Respiratory infections and additional disorders

Respiratory syncytial virus

Respiratory syncytial virus (RSV) produces upper respiratory “cold” symptoms in healthy older children and adults. For young children and adults with medical problems, it can cause pneumonia and severe breathing problems.

RSV spreads by coughing or sneezing. The virus can survive for several hours on infected surfaces. Typical outbreaks of RSV occur in winter and early spring. RSV can cause nasal congestion, low-grade fevers, a runny nose, and a mild cough. Complications can include a barking cough from swelling near the vocal cords, high fevers, wheezing, apnea, cyanosis, and difficulty breathing.

During the physical exam, the provider listens to the lungs, checking for wheezing and other abnormal lung sounds. Additional diagnostic procedures include pulse oximetry, chest x-rays, and laboratory tests (e.g., a CLIA-waived RSV test, viral cultures of the respiratory secretions from the nose). Treatment consists of over-the-counter medication (e.g., acetaminophen [Tylenol]) for the fever and plenty of fluids to prevent dehydration. People with severe cases of RSV are hospitalized. Treatment in the hospital is mainly supportive, such as supplemental oxygen and fluids. For infants and young children with RSV bronchiolitis, the American Academy of Pediatrics recommends against albuterol and epinephrine breathing treatments.

Sinusitis

Sinusitis is the inflammation of the sinuses. It is an upper respiratory system disease and can be acute or chronic. The cause of sinusitis can include structural abnormalities, or a cold may cause mucus to pool and pathogens to grow.

Signs and symptoms of sinusitis include a fever, weakness, fatigue, nasal and sinus congestion, cough, bad breath, or loss of smell.

The provider will complete a history and physical examination. A sinus x-ray may be taken. Treatment includes antibiotics, decongestants, and over-the-counter analgesics. The patient may be encouraged to apply a warm pack to the sinus areas, administer saline nasal sprays, and use a vaporizer.

Strep throat

Strep throat is a highly contagious bacterial infection of the throat. Untreated strep throat can cause kidney inflammation and rheumatic fever. Strep throat is common in children but can affect people of all ages.

Strep throat is caused by group A streptococcal bacteria, which spreads through droplets from coughing, sneezing, or sharing food or drink. Signs and symptoms of strep throat include a rash, nausea, vomiting, fever, headache, painful swallowing, sore throat, tiny red spots at the back of the throat, and white pus patches.

A history and physical will be done. A rapid antigen test (CLIA waived) and a throat culture can be done. Treatment consists of antibiotics, antipyretics, and over-the-counter analgesics. Patients are encouraged to rest, drink plenty of fluids, gargle with warm salt water, and use a humidifier. They should stay home until they have been on the antibiotics for 24 hours.

CLIA note: Rapid antigen tests, like the RSV test and the strep test, are CLIA-waived and can typically be performed by the MA; a throat culture or viral culture is a higher-complexity test sent to a reference lab. Which tests an MA may perform still depends on the practice’s CLIA certificate and state delegation rules.

Additional respiratory system diseases and disorders

There are many respiratory diseases. The descriptions below are grouped by what separates each one from its neighbors — where the problem sits, or what caused it — because that is usually how they are told apart.

What has collected in the pleural space

• Pleural effusion: An abnormal, excessive buildup of fluid between the layers of tissue that line the lungs and chest cavity.
• Hemothorax: A condition that results in a collection of blood in the space between the chest wall and the lung (the pleural cavity). Caused by chest trauma, blood clotting defect, thoracic surgery, lung cancer, and tuberculosis.
• Pyothorax: Pus in the pleural cavity, distinguished from pleural effusion (fluid) and hemothorax (blood). Also called empyema.
• Pneumothorax: Air or gas in the pleural space causes the lung to collapse (atelectasis). Caused by a rupture of a small blister on the lung’s surface or trauma. The person experiences a sudden, sharp pleuritic pain that increases with movement, breathing, or coughing. Shortness of breath, cyanosis, rapid pulse, and respiratory distress is also experienced. Breath sounds are decreased over the collapsed lung field. A chest x-ray, CT scan, pulse oximetry, and arterial blood gases may be done. Treatment depends on the cause of the collapse and may include bed rest and monitoring of vital signs, a chest tube, or surgical procedures to remove a portion of the pleura (pleurectomy).
• Pleurisy: Infection of the pleura. Caused by bacteria, fungi, parasites, or viruses. It can also be caused by inhaling toxins. Causes stabbing pain with inspiration, cough, fever, chills, and dyspnea. A pleural friction rub is heard over the lung field. A chest x-ray, an ultrasound, and CT scan can be done. Treatment involves analgesics, anti-inflammatories, bed rest, and a thoracentesis.

Inhaled dusts and occupational exposure

• Anthracosis: A loss of lung capacity caused by an accumulation of coal dust in the lungs; also called black lung disease.
• Silicosis: The loss of lung capacity caused by an accumulation of silica (quartz) dust in the lungs.

Conditions of premature infants

• Neonatal respiratory distress syndrome (RDS): Seen in premature infants, with risk rising the earlier the birth (highest before about 28 weeks of gestation) because the lungs haven’t yet made enough surfactant. Infants are given warm, moist oxygen and may be put on a ventilator.
• Bronchopulmonary dysplasia (BPD): A chronic respiratory condition that affects premature infants or infants who are on a ventilator (breathing machine). Infants require high concentrations of oxygen and assisted ventilation. They may have lung damage and are at greater risk for repeated respiratory infections.

Infections, by the kind of organism

• Diphtheria: A bacterial respiratory infection characterized by sore throat, fever, and headache.
• Legionnaires’ disease: A serious, life-threatening type of pneumonia caused by breathing in mist or swallowing water containing Legionella pneumophila bacteria. Can come from water in hot tubs, showers, or air conditioning units. Also called legionellosis.
• Pulmonary abscess: A localized collection of infectious material in the lungs.
• Bronchiolitis: A common viral infection in young children and infants. The bronchioles become inflamed, and mucus builds up in the airway, affecting breathing.
• Influenza A (H1N1) infection: Results from transmission of the novel influenza A (H1N1) virus to humans, causing influenza symptoms, diarrhea, and vomiting. Also called swine flu.
• Severe acute respiratory syndrome (SARS): A viral respiratory disorder caused by a coronavirus. It usually results in pneumonia.
• Upper respiratory tract infection: An inflammation or infection of the upper respiratory structures. Known as the common cold.
• Histoplasmosis: A fungal disease of the lungs caused by inhalation of Histoplasma capsulatum. H. capsulatum is found in soil and dust contaminated with bird or bat droppings.
• Rhinomycosis: A fungal infection of the nasal mucous membranes.

Blocked or collapsed airways

• Deviated septum: A shifting of the nasal septum from the midline.
• Atelectasis: A partial or complete collapse of the lung, which prevents normal oxygen absorption. It can be caused by lung disease, surgery, or a blockage.
• Bronchiectasis: An infection or other conditions that cause damage to the airway, leading to bronchial dilation and scarring.

Growths in the nose and pharynx

• Nasal polyps: Soft, saclike growths on the lining of the nose or sinuses. Can obstruct the airway and block drainage from the sinuses.
• Nasopharyngeal carcinoma: Malignant tumors in the pharynx, which can be related to diet or the Epstein-Barr virus. They cause a mass in the neck, nasal obstruction, epistaxis, and serous otitis media (middle ear infection).

Lung tissue and circulation

• Acute respiratory distress syndrome: A life-threatening condition that prevents enough oxygen from getting into the blood. Fluid buildup in the lungs reduces the lungs’ ability to expand and causes hypoxemia.
• Pulmonary edema: An accumulation of fluid in the lung tissue caused by the inability of the heart to pump blood. It is often present in cases of congestive heart failure.
• Pulmonary fibrosis: Scarring of lung tissue, causing the tissues to get stiff and thick. Breathing can be difficult, and the person can have hypoxemia.
• Pulmonary hypertension (PH): The blood pressure is high in the pulmonary arteries, which affects the blood flow in the lungs. The blood vessels become hard and narrow, causing hypoxemia. PH may be related to genetics or other conditions, such as heart or lung disease.
• Sarcoidosis: A condition that causes lesions to form in the lungs and chest lymph nodes. It can lead to chronic illness and organ damage. Its origin is unknown.