Asthma: Pathophysiology, Signs, and Symptoms

• Chronic inflammatory airway disease marked by bronchial hyperresponsiveness, reversible airflow obstruction, and episodic wheezing, dyspnea, chest tightness, and coughing.
• Asthma results from immune system hypersensitivity to environmental triggers.

Pathophysiology

• Exposure to triggers leads to mast cell degranulation and histamine, leukotriene, and prostaglandin release.
• Mediators can cause bronchoconstriction, inflammation, increased mucus, and airway hyperreactivity.
• Chronic inflammation leads to airway remodeling with fibrosis, smooth muscle hypertrophy, and goblet cell hyperplasia.
• Reversible airflow limitation occurs, but long-term cases can develop persistent obstruction.

Signs & Symptoms

• Intermittent wheezing is a sign of asthma
• Shortness of breath (dyspnea)
• Chest tightness
• Chronic cough, often worse at night or early morning.
• Prolonged expiration
• Use of accessory respiratory muscles during severe attacks
• Decreased Peak Expiratory Flow Rate (PEFR) during exacerbations

Diagnosis

• Spirometry shows reduced FEV1/FVC ratio, improving after bronchodilator use.
• PEFR Monitoring shows diurnal variability of >20%.
• Methacholine Challenge Test confirms airway hyperresponsiveness.

Management: Medical Treatment

• Bronchodilators (Relievers) are a main form of medical treatment
  • Short-acting beta-agonists (SABAs) like Salbutamol and Terbutaline
  • Long-acting beta-agonists (LABAs) such as Salmeterol and Formoterol
• Anti-inflammatory Drugs (Controllers)
  • Inhaled corticosteroids (ICS) like Budesonide and Fluticasone
  • Leukotriene receptor antagonists such as Montelukast and Zafirlukast
  • Monoclonal Antibodies: Omalizumab (Anti-IgE therapy)
• Oral Corticosteroids like Prednisolone are good for severe cases

Management: Surgical

• Bronchial thermoplasty treats severe refractory asthma

Physiotherapy Management

• Diaphragmatic breathing strengthens the diaphragm, reducing dyspnea.
• Pursed-Lip Breathing slows expiration and reduces airway collapse.
• Segmental Breathing focuses on underventilated lung areas.
• Buteyko Breathing Technique controls hyperventilation and anxiety-related dyspnea.
• Airway Clearance Techniques (ACTs) utilize deep breathing, breath-holding and forced expiration.
• Active Cycle of Breathing Techniques (ACBT) include deep breathing, breath-holding, and forced expiration.
• Postural Drainage uses gravity to clear mucus from the lungs.
• Oscillatory PEP Devices (Acapella, Flutter) create vibrations to break up mucus.
• Aerobic Training enhances cardiovascular endurance with walking, cycling, or swimming.
• Respiratory Muscle Training improves inspiratory/expiratory muscle strength.
• Yoga & Relaxation Techniques help manage stress-induced asthma.

Patient Education

• Training on correct inhaler technique
• Trigger avoidance (allergens, smoke, cold air, stress)
• Peak flow meter monitoring for early detection of exacerbations

Breathing retraining, Diaphragmatic Breathing

• Encourages deep breathing with lower chest expansion
• Reduces respiratory muscle fatigue and improves oxygenation.
• Performed by placing one hand on the chest and one on the abdomen, inhaling deeply to expand the diaphragm.

Breathing retraining, Pursed-Lip Breathing

• Exhaling through pursed lips to slow expiration and reduce breathlessness.
• Prevents airway collapse and helps in better ventilation by decreasing trapped air.

Breathing retraining, Buteyko Breathing Technique

• Focuses on reducing hyperventilation by controlling breathing patterns.
• Use is for patients with mild asthma to avoid over-breathing and carbon dioxide retention.

Breathing retraining, Segmental Breathing

• Encourages lung expansion in specific lung areas with manual facilitation.
• Useful in patients with areas of reduced ventilation.

Airway Clearance Techniques (ACTs)

• Combination of breathing control, deep breathing, and forced expiratory technique (huffing) to clear mucus.
• Reduces airway resistance and promotes secretion mobilization.

Postural Drainage and Chest Percussion

• Positions the patient to use gravity for mucus clearance from different lung segments.
• Combined with percussion to loosen mucus when there is excessive sputum production.

OPEP Devices

• Generates oscillations in the airways, helping to break up mucus and clear secretions.
• Examples include Flutter, Acapella, RC-Cornet.

Exercise therapies

• Walking, cycling, and swimming improve overall lung function, endurance, and oxygen uptake- reduces airway hyperresponsiveness over time.
• Using devices strengthens the diaphragm and intercostal muscles- improves respiratory effort and reduces dyspnea.
• Breathing control exercises such as Pranayama improve lung capacity- reduces stress-induced asthma exacerbations.

Inhalers

• Training on metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) helps ensure optimal medication delivery.
• Avoidance e.g., dust mites, pollen, pet dander, cold air: maintenance includes air purifiers and humidifiers.
• Meters monitor daily lung function/understanding asthma action plans helps manage exacerbations.

Cystic Fibrosis

• Genetic disorder caused by mutations to the CFTR gene that produce thick, sticky mucus.
• Affects lungs, pancreas, and other organs.
• Results in chronic respiratory infections, pancreatic insufficiency, and progressive lung disease.

Pathophysiology

• CFTR gene mutation creates defective chloride ion transport
  • Leads to thick mucus secretion
  • Blocks airways, leading to chronic infections which are often Pseudomonas, Staphylococcus
  • Results in pancreatic enzyme deficiency, which leads to malabsorption, steatorrhea, and malnutrition.
• Progressive bronchiectasis, fibrosis, and respiratory failure

Signs & Symptoms

• Chronic productive cough
• Recurrent lung infections
• Wheezing, dyspnea, cyanosis
• Clubbing of fingers (chronic hypoxia)
• Salty sweat (due to excess chloride loss)
• Pancreatic insufficiency leads to malnutrition, and poor weight gain

Diagnosis

• Sweat chloride test shows (>60 mmol/L chloride)
• Genetic testing (CFTR mutation analysis)
• Chest X-ray/CT scan shows bronchiectasis with hyperinflation.

Management: Medical

• Dornase alfa (Pulmozyme) and hypertonic saline liquefy secretions.
• Salbutamol and Ipratropium bromide provide bronchodilation.
• Tobramycin and Azithromycin protect the body from infections.
• Creon and Pancrelipase provide Pancreatic Enzyme Replacement Therapy (PERT).
• Ivacaftor and Lumacaftor are CFTR Modulators that treat specific genetic mutations.

Management: Surgical

• Lung transplantation is a possible end-stage treatment for CF.

Physiotherapy Management

• Postural Drainage & Chest Percussion mobilize mucus
• Autogenic Drainage enhances secretion clearance.
• High-Frequency Chest Wall Oscillation aids with airway clearance

Breathing Exercises

• Utilizing Diaphragmatic & Segmental Breathing increases lung expansion, while Huff Coughing clears mucus

Exercise Therapy

• Swimming, cycling, and walking enhances overall lung function.
• Strength training improves muscular endurance, while pulmonary rehabilitation programs include supervised training and patient education.
• Aim for a high-calorie, high-protein diet with hydration strategies.
• Annual flu and pneumococcal vaccines are recommended

Airway Clearance Techniques (ACTs)

• Positioning the patient in different postures to facilitate mucus drainage, Clapping to loosen mucus, and manual shaking to aid clearance during exhalation.
• Breathing at different lung volumes to mobilize mucus that are encouraged by self-management

OPEP Devices

• Vibrations that loosen thick mucus in CF patients
• Flutter, Acapella and RC-Cornet devices

Breathing Exercises

• Diaphragmatic and Segmental Breathing improves oxygenation and expands collapsed alveoli.
• Huff Coughing provides controlled exhalations- avoids airway collapse.
• Splinting: Device encourages deep inhalation- prevents collapsed lung

Nutritional & Patient Education

• High-protein, high-calorie diet with pancreatic enzyme supplements- help maintain mucus hydration and are critical to preventing infections.

Emphysema

• Progressive, chronic obstructive lung disease.
• Destroys alveolar walls and permanently enlarges air spaces distal to the terminal bronchioles.
• Causes air trapping, reduced gas exchange efficiency, and hyperinflation, leading to dyspnea and respiratory dysfunction.

Exposure to Irritants & Inflammatory Process:

• Cigarette smoke and environmental pollutants are major risk factors.
• Genetic predisposition (a1-antitrypsin deficiency) can increase risk.
• Exposure triggers neutrophils, macrophages, and lymphocytes to infiltrate alveoli.
• Enzymes such as elastase and matrix metalloproteinases break down elastin fibers.

Alveolar Destruction & Air Trapping occur

• Loss of alveolar wall integrity leads to enlarged air spaces (bullae formation).
• Reduces alveolar surface area impairing gas exchange, reduces elastic recoil, causes air trapping.

Body Compensatory Changes

• Flattening of the diaphragm reduces breathing efficiency and increases effort using accessory muscles, leading to Hypoxia and hypercapnia..

Pulmonary Hypertension

• Hypoxia-induced vasoconstriction increases pulmonary arterial pressure.
• Right ventricular hypertrophy and heart failure leads to peripheral edema and cyanosis.

Clinical Features

• Progressive dyspnea progressing to exertion.
• Can have pursed-lip breathing, or barrel chest due to lung hyperinflation.
• Diminished breath sounds, wheezing, and hyper-resonance on percussion can also occur
• Pink puffer phenotype or weight loss due to increased energy levels.

Diagnosis

• A FEV1/FVC (<70%) or high residual volume (RV) & total lung capacity indicates irreversible airflow obstruction.
• Hyperinflation, flattened diaphragm can be found on chest x-rays.
• Arterial Blood Gas shows chronic respiratory acidosis.

Treatment

• Short-acting agonists provide quick relief, while long-acting agonists/reduce constriction.
• Inhaled Corticosteroids reduce airway inflammation to help breathing, and is used when oxygen is below 88%.
• For exacerbations, Phosphodiesterase-4 Inhibitors assist in breathing.
• Surgery can remove damage tissue, while support comes from structured exercises.

Physiotherapy

• Breathing techniques such as Pursed-lip breathing & diaphragmatic breathing can help those with constricted airways.
• Low-impact exercising like walking or cycling aid with better oxygen intake

Chronic Bronchitis

• Chronic inflammatory disorder of the bronchi, characterized by excess mucus production, persistent cough, and airflow limitation.
• Classified as Chronic Obstructive Pulmonary Disease (COPD) if it results in irreversible airway obstruction.
• Productive cough that persist for 3 months two years in a row is a confirmed diagnosis

Pathophysiology

• Chronic inhalation of irritants, with goblet cell hyperplasia, reduces ciliary function - leading to mucus plugging.
• Airflow Mismatching can lead to Alveolar Hypoxia- as pulmonary vasoconstriction can effect the heart causing failure/hypertension.

Clincial Features

• Chronic productive cough, progressive loss of breath. "Blue Bloater" Phenotype
• Cyanosis is common from Cor Pulmonale

Diagnosis

• Pulmonary studies reveal FEV1/FVC ratio that are below average/abnormal
• Irreversible Airflow Limitation increases markings/Cor Pulmonale on film/analysis

Healthcare

• Relief can be found in Short and Long term medications, with inhaled steroids.
• Supplemental oxygen helps patients with breathing difficulties, in addition to medical support.
• Diaphragmatic breathing and Active Cycle of Breathing promotes deeper ventilation as well.

Atelectasis

• Collapse of alveoli results to reduced gas exchange, ventilation-perfusion mismatch, and hypoxia
• Commonly caused by airway obstruction, lung compression, or surfactant deficiency
  • Obstructive is caused by mucus, blocked airway
  • Adhesion is caused by lack of surfactant
  • Scatricial Fibortic is caused fibrotic scarring

Symptoms

• Symptoms can range from Shortness of breath, with abnormal breathing sounds in conjunction with collapsed lungs
• Tracheal Deviation or Cyanosis often occur

Diagnosis

• Radiography can detect opacification of lung. Further analyses are bronchoscopy and the like.

Treatment

• Mucolytics and bronchodialators work to reduce thickness. Additional treatments are to manage pain and lung function.

Pneumonia

• Acute infection of the lung which results from fluid build-up that can block air.

Pathophysiology

• Pathogen finds its way into lung/air tissue and inflames
• Capillary leak causes fluid build up, creates a mismatch and impacts breathing capability
• A cough may develop along with other symptoms

Community and Hospital related pneumonia

• Commmunity strep is the most common
• Hospital is common after a 48 hour wait due to pseudonomas aeruginosa or MSRA
• Aspiration occur with food/saliva

Types of viral pneumonia

• Influenza SARS-CoV-2 can occur

Symptoms

• Fever are common, sputum and and chest pain are very common/indicative in the lungs
• One may contract cyanosis as well during this

Diagnoses

• Analysis via blood culture, such as gram stain, and ABG are performed.
• Lober or different infiltrates can also be observed.

Healthcare

• Antibiotics with antivirals are common if one is present.
• Balance via fluids electrolyte intake are necessary.
• Breathing/ Mobilization via diaphragmatic practices can help
• Energy activities

Acute Respiratory Distress Syndrome (ARDS)

• ARDS is a severe, acute inflammatory lung injury that results in non-cardiogenic pulmonary edema, profound hypoxemia, and respiratory failure.
• Increased alveolar-capillary permeability causes fluid accumulation that reduces lung compliance that fails without support.
• Sepsis (most common cause), pneumonia, aspiration, massive transfusion can be triggers.

Major Phases with ARDS

• Cytokines trigger (IL-I, IL-6) that damage alveolar membranes in under a week. That can cause flooding.
• 7 to 21 days involves Lung Repairing with persistent mismatches.
• Over >21 days, fibrosis that can lead to insufficieny and can pressure related hypertension.
• Can be identified by severe loss of breath, crackles, unresponsive oxygen levels

Treatment and Care

• Can be analysed by PaO2 tests. To then treat, Mechanical Ventilation, fluids, or neuromuscular blockade (paralalysis).
• Prone positions are often used.

Lung Tumors (Lung Cancer)

• Definition is uncontrolled spread that forms masses that block passageways
• Is the #1 leader in cancer deaths worldwide
• The #1 cancer is nonsmall cell, with a small portion under small
• Both require the lung that forms, DNA and metasistization that creates the tumors.
• Local symptoms are cough and pain, with a large array of disorders.

Tests

• X RAY or CAT scans can detect lung masses
• PET scans and pulmonary screenings can detect/monitor cancer
• To treat may require chemotherapy, targeted therapy and surgery. PT promotes deep breathing
• Preoperative scans will include incentives with breathing and other pulmonary routines.

Pneumothorax

• Accumulation of air in the pleural cavity, which disrupts the negative pressure required for lung expansion.

Causes

• Primary Spontaneous cases do not have underlining issues
• Secondary cases are commonly COPD and Tuberculosis.
• Traumatic cases stem from rib cage fractures or injuries.
• Intergenic can also occur via mechanical ventilation or lung biopsy.

Tension Pneumothorax

• When lung issues worsen over time it can be categorized as tension: causing collapses, heart issues.

Indicators

• Sudden chest pains and breath loss
• Absent breathing sounds, with abnormal percussion stemming from tensions.
• Severe cases can require Tension Pneumothorax

Treatment

• Small Pneumothorax requires monitoring, where as Moderate Pneumothorax requires needle aspiration.
• Serious cases may require VATS

Pleural Effusion

• Definition: abnormal collection of fluid that inhibits breathing function.

Types of Pleural Effusion:

• Transudative are low/contain some proteins
• Exudative contain pneumonia, embolism and cancer
• Empyema is infections located in lung tissue

Analysis, Side Effects and Signs

• Hemothrorax or blood is known from trauma. This causes poor ventilation.
• Pain can occur if you get hurt. Dullness and bad breathing sounds may occur.
• Diagnosis often occurs via X rays that determine high fluid.

Care

• Support is known via draining and managing if something persists such as surgical management.
• High fowlers are great for positional help too

Goodpasture Syndrome

• Definition- Autoimmune disorder triggered by glomerular malfunction

Etiology-

• Autoimmune mechanisms mistarget Type IV
• Can be triggered by smoking or infections
• Triggerd by glomerular disruption and bleeding that can cause failure.

Pulmonary Symptoms-

• Breathing issues,coughing and blood loss. Renal Issues are seen from blood loss.
• Can be tested, with antibody screenings via lung tests.
• Patients require oxygen or kidney maintenance

Education

• Life modifications such as avoid lung damage are great methods as well. Steriods help breathing

Pulmonary Rehabilitation

• Improve physical funtion, provide symptom comfort while improving life quality due to infections

Goal

• Lower hospital admission, make life easier.
• Good treatment needs functional training and laboratory tests.

Physical Examination

• Measurement along with joint functions/analysis.
• Is a 6 minute walking test for breathing
• Diagpraghmatic and Thoractic Exercises
• Aerobic routines help as well with lifestyle changes
• May need higher doses of O2 with smoking plans.

Laryngitis

• Definition: Is when voice chords infame and cause pain
• Main causes are viral
• You can strain vocally with pollution and GERD- causing lots of strain.

Signs

• Swelling of chrods and higher mucus production can contribute to it
• Can be diagosed via throat culture for bacteria
• Requires voice rest and proper vocal habits

Lifestyle

• Hydration is important to reduce stress, with heat humidity and vocal activities.
• Stretches can be done at the moment.

Common Cold

• Is a limiting viral infection
• Most have rhinovirus with airborne transmissions,

Process

• Virus comes in and mucus forms
• Fever comes with it due to increased cytokine activity

Signs of sickness

• Sore throats appear
• A Low grade level of discomfort and breathing symptoms

Prevention

• Stay hydrated, as symptoms can be reduced. Make sure to reduce mucus as well too to reduce inflammation.

Tonsillitis

• Tonsillitis, a role in lymphoid immune functions with a painful sore throat
• It is a swelling with an infection that is categorized by swollen lymph nodes. This is often from viral

Causes and Risk

• Strep and fungical bacterias exist and can cause this.
• Swelling of pus with bad breath, causes ear and tough speaking
• One may experience the symptoms, and strep can be diagnosed then. If serious, tonsil will be removed

Treatment

• Supportive warm treatments are great, so long as anti biotic are avoided.

Healing

• If the tonsils are removed, encourage speech sounds and liquids with hygiene

Sinusitis

• Definition: Inflammation of the paranasal with congestion
• Can be bacterial,fungal and allergic

Common Triggers

• Air,CF or allergic reactions
• Mucosa with fluids lead to sinus formation

Clinical

• Discharge and smell loss
• Can be analyzed with structural scans. With medication

Care

• Antibiotics and Steroids can control/clear up and or sinus surgies. Pts will help in airflow with techniques after.