OBT356 LIFESTYLE DISEASES

UNIT 5
RESPIRATORY DISEASES
Chronic lung disease, Asthma, COPD; Causes - Breathing pattern (Nasal vs mouth),
Smoking – Diagnosis - Pulmonary function testing

CHRONIC LUNG DISEASE

Chronic lung diseases are a group of conditions that affect the lungs and airways,
causing breathing difficulties and other respiratory problems. Some common chronic
lung diseases include:
1. Chronic Obstructive Pulmonary Disease (COPD): A progressive lung disease that
makes it hard to breathe, caused by long-term exposure to lung irritants like smoke and
air pollution.
2. Asthma: A chronic inflammatory disease that causes recurring episodes of wheezing,
coughing, chest tightness, and shortness of breath.
3. Pulmonary Fibrosis: A condition where scar tissue builds up in the lungs, making it
difficult to breathe and causing fatigue, dry cough, and chest pain.
4. Cystic Fibrosis: A genetic disorder that causes severe damage to the lungs, digestive
system, and other organs, leading to respiratory and digestive problems.
5. Emphysema: A type of COPD that damages the air sacs in the lungs, making it hard to
breathe and causing shortness of breath.
6. Bronchiectasis: A condition where the airways are damaged, leading to recurring lung
infections and chronic coughing.
7. Chronic Bronchitis: A type of COPD that causes inflammation and congestion in the
bronchial tubes, leading to coughing and mucus production.
These diseases can be managed with medication, lifestyle changes, and pulmonary
rehabilitation, but early diagnosis and treatment are crucial to slow disease progression
and improve quality of life.
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ASTHMA:

Asthma, also called bronchial asthma, is a disease that affects your lungs. It’s a chronic
(ongoing) condition, meaning it doesn’t go away and needs ongoing medical
management.

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Asthma is a condition in which your airways narrow and swell and may produce extra
mucus. This can make breathing difficult and trigger coughing, a whistling sound
(wheezing) when you breathe out and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that
interferes with daily activities and may lead to a life-threatening asthma attack

Asthma can't be cured, but its symptoms can be controlled. Because asthma often
changes over time, it's important that you work with your doctor to track your signs
and symptoms and adjust your treatment as needed

Asthma Attack:

When you breathe normally, muscles around your airways are relaxed, letting air move
easily and quietly. During an asthma attack, three things can happen

Bronchospasm: The muscles around the airways constrict (tighten). When they
tighten, it makes your airways narrow. Air cannot flow freely through constricted
airways

Inflammation: The lining of your airways becomes swollen. Swollen airways don’t let
as much air in or out of your lungs

Mucus production: During the attack, your body creates more mucus. This thick mucus
clogs airways

When your airways get tighter, you make a sound called wheezing when you breathe, a
noise your airways make when you breathe out. You might also hear an asthma attack
called an exacerbation or a flare-up. It’s the term for when your asthma isn’t controlled

Types of asthma:

Today, asthma is no longer thought of as a single disease. Asthma is often categorized

into different types. They include:

 Allergic asthma
 Aspirin-induced asthma
 Cough-variant asthma
 Exercise-induced asthma
 Nighttime asthma
 Steroid-resistant asthma
 Occupational asthma

Symptoms:

Asthma symptoms vary from person to person. You may have infrequent asthma
attacks, have symptoms only at certain times — such as when exercising — or have
symptoms all the time.

Asthma signs and symptoms include:

 Shortness of breath
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  Chest tightness or pain

 Wheezing when exhaling, which is a common sign of asthma in children

 Trouble sleeping caused by shortness of breath, coughing or wheezing

 Coughing or wheezing attacks that are worsened by a respiratory virus, such as a

cold or the flu

Signs that your asthma is probably worsening include:

 Asthma signs and symptoms that are more frequent and bothersome

 Increasing difficulty breathing, as measured with a device used to check how

well your lungs are working (peak flow meter)

 The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

 Exercise-induced asthma, which may be worse when the air is cold and dry

 Occupational asthma, triggered by workplace irritants such as chemical fumes,

gases or dust

 Allergy-induced asthma, triggered by airborne substances, such as pollen, mold

spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet
dander)

Causes:

 Family history :If you have a parent with asthma, you are three to six times
more likely to develop asthma than someone who does not have a parent with
asthma.
 Allergies: Some people are more likely to develop allergies than others,
especially if one of their parents has allergies. Certain allergic conditions, such as
atopic dermatitis (eczema) or allergic rhinitis (hay fever), are linked to people
who get asthma.

 Viral respiratory infections: Respiratory problems during infancy and

childhood can cause wheezing. Some children who experience viral respiratory
infections go on to develop chronic asthma.

 Occupational exposures : If you have asthma, exposures to certain elements in

the workplace can cause asthma symptoms. And, for some people, exposure to
certain dusts (industrial or wood dusts), chemical fumes and vapors, and molds
can cause asthma to develop for the very first time.

 Smoking: Cigarette smoke irritates the airways. Smokers have a high risk of
asthma. Those whose mothers smoked during pregnancy or who were exposed
to second hand smoke are also more likely to have asthma.

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  Air Pollution: Exposure to the main component of smog (ozone) raises the risk
for asthma. Those who grew up or live in urban areas have a higher risk for
asthma.

 Obesity: Children and adults who are overweight or obese are at a greater risk
of asthma. Although the reasons are unclear, some experts point to low-grade
inflammation in the body that occurs with extra weight. Obese patients often use
more medications, suffer worse symptoms and are less able to control their
asthma than patients in a healthy weight range.

Testing:

Medical History

You will be asked for some medical history, which should include:

 Family members with asthma

 Allergies
 Smoking and exposure to second hand smoke
 Exposure to pollutants in your workplace

Testing for Asthma

There are also several breathing tests your healthcare provider may perform. The most
common lung function test is called spirometry. This lung function test uses a device
called, a spirometer, to measure the amount and speed of the air you blow out. This
helps your healthcare provider see how well your lungs are working.

Other tests could include allergy testing (blood or skin), a blood test to check for cells
responsible for inflammation, exhaled nitric oxide or FeNo test, and challenge tests,
such as methacholine. Other lung diseases may cause some of the same symptoms as
asthma. If your doctor thinks you might have something else, they may order additional
tests.

Treatment:

Bronchodilators: These medicines relax the muscles around your airways. The relaxed
muscles let the airways move air. They also let mucus move more easily through the
airways. These medicines relieve your symptoms

Anti-inflammatory medicines: These medicines reduce swelling and mucus production

in your airways. They make it easier for air to enter and exit your lungs. Your healthcare
provider may prescribe them to take every day to control or prevent your symptoms of
chronic asthma

Biologic therapies for asthma: These are used for severe asthma when symptoms
persist despite proper inhaler therapy

COPD : CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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Chronic obstructive pulmonary disease (COPD) is a common lung disease causing
restricted airflow and breathing problems. It is sometimes called emphysema or
chronicbronchitis.

In people with COPD, the lungs can get damaged or clogged with phlegm. Symptoms
include cough, sometimes with phlegm, difficulty breathing, wheezing and tiredness.
Smoking and air pollution are the most common causes of COPD. People with COPD are
at higher risk of other health problems.

Types of COPD

There are two main types of COPD associated with damage to the airways and breathing
difficulties. These are called chronic bronchitis and emphysema.

1.Chronic Bronchitis : Chronic bronchitis occurs when the air passages (bronchial
tubes) become inflamed and narrowed, restricting airflow through them. As a result,
mucus builds up in the airways, which results in chronic cough and mucus (phlegm)
production. The combination of narrowed airways and excess mucus makes breathing
difficult.

2.Emphysema: Emphysema occurs when air sacs in the lungs are damaged. The air sacs
are ordinarily elastic, but damage from exposure to irritants causes them to become
saggy and impairs the air sacs’ ability to move oxygen and carbon dioxide in and out of
the lungs.

Most people with COPD have both chronic bronchitis and emphysema.

Risk Factors:

Certain risk factors can increase a person’s risk of developing COPD:

 Smoking or exposure to second-hand smoke
 Occupational exposure to chemicals, dust, vapors, or fumes
 Indoor and outdoor air pollutants such as smog, mold, dust mites, asbestos, and
combustible pollutants (e.g., firewood smoke, furnaces that use gas or coal)
 Frequent or severe respiratory infections in childhood that stunt lung growth
 Asthma in childhood
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  Alpha-1 antitrypsin deficiency, a rare genetic condition

Signs and symptoms of COPD :

COPD is not curable but symptoms can improve if one avoids smoking and exposure to
air pollution and gets vaccines to prevent infections. It can also be treated with
medicines, oxygen and pulmonary rehabilitation.
Signs and symptoms of COPD may include:
 Shortness of breath, especially during physical activities
 Wheezing
 Chest tightness
 A chronic cough that may produce mucus (sputum) that may be clear, white,
yellow or greenish
 Frequent respiratory infections
 Lack of energy
 Unintended weight loss (in later stages)
 Swelling in ankles, feet or legs
People with COPD are also likely to experience episodes called exacerbations, during
which their symptoms become worse than the usual day-to-day variation and persist
for at least several days.

Causes
Several processes can cause the airways to become narrow and lead to COPD. There
may be destruction of parts of the lung, mucus blocking the airways, and inflammation
and swelling of the airway lining.
COPD develops gradually over time, often resulting from a combination of risk factors:
 tobacco exposure from active smoking or passive exposure to second-hand
smoke;
 occupational exposure to dusts, fumes or chemicals;
 indoor air pollution: biomass fuel (wood, animal dung, crop residue) or coal is
frequently used for cooking and heating in low- and middle-income countries
with high levels of smoke exposure;
 early life events such as poor growth in utero, prematurity, and frequent or
severe respiratory infections in childhood that prevent maximum lung growth;
 asthma in childhood
 a rare genetic condition called alpha-1 antitrypsin deficiency, which can cause
COPD at a young age.

COPD should be suspected if a person has typical symptoms, and the diagnosis onfirmed
by a breathing test called spirometry, which measures how the lungs are working. In
low- and middle-income countries, spirometry is often not available and so the
diagnosis may be missed.

Diagnosis:
To assess your lungs and overall health, your healthcare provider will take your medical
history, perform a physical exam and order some tests, like breathing tests
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Medical History:

To diagnose COPD, your provider will ask questions like

 Do you smoke?
 Have you had long-term exposure to dust or air pollutants?
 Do other members of your family have COPD?
 Do you get short of breath with exercise? When resting?
 Have you been coughing or wheezing for a long time?
 Do you cough up phlegm?
Physical Exam:
To help with the diagnosis, your provider will do a physical exam that includes:
 Listening to your lungs and heart
 Checking your blood pressure and pulse
 Examining your nose and throat
 Checking your feet and ankles for swelling
Tests:
Providers use a simple test called spirometry to see how well your lungs work. For this
test, you blow air into a tube attached to a machine. This lung function test measures
how much air you can breathe out and how fast you can do it

If you have symptoms of COPD, your healthcare provider will investigate to determine
the cause. They may ask for a detailed personal and family medical history and perform
a physical examination. During the exam, they will use a stethoscope to listen to your
lungs as you breathe to check for crackling or wheezing sounds. 10
In addition to the physical exam, your provider may order additional procedures and
tests to diagnose COPD, including:

 Spirometry: A non-invasive lung function test that measures the maximum

amount of air you can hold in your lungs and how quickly you can blow the air
out.

 Six-minute walk test: You will walk for 6 minutes at your usual pace while
doctors measure your blood pressure, pulse, and oxygen levels to check on how
well your lungs function.
 Complete blood count (CBC): A blood test that helps your doctor determine if
you have an infection or low iron (anemia).

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  Arterial blood gas (ABG): A blood test that measures how much oxygen and
carbon dioxide are in your blood to determine how well your lungs are
functioning.
 Alpha-1 antitrypsin (AAT) deficiency: A genetic test that checks for levels of
AAT in the blood. Low levels of AAT may be a sign of a rare genetic condition
called AAT deficiency, which is linked to an increased risk of COPD.
 Computed tomography (CT) scan: An imaging test that takes detailed pictures
of your lungs and other structures in your chest so doctors can look for damage
and scarring in the airways.
 Chest X-ray: An imaging test that takes pictures of the structures in and around
your chest to check for signs of lung tissue damage and scarring.

Stages:
Mild COPD (stage 1 or early stage)
The first sign of COPD is often feeling out of breath with light exercises, like walking up
stairs. Because it’s easy to blame this symptom on being out of shape or getting older,
many people don’t realize they have COPD. Another sign is a phlegmy cough (a cough
with mucus) that’s often particularly troublesome in the morning. These are early
warning signs of COPD
Moderate to severe COPD (stages 2 and 3)
In general, shortness of breath is more evident with more advanced COPD. You may
develop shortness of breath even during everyday activities. Also, exacerbations of
COPD — times when you experience increased phlegm, discoloration of phlegm, and
more shortness of breath — are generally more common in higher stages of COPD. You
also become prone to lung infections like bronchitis and pneumonia.
Very severe COPD (stage 4)
When COPD becomes severe, almost everything you do can cause shortness of breath.
This limits your mobility. You may need supplemental oxygen from a portable tank

Treatments for COPD

The goals of treating COPD include improving airflow to make breathing easier,
preventing disease progression, reducing exacerbations and complications, and
improving quality of life.
Treatments vary depending on the severity of the condition but generally include a
combination of lifestyle interventions, prescription medications, oxygen therapy, and
pulmonary rehabilitation. Surgery may be an option for some people with severe COPD.
1. Lifestyle Interventions:
Making healthy lifestyle choices is an essential part of treating COPD. Lifestyle
interventions for COPD include:
 Quitting smoking
 Limiting exposure to lung irritants: secondhand smoke, pollutants, gasses, and
 fumes
 Regular exercise
 Eating a healthy, balanced diet
 Getting vaccinated for influenza, pneumococcal viruses, and COVID-19
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  Avoiding contact with people who have respiratory infections
2. Prescription Medications:
Medications to reduce inflammation and swelling to open the airways, decrease mucus
production, and improve lung function are often prescribed to treat COPD. Many drugs
are breathed in through inhalers or nebulizer devices, and some are taken orally as pills.
Prescription medicines for COPD include:
Bronchodilators: These relax the muscles around the airways to make breathing easier.
Some take a while to work but last about 12 to 24 hours, and others are fast-acting to
help relieve sudden shortness of breath.
Corticosteroids: These reduce inflammation and swelling to open the airways.
Corticosteroids are usually inhaled, but pills may be prescribed during a flare-up.
Antibiotics: These medications treat bacterial respiratory infections to help clear the
infection and prevent complications.
3. Oxygen therapy:
Supplemental oxygen may be recommended if you have low blood oxygen levels when
at rest, during physical activities, or while sleeping.
4. Pulmonary Rehabilitation :
Pulmonary rehabilitation is a supervised program that includes physical exercise,
education, and support. These programs can help you improve your endurance and
breathing ability during exercise and daily activities. Pulmonary rehab programs are
generally offered in group settings, so you can meet others with COPD to give and
receive support.
5. Surgery
Surgery may be an option for some people with severe and frequent symptoms that are
not well-managed with medications. Surgical procedures improve lung capacity and
make it easier to breathe. Lung surgeries for COPD include:
 Bullectomy: Bullae are large air pockets that form inside the lung due to certain
medical conditions, such as emphysema and chronic obstructive pulmonary
disease.
Bullae often grow in size once they form. Without treatment, enlarged bullae
take up an increasing amount of space in the lungs, causing pressure to build.
The pressure can make it difficult for a person to breathe.
Bullectomy, which is the surgical removal of the bullae, if they cause breathing
problems or other health complications
 Lung volume reduction surgery :
Surgeon removes areas of diseased lung tissue that are not being used by the
body. Then the remaining lung tissue can work better. After surgery, people
often have less shortness of breath and better quality of life. They also are better
able to exercise.
 Lung transplant:
Lung transplantation, or pulmonary transplantation, is a surgical procedure
in which one or both lungs are replaced by lungs from a donor. Donor lungs can
be retrieved from a living or deceased donor. A living donor can only donate
one lung lobe.
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DIFFERENCE BETWEEN ASTHMA AND COPD

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NOSE AND MOUTH BREATHING

Benefits Of Nose Breathing Vs Mouth Breathing

1. The inside of your nose is lined with tiny hairs called cilia. The cilia filter, warm and
humidify inhaled air. They protect you against 20 billion particles of foreign matter
every day.
2. Some people argue you need to mouth breathe to bring in enough air during exercise.
But research proves the opposite. The extra resistance during nose breathing results in
10 to 20% better oxygenation
3. Nose breathing is 22% more efficient than mouth breathing . Which means breathing
is much easier, and the breathing muscles don’t get so tired.

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4. Nose breathing keeps your airways clear. Breathing in through the nose and out
through the mouth causes nasal congestion and makes it harder to breathe . If you’re
wondering how to breathe with a stuffy nose, the surprising answer is that you need to
get used to nose breathing.
5. The lungs draw oxygen from inhaled air during nasal exhalation too. Nose breathing
is slower, and nasal exhalation creates a backflow of air into the lungs. The air stays in
the lungs for longer, and the body has more time to extract oxygen from that air.
6. The air hunger during nose breathing forces you to slow down until your breath is
properly trained. This reduces stress and high blood pressure. And it stops you from
overtraining.
7. Nose breathing harnesses nitric oxide (NO) Nitric oxide is produced in the sinuses
around the nose. It protects against airborne viruses, bacteria, allergens, and other
pathogens. It opens the blood vessels in the lungs, allowing better oxygen diffusion.
8. When there is a proper balance of oxygen and carbon dioxide (CO2) in the blood, the
body maintains a balanced pH. Most oxygen travels around the body in red blood cells.
CO2 is the catalyst that causes the red blood cells to release this load of oxygen to the
body. If you breathe through an open mouth, you lose too much CO2 . So nose breathing
enhances your body’s ability to access the oxygen in your blood.
9. Nose breathing during sleep makes sleep apnea less severe. Scientists found that
during mouth breathing, apneas increase, and oxygen desaturation is worse.
10. It is not possible to maintain diaphragm breathing through the mouth. Nose
breathing engages and strengthens your diaphragm, which is an integral muscle of the
core and necessary for the stability of your spine.
11. During exercise, nose breathing can improve mental focus and boost coronary
artery blood flow
12. Nose breathing reduces symptoms of exercise-induced asthma because it protects
the airways from trauma and inflammation.
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SMOKING
Smoking cigarettes can kill you, but before you die, you could experience some pretty
terrible diseases and health conditions from smoking. Here are some of the most
gruesome diseases caused by smoking*:
1. Lung Cancer
2. COPD (chronic obstructive pulmonary disease)
3. Heart Disease
4. Stroke
5. Asthma
6. Reproductive Health in Women
7. Premature, Low Birth-Weight Babies
8. Diabetes
9. Blindness, Cataracts and Age-Related Macular Degeneration
10. Over 10 Other Types of Cancer, Including Colon, Cervix, Liver, Stomach and
Pancreatic Cancer

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PULMONARY FUNCTION TESTS (PFTS)
Pulmonary function tests (PFTs) are tests that show how well your lungs are working.
The tests measure lung volume, capacity, rates of flow, and gas exchange. This
information can help your healthcare provider diagnose and decide the treatment of
certain lung disorders.

There are several types of disorders that cause problems with air moving in and out of
the lungs:
 Obstructive. This is when air has trouble flowing out of the lungs because of
airway resistance. This causes slower flow of air.
 Restrictive. This is when the lung tissue or chest muscles can’t expand enough.
This creates problems with air flow, mostly because you have less lung volume.

Types of PRT:
PFTs can be done in two ways. These two ways may be used together and do different
tests. It depends on the information that your healthcare provider is looking for:
Spirometry. A spirometer is a device with a mouthpiece hooked up to a small electronic
machine.

Plethysmography. You sit or stand inside an airtight box to do the tests.

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PFTs measure:
 Tidal volume. This is the amount of air breathed in or out during normal
breathing.
 Minute volume. This is the total amount of air breathed out per minute.
 Vital capacity. This is the total volume of air that can be breathed out after
breathing in as much as you can.
 Functional residual capacity. This is the amount of air left in lungs after
breathing out normally.
 Residual volume. This is the amount of air left in the lungs after breathing out
asmuch as you can.
 Total lung capacity. This is the total volume of the lungs when filled with as much
air as possible.
 Forced vital capacity (FVC). This is the amount of air breathed out forcefully and
quickly after breathing in as much as you can.
 Forced expiratory volume. This is the amount of air breathed out during the first,
second, and third seconds of the FVC test.
 Forced expiratory flow. This is the average rate of flow during the middle half of
the FVC test.
 Peak expiratory flow rate. This is the fastest rate that you can force air out of
your lungs.

Normal values for PFTs vary from person to person. The amount of air breathed in and
out in your test results are compared with the average for someone of the same age,
height, sex, and race. Results are also compared with any of your past test results. You
may need other tests if you have abnormal PFT measurements or if your results have
changed.

Why might I need pulmonary function tests?

There are many different reasons why pulmonary function tests (PFTs) may be done.
They are sometimes done in healthy people as part of a routine physical. They are also
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routinely done in certain types of work environments to make sure of employee health.
This might be in graphite factories or coal mines. Or you may have PFTs if your
healthcare provider needs help to diagnose you with a health problem. These include:

 Allergies
 Respiratory infections
 Trouble breathing from injury to the chest or a recent surgery
 Long-term (chronic) lung conditions, such as asthma, bronchiectasis,
emphysema, or chronic bronchitis
 Asbestosis, a lung disease caused by inhaling asbestos fibers
 Restrictive airway problems from scoliosis, tumors, or inflammation or scarring
of the lungs
 Sarcoidosis, a disease that causes lumps of inflammatory cells around organs,
such as the liver, lungs, and spleen
 Scleroderma, a disease that causes thickening and hardening of connective tissue

PFTs may be used to check lung function before surgery or other procedures. This may
be done in people who have lung or heart problems, who are smokers, or who have
other health conditions. Another use of PFTs is to assess treatment for asthma,
emphysema, and other chronic lung problems. Your healthcare provider may also have
other reasons to advise PFTs.

Risks of pulmonary function tests

Because pulmonary function testing is not an invasive procedure, it is safe and quick for
most people. But the person must be able to follow clear, simple directions. All
procedures have some risks.
The risks of this procedure may include:
 Dizziness during the tests
 Feeling short of breath
 Coughing
 Asthma attack brought on by deep inhalation

In some cases, you shouldn’t have PFTs. Reasons for this can include:
 Recent eye surgery, because of increased pressure inside the eyes during the
procedure
 Recent belly or chest surgery
 Chest pain, recent heart attack, or an unstable heart condition
 A bulging blood vessel (aneurysm) in the chest, belly, or brain
 Active tuberculosis or respiratory infection, such as a cold or the flu

Certain things can make PFTs less accurate. These include:

 Not following the instructions for doing the test

 Using medicines that open the airways (bronchodilators)
 Using pain medicines
 Pregnancy
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  Stomach bloating. This can affect your ability to take deep breaths
 Extreme tiredness or other conditions, such as a head cold, that affect your
ability to do the tests
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