Respiratory Problems
What is Respiratory Problems?
The term respiratory problems indicates diseases of the respiratory system comprising of the lungs, pleural cavity, bronchial tubes, trachea, upper respiratory tract and also the nerves and muscles required in the process of breathing. Respiratory problems vary in their severity from mild and easily curable like common cold, to life-threatening like bacterial pneumonia or pulmonary embolism (abnormal blood flow inside the lungs). The study of respiratory disease is known as Pulmonology. Respiratory problems are responsible for over 10% of hospitalizations and over 16% of deaths in cold countries like Canada. Hence, research in respiratory ailments is widespread over the world to prevent avoidable deaths.
Symptoms of Respiratory Problems
The symptoms of respiratory problems differ depending on the type of infection, location of infection and severity. Also in some cases, respiratory problems are diagnosed without obvious symptoms while investigating another disease or through a routine medical checkup.
Common symptoms are:
1) Dyspnea – shortness of breath which is similar to that after vigorous exercise even while resting
2) Cough - exudative (sputum) or non-exudative (dry)
3) Haemoptysis – coughing blood
4) Stirdor – wheezing or noisy breathing
5) Chest pain – this worsens with the movement of breathing
6) Loss of appetite
7) Weight loss
8) Cyanosis – bluish color of the lips, fingers and tongue.
Diagnosis of Respiratory Problems
Respiratory problems may be investigated by performing one or more of the following tests as required by the severity of the symptoms:
Chest X-ray: Chest radiography is carried out to check for inflammation, exudation, tumors or growths, blockages, etc.
Spirometry: A pulmonary function test called Spirometry is undertaken. This test helps to measure the lungs’ ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines that a patient must breathe into.
Computed Tomography (CT) scan: This is an imaging procedure that uses a combination of X-rays and computer technology to produce horizontal as well as vertical cross-sectional images called slices of the affected area. CT scan shows detailed images of every part of the body in that area, including the bones, muscles, fat, and organs.
Sputum test: Culture of microorganisms from secretions such as sputum help to identify the microorganism which has caused the respiratory problem, without which accurate medication would be impossible.
Bronchoscopy: A fiberoptic, flexible tube is passed through the mouth into the bronchi to locate tumors or blockages in the respiratory tract. Also, samples of tissue and/or fluid are gathered for further investigation.
Ultrasonography: Ultrasound scanning is undertaken to detect fluid accumulation like in the case of pleural effusion.
Test for carcinogens: Biopsy of the lung or pleura in undertaken to eliminate the possibility of cancer as a cause of respiratory problems.
Ventilation-Perfusion lung scan: Also called a V/Q lung scan, this type of imaging is used to gauge the circulation of air as well as blood within a patient’s lungs. The ventilation part of the test checks the ability of air to reach all parts of the lungs. The perfusion part checks to see how well the blood circulates within the lungs. This test is most commonly undertaken to check for the presence of blood clot, pulmonary embolism or PE, Chronic Obstructive Pulmonary Disease (COPD) or Pneumonia.
Causes of Respiratory Problems
The usual causes of respiratory problems are:
a) Smoking – cigarettes are a major cause of most respiratory problems and the main cause of lung cancers
b) Allergies and asthma – allergic reaction to climatic changes, pollen, certain foodstuff, etc can cause certain types of respiratory problems
c) Sinusitis – inflamed sinuses, headaches, etc can be another cause of respiratory problems
d) Air pollution – exhaust from vehicles, industrial effluent and toxic gases, etc can be a cause for respiratory ailments
e) Chronic obstructive pulmonary disease (COPD) – this disease causes other respiratory symptoms
f) Lung cancer – the lungs are weakened and susceptible to other respiratory infections.
Types of Respiratory Problems
There are various types of respiratory problems, classified as per the type of infection and the location of infection. They are:
Chronic Obstructive Pulmonary Disease (COPD) – Obstructive lung diseases are where the bronchial tubes become narrowed making it hard to move air in and out of the lung. It is a respiratory problem of more than one disease like asthma, emphysema or chronic bronchitis existing simultaneously. Other examples are acute respiratory distress syndrome (ARDS); pulmonary edema (leakage of fluid from capillaries of the lung into the alveoli); pulmonary embolism (blood clot in a vein); pulmonary hemorrhage (inflammation and damage to capillaries in the lung resulting in blood leaking into the alveoli); and even severe acute respiratory syndrome (SARS). Some of these are fatal.
Chronic Bronchitis – The bronchi and bronchioles will stimulate an increased secretion of mucus in response to infection. In chronic bronchitis the air passages become clogged with mucus leading to persistent cough.
Emphysema - The delicate walls of the alveoli break down, reducing the gas exchange area of the lungs. The condition develops slowly and is seldom a direct cause of death.
Asthma – Restrictive lung diseases (also known as interstitial lung diseases) are characterized by inadequate lung expansion and increased lung stiffness while breathing. Periodic constriction of the bronchi and bronchioles makes it more difficult to breathe.
Pneumonia: Pneumonia is an infection of the alveoli caused by bacteria as well as viruses. The alveoli cannot take in sufficient oxygen from the air due to fluid accumulation. This reduces the level of oxygen in the bloodstream. Also, in severe cases the patient may need artificial ventilation for breathing.
Upper respiratory tract infections: The common cold is the usual respiratory problem pertaining to the upper respiratory tract. Other ailments affecting this region of the body are Sinusitis, Tonsillitis, Pharyngitis and Laryngitis.
Lower respiratory tract infections: The most common lower respiratory tract infection is Pneumonia, which can lead to other complications like lung abscess (a round cavity in the lung caused by the infection) or empyema (collection of pus) and the spread of the infection to the pleural cavity.
Tumors: Tumors of the respiratory system (lung cancers) are either malignant or benign. Malignant lung tumors form 29% of all cancer deaths. The majority of respiratory system cancers are attributable to smoking tobacco. Some lung cancers are carcinoma, Koposi’s sarcoma, melanoma, pulmonary hamartoma and congenital cystic adenomatoid malformation (CCAM).
Pleurisy: A collection of fluid in the pleural cavity is known as a pleural effusion. This can be due to fluid shifting from the bloodstream into the pleural cavity caused by other diseases like congestive heart failure, pulmonary embolism, tuberculosis, etc.
Sleep-related respiratory problems: The brain co-ordinates breathing with signals to the muscles of respiration. Disorders of the brain’s control over breathing can result in respiratory problems like obstructive or central sleep apnea, amyotrophic lateral sclerosis, etc.
Treatment of Respiratory Problems
Treatment of respiratory disease depends on the type and severity of disease as well as the general health of the patient. The following treatments are often used for respiratory diseases:
Medications: In oral or inhaled form, medicines administered are like corticosteroids (like prednisone), bronchodilators(like anti-cholinergics or beta2-agonists), antibiotics (like amoxicillin), anticoagulants, cancer chemotherapy, immunosuppressants (or anti-rejection medicines), etc.
Chest Physiotherapy (CPT): This involves the use of “flutter” or oscillating positive pressure devices, positive expiratory pressure (PEP) masks or devices as well as specific respiratory exercise regimes like autogenic drainage. General cardiovascular exercises which assist the body to remove sputum as well as to improve the efficiency of oxygen up-take in muscles are also undertaken.
Mechanical ventilation: Transport ventilators are small, rugged portable ventilators powered pneumatically. Also, PAP ventilators are specifically designed for non-invasive ventilation for home-use.
Liquid ventilation: Liquid breathing (fluid breathing) is a form of respiration in which a patient breathes an oxygen-rich liquid (usually a perfluorocarbon) rather than breathing air.
Surfactant Replacement Therapy (SRT): Surfactant, a naturally produced substance, is a kind of foamy, fatty liquid that acts like grease within the lungs. Without it, the air sacs have difficulty remaining open because they stick together. Surfactant allows the sacs to remain open. Surfactant is delivered using an artificial airway or breathing tube that is inserted into the trachea (windpipe) once respiratory problems occur.
Radiotherapy: This refers to the use of high-energy rays to kill cancerous chest tumors. Radiation therapy is a local therapy and affects cancer cells only in the treated area.
Surgery: Removal of a cancer e.g. Lobectomy, Pneumonectomy, Pleurodesis, Lung volume reduction surgery, Lung transplantation and Artificial lung.
Living with Respiratory Problems
The symptoms like cough, fever, difficult and painful breathing, loss of appetite and fatigue adversely affects the quality of life. Day-to-day activities are hampered. The personal and professional life of the patient with respiratory problems is adversely affected.
Prevention of Respiratory Problems
1) Lifestyle factors like regular exercise, a healthy, nutritious diet can 
improve the general health and functioning of the respiratory organs.
2) Annual vaccination against influenza can prevent frequent respiratory ailments.
3) Cessation of smoking and alcohol is a must to prevent respiratory diseases.
4) If environmental factors like pollution are the cause of respiratory problems, change in environment can be a help.
5) If the disease is due to pollen-allergy, again change of environment would be helpful in preventing the disease.
6) If other diseases like sinusitis and cancer are the cause of respiratory problems, quick treatment is the only solution as it cannot really be prevented.
