Upper and lower Respiratory Tract Infections
The upper respiratory tract consists of our nasal cavities, pharynx, and larynx. Upper respiratory infections (URI) can spread from our nasal cavities to our sinuses, ears, and larynx. Sometimes a viral infection can lead to what is called a secondary bacterial infection. “Strep throat” is a primary bacterial infection and can lead to an upper respiratory infection that can be generalized or even systemic (affects the body as a whole).
Antibiotics aren’t used to treat viral infections, but are successful in treating most bacterial infections, including strep throat. The symptoms of strep throat can be a high fever, severe sore throat, white patches on a dark red throat, and stomach ache.
An infection of the cranial sinuses is called sinusitis. Only about 1-3% of URI’s are accompanied by sinusitis. This “sinus infection” develops when nasal congestion blocks off the tiny openings that lead to the sinuses.
Some symptoms include: post nasal discharge, facial pain that worsens when bending forward, and sometimes even tooth pain can be a symptom.
Successful treatment depends on restoring the proper drainage of the sinuses. Taking a hot shower or sleeping upright can be very helpful. Otherwise, using a spray decongestant or sometimes a prescribed antibiotic will be necessary.
Otitis media in an infection of the middle ear. Even though the middle ear is not part of the respiratory tract, it is discussed here because it is often a complication seen in children who has a nasal infection. The infection can be spread by way of the ‘auditory (Eustachian) tube that leads form the nasopharynx to the middle ear.
The main symptom is usually pain. Sometimes though, vertigo, hearing loss, and dizziness may be present. Antibiotics can be prescribed and tubes are placed in the eardrum to prevent the buildup of pressure in the middle ear and the possibility of hearing loss.
Tonsillitis occurs when the tonsils become swollen and inflamed. The tonsils located in the posterior wall of the nasopharynx are often referred to as adenoids. If you suffer from tonsillitis frequently and breathing becomes difficult, they can be removed surgically in a procedure called a tonsillectomy.
An infection of the larynx is called laryngitis. It is accompanied by hoarseness and being unable to speak in an audible voice. Usually, laryngitis disappears with treatment of the URI. Persistent hoarseness without a URI is a warning sign of cancer, and should be checked into by your physician.
Lower respiratory tract infections
Lower respiratory tract disorders include infections, restrictive pulmonary disorders, obstructive pulmonary disorders, and lung cancer.
An infection that is located in the primary and secondary bronchi is called bronchitis. Most of the time, it is preceded by a viral URI that led to a secondary bacterial infection. Usually, a nonproductive cough turns into a deep cough that will expectorate mucus and sometimes pus.
A bacterial or viral infection in the lungs where the bronchi and the alveoli fill with a thick fluid. Usually it is preceded by influenza.
Symptoms of pneumonia include high fever & chills, with headache and chest pain. Pneumonia can be located in several lobules of the lung and obviously, the more lobules involved, the more serious the infection.
It can be caused by a bacteria that is usually held in check, but due to stress or reduced immunity has gained the upper hand.
Restrictive Pulmonary Disorders Pulmonary Fibrosis
Vital capacity is reduced in these types of disorders because the lungs have lost their elasticity. Inhaling particles such as sand, asbestos, coal dust, or fiberglass can lead to pulmonary fibrosis, a condition where fibrous tissue builds up in the lungs. This makes it so our lungs cannot inflate properly and are always tending toward deflation.
Out in cold air can be an irritant. When exposed to an irritant, the smooth muscle in the bronchioles undergoes spasms. Most asthma patients have at least some degree of bronchial inflammation that reduces the diameter of the airways and contributes to the seriousness of the attack.
Respiratory Distress Syndrome Pathophysiology
At birth the pressure needed to expand the lungs requires high inspiratory pressure. In the presence of normal surfactant levels the lungs retain as much as 40% of the residual volume after the first breath and thereafter will only require far lower inspiratory pressures. In the case of deficiency of surfactant the lungs will collapse between breaths, this makes the infant work hard and each breath is as hard as the first breath.
If this goes on further the pulmonary capillary membranes become more permeable, letting in fibrin rich fluids between the alveolar spaces and in turn forms a hyaline membrane. The hyaline membrane is a barrier to gas exchange, this hyaline membrane then causes hypoxemia and carbon dioxide retention that in turn will further impair surfactant production.
Type two alveolar cells produce surfactant and do not develop until the 25th to the 28th week of gestation, in this, respiratory distress syndrome is one of the most common respiratory disease in premature infants. Furthermore, surfactant deficiency and pulmonary immaturity together leads to alveolar collapse.
Predisposing factors that contribute to poorly functioning type II alveolar cells in a premature baby are if the child is a preterm male, white infants, infants of mothers with diabetes, precipitous deliveries, cesarean section performed before the 38th week of gestation. Surfactant synthesis is influenced by hormones, this ranges form insulin and cortisol. Insulin inhibits surfactant production, explaining why infants of mothers with diabetes type 1 are at risk of development of respiratory distress syndrome.
Cortisol can speed up maturation of type II cells and therefore production of surfactant. Finally, in the baby delivered by cesarean section are at greater risk of developing respiratory distress syndrome because the reduction of cortisol produced because the lack of stress that happens during vaginal delivery, hence cortisol increases in high stress and helps in the maturation of type II cells of the alveoli that cause surfactant.
Today to prevent respiratory distress syndrome are animal sources and synthetic surfactants, and administrated through the airways by an endotracheal tube and the surfactant is suspended in a saline solution. Treatment is initiated post birth and in infants who are at high risk for respiratory distress syndrome.
Sleep apnea or sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. These episodes, called apneas (literally, “without breath”), each last long enough so one or more breaths are missed, and occur repeatedly throughout sleep.
The standard definition of any apneic event includes a minimum 10 second interval between breaths, with either a neurological arousal (3- second or greater shift in EEG frequency, measured at C3, C4, O1, or O2), or a blood oxygen desaturation of 3-4 percent or greater, or both arousal and desaturation. Sleep apnea is diagnosed with an overnight sleep test called polysomnogram.
One method of treating central sleep apnea is with a special kind of CPAP, APAP, or VPAP machine with a Spontaneous Time (ST) feature. This machine forces the wearer to breathe a constant number of breaths per minute. (CPAP), or continuous positive airway pressure, in which a controlled air compressor generates an airstream at a constant pressure. This pressure is prescribed by the patient’s physician, based on an overnight test or titration.