Lesson 1, Topic 1
In Progress

Acute Respiratory Diseases

April 11, 2024

Learning Objective: Examine acute respiratory diseases and disorders, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      An acute disease is a disease that has a severe, sudden onset. There are many acute respiratory diseases. The following sections examine common acute respiratory diseases.


Acute Bronchitis
Learning Objective: Describe acute bronchitis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Acute bronchitis is an inflammation of the lining of the bronchial tubes. The bronchial tubes become irritated and swollen, narrowing the airway. Excessive mucus is produced, leading to increased coughing.
      Acute bronchitis is usually caused by a lower respiratory viral infection. Viral conditions, such as the common cold, influenza, and pertussis (whooping cough), can also cause acute bronchitis. In rare cases, a bacterial infection causes the disease. In addition, breathing in irritants or inhaling food or vomit can cause acute bronchitis. Acute bronchitis can cause a dry, hacking cough that can turn into a productive cough. The patient may also experience a low-grade fever, fatigue, and weakness.
      After obtaining a medical history and performing an examination, the provider may order a chest x-ray. Pulse oximetry, which determines the oxygen saturation in the blood, may also be performed. In most cases, acute bronchitis is viral, so no antibiotics are prescribed. At-home treatments include using cough drops and a humidifier to soothe a dry throat. Patients are encouraged to drink plenty of fluids and get adequate rest. Over-the-counter (OTC) medications are used for fevers and body aches. Patients are encouraged to stop smoking and using e-cigarettes.


COVID-19
Learning Objective: Describe COVID-19, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      COVID-19 is also called coronavirus disease 2019 and SARS-CoV-2. This disease originated in China in 2019 and created a worldwide pandemic. Several vaccines have been approved and can prevent or decrease the severity of the illness should a person get COVID-19. Because this is a new disease, new information is being learned all the time.
      COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronaviruses are a group of viruses that cause several illnesses, including the common cold and severe acute respiratory syndrome (SARS). The following factors put people at a higher risk of serious illness with COVID-19:
                 • Age over 65
                 • Lung disease, such as COPD, asthma, and cystic fibrosis
                 • Weakened immune system, from cancer treatments, transplants (e.g., bone marrow, solid organ), and chronic diseases
                 • Type 1 or type 2 diabetes mellitus, chronic kidney disease, liver disease, sickle cell disease, high blood pressure, heart disease, severe obesity, and nervous system conditions
      The severity of the signs and symptoms can vary and can appear 2 to 14 days after exposure to the virus. COVID-19 can cause the following reactions:
• Fever, chills, muscle aches, and fatigue
                 • New loss of taste or smell, headache
                 • Rhinorrhea, sore throat, cough, shortness of breath, and chest pain
                 • Nausea, vomiting, and diarrhea
                 • Emergency warning signs: dyspnea, persistent chest pressure or pain, new confusion, inability to wake or stay awake, and cyanosis
      A viral test is performed to diagnose a current infection. A nasal or throat specimen is obtained, and viral tests can be used to check for SARS-CoV-2, the virus that causes COVID-19. Nucleic acid amplification tests (NAATs) detect the virus’s genetic material. NAATs are more accurate but take longer to process than the antigen test. Antigen tests detect viral proteins and are less sensitive; thus the test result may need to be confirmed with a NAAT. The antibody (serology) test is used to test for COVID-19 antibodies, indicating a past infection.
      Treatments depend on the severity of the illness. Home care treatments include analgesics, cough medication, rest, and fluid intake. Quarantining helps to minimize the spread of the disease. Severe cases can lead to hospitalization and oxygen therapy. Many clinical studies are underway, and additional treatments are being researched. COVID vaccines are available.
      Most people return to normal health, but some people may have post-COVID conditions (or long COVID). They may experience many symptoms for weeks to months after the infection. Post-COVID signs and symptoms can include:
                 • Tiredness, fatigue, and fever
                 • Heart palpitations, difficulty breathing, cough, and chest pain
                 • Difficulty concentrating or thinking (“brain fog”), headache, sleep issues, lightheadedness, change in smell or taste, and depression
                 • Diarrhea and stomach pain
                 • Joint or muscle pain, rash, and changes in menstrual cycles


Croup
Learning Objective: Discuss croup, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Croup is caused by inflammation of the trachea and larynx. It usually affects children ages 3 months to 5 years but can occur at any age. Croup is caused by bacteria and viruses, such as parainfluenza RSV, adenovirus, and influenza. Bacterial croup is more severe than viral croup. Usually, the person has a mild cold and low-grade fever for several days before the barking cough and hoarseness occur. As croup worsens, the child may have trouble breathing, such as inspiratory stridor, wheezing, and chest retractions.
      The provider will complete a history and physical examination. Additional tests and chest X-rays may be completed. Treatment includes antipyretics, humidifier, bed rest, and increased fluid intake. Sitting up may help the person breathe easier. In severe cases, hospitalization with antibiotics and oxygen therapy may be necessary.


Epiglottis
Learning Objective: Describe epiglottis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Epiglottis, an upper respiratory system disease, is a life-threatening inflammation of the epiglottis. Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and viruses cause epiglottis. Signs and symptoms include a high fever, pharyngitis, stridor, cyanosis, drooling, difficulty breathing and swallowing, and hoarseness.
      The provider will complete a history and physical examination. Blood and throat cultures, a complete blood count (CBC), and a neck x-ray may be ordered. Treatments for epiglottis include hospitalization, humidified oxygen, antibiotics, and corticosteroids.


Influenza
Learning Objective: Describe influenza, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Influenza, also called the flu, is an acute contagious respiratory viral infection. Two main types of influenza include Types A and B. Influenza is spread mainly by droplets from coughing, sneezing, or talking. Signs and symptoms include a fever, cough, sore throat, nasal congestion, body aches, headache, and fatigue. Children may experience vomiting and diarrhea.
      The provider will complete a history and physical examination. A nasopharyngeal swab is used to collect a specimen, and a rapid influenza diagnostic test (waived by the Clinical Laboratory Improvement Amendments [CLIA]) is done. Treatment involves bed rest, increased fluids, antiviral medications, and over-the-counter analgesics. A yearly vaccine is available for influenza.


Laryngitis
Learning Objective: Describe laryngitis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Laryngitis is inflammation of the voice box (larynx) and an upper respiratory system disease. The cause of laryngitis is overuse of the voice, irritation, or infection. Signs and symptoms include hoarseness, weakened (or loss of) voice, tickling sensation, sore or dry throat, and cough.
      The provider will complete a history and physical examination. With chronic laryngitis, a laryngoscopy and biopsy may be done. Treatment consists of antibiotics and corticosteroids. The patient is encouraged to increase fluid intake, rest the voice, and breathe moist air.


Pertussis
Learning Objective: Describe pertussis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Pertussis (also called whooping cough) is a contagious disease that is caused by Bordetella pertussis. Pertussis is spread by coughing or sneezing and develops within 5 to 10 days after exposure. Initially, the person may experience nasal drainage, a low-grade fever, and a mild, occasional cough. Later signs include a rapid coughing followed by a high-pitched “whoop” sound and vomiting. The person may be exhausted after the coughing fit. According to the CDC, infected people are most contagious up to about 2 weeks after the cough begins.
      The provider will complete a history and physical examination. A nasopharyngeal specimen is obtained for a culture. A polymerase chain reaction (PCR) test can be done. Pertussis is treated with antibiotics. The person is encouraged to stay home, rest, and use a humidifier. Good hand washing helps to eliminate transmission. The DTaP and Tdap vaccines are used to help prevent pertussis.


Pneumonia
Learning Objective: Describe pneumonia, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Pneumonia is an infection of the lungs. It may affect one or both lungs. The alveoli fill with fluid or pus. Young children, adults over 65 years of age, people who smoke, and those with chronic illnesses are at more risk for pneumonia. The severity of pneumonia can range from mild to life threatening. In the United States, about 1 million people have pneumonia yearly, and about 50,000 people die from the disease. Adults are at the most risk. Globally, it is the leading infectious disease killer of children under age 5.
      Pneumonia can be caused by bacteria, viruses, and fungi (TABLE 26.2). If a person has viral pneumonia, there is also a risk of getting bacterial pneumonia. Various chemicals can also cause pneumonia. Aspirating fluid or a foreign material into the lungs can also cause pneumonia. Signs and symptoms of pneumonia vary based on the severity and type of pneumonia. Typically, pneumonia causes high fever, chills, productive cough, shortness of breath, and chest pain with coughing or breathing. A person may also experience decreased appetite and fatigue. Confusion may occur in older adults.
      Providers will listen to a patient’s lungs for abnormal sounds. Chest x-rays, a CBC, a sputum culture, and pulse oximetry are typical diagnostic procedures used to check for pneumonia. Treatment for pneumonia is based on the type of pneumonia a person has. Antibiotics are used for bacterial pneumonia, and antiviral medications are used for viral pneumonia. Patients are encouraged to drink plenty of fluids and get rest. OTC antipyretics and analgesics (e.g., ibuprofen and acetaminophen) may be recommended.

26.4 Critical Thinking Application
Renee is rooming Carl Bowden. He is here today for a recheck appointment. He was diagnosed 10 days ago with pneumonia. As Renee gathers Carl’s history, he tells her he has smoked two packs a day for the past 30 years. He also states that he has had pneumonia six times over the past 2 years. He asks Renee if smoking might have something to do with that. Thinking back to the respiratory structures and functions you have learned about in this chapter, how would you answer his question?


Pulmonary Embolism
Learning Objective: Discuss pulmonary embolism, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Pulmonary embolism (PE) is a condition in which one of the pulmonary arteries is blocked. PE is a medical emergency and can be life-threatening. Due to the blockage, blood flow may be interrupted to that section of the lung. This can lead to pulmonary hypertension. Oxygen can be limited to other body organs.
      Often PE is a complication of deep vein thrombosis (DVT). Blood clots form in the veins, usually in the legs. Some of the clots break off and travel through the bloodstream. Eventually, the clot blocks a pulmonary artery. Risk factors for PE include the following:
                 • Current or past DVT
                 • Being bedridden, having surgery; breaking a bone
                 • Pregnancy
                 • Chronic illness (stroke, hypertension, chronic heart disease, obesity)
                 • Smoking
                 • Use of birth control pills or hormone therapy pills
      Pulmonary embolism can cause problems breathing, unexplained shortness of breath, and rapid breathing. A patient may experience chest pain, coughing or coughing up blood, arrhythmias, lightheadedness, and fainting.
Besides a medical history and physical examination, the provider may order the following diagnostic procedures:
                 • Ultrasound: to detect DVT in the legs
                 • CT scan with contrast to detect PE or DVT
                 • Lung ventilation/perfusion scan (VQ scan)
                 • Pulmonary angiography
                 • Chest x-ray and chest MRI scan
                 • Echocardiography and electrocardiogram (ECG)
The goals of treatment include preventing more clots or larger clots from forming. Treatment includes the following:
                 • Anticoagulants: “Blood thinners” (e.g., warfarin [Coumadin] and heparin) to prevent clots from forming.
                 • Thrombolytics: Medications that break up the clot. These are used in emergencies. Thrombolytics can be delivered by a catheter to the site of the clot.
                 • Compression stockings: To help prevent blood from pooling and clotting in the legs.


Pulmonary Tuberculosis
Learning Objective: Describe pulmonary tuberculosis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      Pulmonary tuberculosis (TB) is caused by bacteria that can affect the lungs. There are two TB-related conditions: latent TB infection and TB disease. Tuberculosis is caused by Mycobacterium tuberculosis, which is spread through the air. The following individuals are at risk for TB:
                 • Anyone who has lived in a country where TB is prevalent
                 • Anyone in frequent close contact with someone with TB disease
                 • Those working in healthcare, a homeless shelter, or a prison
                 • Those living in a nursing home, prison, or homeless shelter
                 • People who have latent TB infection and a weakened immune system because TB can become active under these conditions
There are differences regarding the spread and the signs/symptoms of the two TB-related conditions:
                 • With latent TB infection, a person cannot spread TB bacteria to others, and there are no signs or symptoms.
                 • With TB disease, a person can spread the disease by coughing, sneezing, singing, or talking. TB disease can cause a bad cough that lasts 3 or more weeks, pain in the chest, blood in the sputum, weakness, no appetite, weight loss, chills, fever, and night sweats.
      Initially, the person is tested with either a Mantoux tuberculin skin test (TST) (also known as a purified protein derivative [PPD] test) or a TB blood test (e.g., QuantiFERON-TB Gold Plus [QFT-Plus], T-SPOT.TB). If the test is positive, then the person will have additional testing (e.g., chest x-ray and sputum smear/culture) to determine if it is latent TB infection or TB disease. With latent TB infection, the chest x-ray is normal, and the sputum smear/culture is negative. With TB disease, the chest x-ray is abnormal, and the sputum smear/culture is positive. Treatments include the following:
                 • For latent TB infections, isoniazid or rifapentine may be prescribed. The goal is to prevent TB disease; a weakened immune system can increase the risk of TB disease.
                 • For TB disease, isoniazid, rifampin, ethambutol, or pyrazinamide may be prescribed. With treatment, TB disease symptoms tend to diminish within 2 to 3 weeks, but medication treatment may last for 6 to 9 months.


26.5 Critical Thinking Application
Renee is confused about the two different types of tuberculosis (TB). She asks John to summarize the difference between latent TB infection and TB disease. How would you summarize the differences?


Respiratory Syncytial Virus
Learning Objective: Describe respiratory syncytial virus, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      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, and 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. Supplemental oxygen, albuterol breathing treatments, and inhaled epinephrine may be given.


Sinusitis
Learning Objective: Discuss sinusitis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      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 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
Learning Objective: Discuss strep throat, including the signs, symptoms, etiology, diagnostic procedures, and treatments.
      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.


Additional Respiratory System Diseases and Disorders
Learning Objective: Describe additional respiratory system diseases and disorders.
There are many respiratory diseases. The following list provides a brief description of several of them:
                 • 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.
                 • Anthracosis: A loss of lung capacity caused by an accumulation of coal dust in the lungs; also called black lung disease.
                 • 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.
                 • Bronchiolitis: A common viral infection in young children and infants. The bronchioles become inflamed, and mucus builds up in the airway, affecting breathing.
                 • 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.
                 • Deviated septum: A shifting of the nasal septum from the midline.
                 • Diphtheria: A bacterial respiratory infection characterized by sore throat, fever, and headache.
                 • 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 defects, thoracic surgery, lung cancer, and tuberculosis.
                 • 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.
                 • 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.
                 • 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.
                 • 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).
                 • Neonatal respiratory distress syndrome (RDS): Often seen in premature babies born before 37 to 39 weeks of gestation. They lack enough surfactant in their lungs, which leads to respiratory distress. Infants are given warm, moist oxygen and may be put on a ventilator.
                 • Pleural effusion: An abnormal, excessive buildup of fluid between the layers of tissue that line the lungs and chest cavity.
                 • Pleurisy: Infection of the pleura. They are caused by bacteria, fungus, 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.
                 • 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).
                 • Pulmonary abscess: A localized collection of infectious material in the lungs.
                 • 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.
                 • Pyothorax: Pus in the pleural cavity. Also called empyema.
                 • Rhinomycosis: A fungal infection of the nasal mucous membranes.
                 • 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.
                 • Severe acute respiratory syndrome (SARS): A viral respiratory disorder caused by a coronavirus. It usually results in pneumonia.
                 • Silicosis: The loss of lung capacity caused by an accumulation of glass dust in the lungs.
                 • Upper respiratory tract infection: An inflammation or infection of the upper respiratory structures. Known as the common cold.