura itself as can
occur with infection, pulmonary embolus,
tuberculosis, mesothelioma and other
conditions.[17]

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.
Pulmonary vascular disease

Pulmonary vascular diseases are

conditions that affect the pulmonary
circulation. Examples are:[18]

Pulmonary embolism, a 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 (travel
through the blood stream) 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 – caused by
invasive medical procedures).
Pulmonary arterial hypertension,
elevated pressure in the pulmonary
arteries. Most commonly it is idiopathic
(i.e. of unknown cause) but it can be 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.
Pulmonary edema, leakage of fluid from
capillaries of the lung into the alveoli (or
 air spaces). It is usually due to
congestive heart failure.
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
granulomatosis with polyangiitis and
Goodpasture's syndrome.

Neonatal diseases

Pulmonary diseases also impact

newborns and the disorders are often
unique from those that affect adults.
Infant respiratory distress syndrome most
commonly occurs in less than six hours
after birth in about 1% of all births in the
United States.[9] The main risk factor is
prematurity with the likelihood of it
occurring going up to 71% in infants under
750g.[19] Other risk factors include infant
of a diabetic mother (IDM), method of
delivery, fetal asphyxia, genetics,
prolonged rupture of membranes (PROM),
maternal toxemia, chorioamnionitis, and
male sex. The widely accepted
pathophysiology of respiratory distress
syndrome is it caused by insufficient
surfactant production and immature lung
and vascular development. The lack of
surfactant makes the lungs atelectatic
causing a ventilation to perfusion
mismatch, lowered compliance, and
increased air resistance. This causes
hypoxia and respiratory acidosis which can
lead to pulmonary hypertension. It has a
ground glass appearance on an x-ray.
Symptoms can include tachypnea, nasal
flaring, paradoxical chest movement,
grunting, and subcostal retractions.[9]

Bronchopulmonary Dysplasia is a
condition that occurs after birth usually
from mechanical ventilation and oxygen
use. It happens almost exclusively in pre-
mature infants and is characterized by the
alveoli, and lung vasculature becoming
inflamed and damaged. Complications
from BPD can follow a patient into
adulthood. As a child they may experience
learning disabilities, pulmonary
hypertension, and hearing problems. As an
adult, there is an increased likelihood for
asthma and exercise intolerance.[20]

Meconium Aspiration Syndrome occurs in

full term or post-term infants who aspirate
meconium. Risk factors include a diabetic
mother, fetal hypoxia, precipitous delivery,
and maternal high blood pressure.[21] Its
diagnosis is based on meconium stained
amniotic fluid at delivery and staining on
the skin, nails, and umbilical cord.
Aspiration can cause airway obstruction,
air-trapping, pneumonia, lung inflammation,
and inactivated surfactant. It presents as
patchy atelectasis and hyperinflation on an
x-ray with a pneumothorax of
pneumomediastinum also possible.[9]

Persistent Pulmonary Hypertension of the

Newborn (PPHN) is a syndrome that
occurs from an abnormal transition to
extra-uterine life. It is marked by an
elevated pulmonary vascular resistance
and vasoconstriction causing a right-to-
left shunt of the blood through the
foramen ovale or ductus arteriosus.[9]
There are three main causes of PPHN are
parenchymal diseases such as meconium
aspiration syndrome, idiopathic, and
hypoplastic vasculature like in a
diaphragmatic hernia. It will eventually
resolve in most infants.[22] This is the only
syndrome that inhaled nitric oxide is
approved for by the FDA.[23]

Pulmonary interstitial emphysema

Transient Tachypnea of the Newborn is

caused by the retention of alveolar fluid in
the lungs. It commonly occurs in infants
who are delivered via caesarean section
without the onset of labor because
absorption of amniotic fluid in the lungs
has not yet commenced. Other risk factors
are male sex, macrosomia, multiple
gestations, and maternal asthma. It
usually presents with tachypnea and
increased work of breathing. On an x-ray
diffuse infiltrates, interlobar fissures, and
sometimes pleural effusions can be seen.
It is a diagnosis of exclusion because of
its similarity to other diseases and
frequently CPAP is used to help push the
lung fluid into the pulmonary
vasculature.[9][24]
Pulmonary interstitial emphysema is the
condition of air escaping overdistended
alveoli into the pulmonary interstitium. It is
a rare disease that occurs most often in
premature infants, even though it is
possible to appear in adults.[25] It often
presents as a slow deterioration with the
need for increased ventilatory support.
Chest x-ray is the standard for diagnosis
where it is seen as linear or cystic
translucencies extending to the edges of
the lungs.[9]

Bronchiolitis is the swelling and buildup of

mucus in the bronchioles. It is usually
caused by respiratory syncytial virus (RSV),
which is spread when an infant touches
the nose or throat fluids of someone
infected.[26] The virus infects the cells
causing ciliary dysfunction and death. The
debris, edema, and inflammation
eventually leads to the symptoms.[27] It is
the most common reason for admission
of children under the age of one year. It
can present widely from a mild respiratory
infection to respiratory failure. Since there
is no medication to treat the disease, it is
only managed supportively with fluids and
oxygen.[28]
Diagnosis

Respiratory diseases may be investigated

by performing one or more of the following
tests:

Biopsy of the lung or pleura

Blood test
Bronchoscopy
Chest X-ray
CT scan, including high-resolution
computed tomography
Culture of microorganisms from
secretions such as sputum
 Ultrasound scanning can be useful to
detect fluid such as pleural effusion
Pulmonary function test
Ventilation–perfusion scan

Epidemiology

Deaths from respiratory diseases per million

persons in 2012
19–125 276–308
126–169 309–365
170–196 366–440
197–225 441–593
226-–75 594–1,227

Respiratory disease is a common and

significant cause of illness and death
around the world. In the US, approximately
one billion common colds occur each
year.[29] A study found that in 2010, there
were approximately 6.8 million emergency
department visits for respiratory disorders
in the U.S. for patients under the age of
18.[30] In 2012, respiratory conditions were
the most frequent reasons for hospital
stays among children.[31]

In the UK, approximately 1 in 7 individuals

are affected by some form of chronic lung
disease, most commonly chronic
obstructive pulmonary disease, which
includes asthma, chronic bronchitis and
emphysema.[32] Respiratory diseases
(including lung cancer) are responsible for
over 10% of hospitalizations and over 16%
of deaths in Canada.[33]

In 2011, respiratory disease with ventilator

support accounted for 93.3% of ICU
utilization in the United States.[34]

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