Respiratory diseases: signs, symptoms, and chronic conditions

Besides cancer, most respiratory diseases can be divided into chronic or acute conditions. The disease sections of this chapter discuss these three categories of respiratory diseases. Prior to learning about the diseases, it is important for the medical assistant to understand the common signs and symptoms of respiratory diseases. Respiratory diseases can cause the following reactions:

• Dyspnea: Difficulty with breathing.
• Shortness of breath (SOB): Breathlessness
• Hemoptysis: Expectorate of blood or blood-streaked sputum
• Hiccup: Sound produced by the spasmodic involuntary contraction of the diaphragm that causes an uncontrolled breathing in of air followed by the rapid closure of the glottis
• Epistaxis: Nosebleed
• Rhinorrhea: Nasal discharge

Additional signs and symptoms relate to breathing, changes in the oxygen amount in the blood and tissues, and abnormal lung sounds.

Breathing changes

Signs and symptoms of respiratory diseases that relate to abnormal breathing rate changes include the following:

• Apnea: Temporary absence of breathing
• Bradypnea: Abnormally slow breathing
• Cheyne-Stokes respiration: An increase in the depth and rate of breathing, followed by a decrease in breathing, and then a period of apnea
• Hyperpnea: An increase in the depth of breathing; the rate may also be increased.
• Hyperventilation: Abnormal increase in breathing
• Orthopnea: Difficulty breathing unless in an upright position (e.g., sitting or standing)
• Tachypnea: Rapid, shallow breathing

Oxygen changes

Respiratory conditions can also change the amount of oxygen in the blood and tissues. These signs and symptoms include the following:

• Cyanosis: Lack of oxygen in the blood, causing a bluish color in the skin, nail beds, and lips
• Hypoxemia: Insufficient oxygen in the blood
• Hypoxia: Decrease in oxygen in the tissues

Abnormal lung sounds

Abnormal lung sounds are heard when using a stethoscope, which is placed over the lung field:

• Pleural rub or pleuritic rub: An auscultatory sound caused by the rubbing together of the visceral and costal pleurae.
• Rales: Inspiratory auscultatory sounds resembling crackles or popping sounds caused by fluid in the airway or alveoli. Can be described as moist, dry, fine, or coarse.
• Rhonchi: Auscultatory sounds resembling snoring. Occurs when airflow is partially blocked through the large airways.
• Stridor: High-pitched inspiratory sound due to a blockage in the upper airway; can be heard with or without a stethoscope.
• Wheezing: High-pitched sound produced by a narrowed airway; can be heard with or without a stethoscope.

Chronic and acute respiratory diseases

A chronic disease, disorder, or syndrome that lasts longer than 6 months. Some chronic diseases last a lifetime. The following sections examine common chronic respiratory diseases.

Allergic rhinitis

When a person is allergic to dust, animal dander, pollen, or foods, allergic rhinitis can occur. When the reaction is due to a pollen allergy, the person is said to have hay fever, seasonal allergies, or allergic rhinitis.

The cause of allergic rhinitis can be traced to an allergen that triggers an allergy in a person. When the allergen is breathed in, histamines in the body cause allergy symptoms to occur. Allergic rhinitis can cause the following:

• Itchy nose, mouth, eyes, and throat
• Problems smelling and runny nose
• Sneezing and watery eyes

Later symptoms may include nasal congestion, coughing, decreased sense of smell, and sore throat. Patients can also have dark circles and puffiness under the eyes. Fatigue and headaches are also common.

The provider will perform a physical exam and ask about the patient’s allergy history. Allergy testing, a complete blood count (CBC), and other allergy-related tests (e.g., the IgE radioallergosorbent test [RAST] test) may be done. Treatment consists of avoiding the allergen or reducing exposure. A nasal wash may be recommended to remove mucus from the nose. Medications, such as antihistamines, decongestants , and corticosteroids , may also be ordered. Depending on the severity, the provider may also refer the patient to an allergy department for evaluation. Allergy shots** (immunotherapy)** are sometimes recommended.

Asthma

Asthma is a chronic disease that affects the airway. Bronchospasms and airway swelling narrow the passageway. Mucus in the lungs clogs the airway. Getting air into and out of the lungs becomes harder. The frequency of asthma episodes can vary. Severe asthma attacks are life-threatening and require immediate emergency care.

Many different things can trigger an asthma episode:

• Allergens, including foods (e.g., tree nuts), medications, and environmental substances, such as pollen, mold spores, pet dander, tobacco smoke, dust mites, cockroaches, wood smoke, and latex
• Environmental causes, such as chemical gases or fumes, dust, high humidity, and cold, dry air
• Strong emotional states
• Strenuous physical exercise

Asthma symptoms can vary in type and frequency. Typical symptoms include shortness of breath, chest tightness or pain, coughing or wheezing attacks, and early morning or nighttime coughing.

The provider may order peak flow monitoring, pulse oximetry (also called oxygen saturation measurement), and spirometry tests for diagnostic testing. Peak flow monitoring measures the amount of air exhaled. Peak flow monitoring can be used with at-home management of asthma. The provider can set up an asthma action plan to accompany the peak flow readings

Asthma treatment is based on the severity of the disease. Asthma medications can be taken orally or inhaled. Inhaled medications are usually taken via a metered-dose inhaler with a spacer or a nebulizer. Long-term control medications are usually taken daily and may include inhaled corticosteroids, leukotriene modifiers, long-acting beta-agonists, and combination inhalers. Quick-relief medications are usually taken during an asthma episode because they provide rapid, short-term relief. Quick-relief medications include short-acting beta agonists supplied by metered-dose inhalers (MDIs), such as albuterol and levalbuterol. If the quick-relief medications do not reduce the episode, immediate emergency care is required.

Chronic Obstructive Pulmonary Disease (COPD)

According to the Centers for Disease Control and Prevention (CDC), more than 16 million Americans have COPD, and more than 150,000 Americans die of COPD each year. This condition is both treatable and preventable. COPD develops slowly, making it hard for the affected person to breathe. It includes two conditions:

• Emphysema: Thinning and eventual destruction of the alveoli. This usually accompanies chronic bronchitis.
• Chronic bronchitis: Inflammation of the bronchial tubes, excessive production of mucus, and diminished activity of the cilia.

The main cause of COPD is smoking tobacco. Other causes include secondhand smoke, air pollution, dust, and chemical fumes. COPD can also be caused by an alpha-1 antitrypsin (AAT) deficiency.

The symptoms of COPD often appear after damage has already been done to the lungs. With chronic bronchitis, a long-term, daily productive cough is seen. Additional symptoms of COPD include shortness of breath, chest tightness, breathlessness, wheezing, cyanosis of the lips and nail beds, and clubbing. The patient may experience a lack of energy and fatigue. Frequent respiratory infections are common.

Typical diagnostic tests include lung function tests (i.e., spirometry and pulse oximetry), chest x-ray, and chest computed tomography (CT) scan. An arterial blood gas test may be done to identify the severity of COPD. Because there is no cure for COPD, the goal of treatment is to slow the disease progression. Patients typically use bronchodilators and a bronchodilator-corticosteroid combination to reduce the inflammation. Patients may use low-level oxygen therapy. Adequate nutrition, vaccinations, and smoking cessation are also important in the treatment plan. With severe COPD, surgical options may be considered, such as lung volume reduction surgery (removal of damaged lung tissue) and lung transplantation.