Respiratory System Pathologies 2

Question 1

What is acute bronchitis?

Answer 1

An acute infection of the bronchial tree causing inflammation of medium and large-sized bronchi and trachea.

Question 2

What are the key pathological effects of acute bronchitis?

Answer 2

• Bronchial mucosal irritation, hyperemia, and edema.
• Diminished bronchial mucociliary function.
• Airways blocked or clogged by debris.
• Increased mucus secretion leading to coughing.

Question 3

What are common causes of acute bronchitis?

Answer 3

• Bacterial infection (most common).
• Viral infection.
• Allergic reactions.
• Exposure to toxins or pollutants.
• Smoking.
• Immunosuppression (young children, advanced age).

Question 4

How long does acute bronchitis typically last?

Answer 4

Approximately 10 days; if bacterial, it can be effectively treated with antibiotics.

Question 6

What can happen if inflammation extends into the bronchioles and alveoli?

Answer 6

Bronchopneumonia may result.

Question 7

What are the long-term effects of recurrent acute bronchitis?

Answer 7

• Damage to mucosa and mucociliary elevator.
• Impairment of mucus and particle removal.
• Potential contribution to bronchial epithelial metaplasia (cancer).

Question 8

What are the signs and symptoms of acute bronchitis?

Answer 8

• Productive intense cough with clear, yellow, green, or occasionally blood-tinged sputum.
• General malaise, extreme fatigue, muscle aches.
• Chest pain (severe cases, due to coughing).
• Dyspnea and cyanosis (if underlying COPD is present).
• Sore throat, stuffy nose, headache.
• Wheezing and use of accessory muscles (severe cases).
• Fever is rare; if present, flu or pneumonia is more likely.

Question 9

What is COPD?

Answer 9

A term encompassing lung diseases associated with an abnormal reaction of the lungs to inhaled noxious particles/gases, leading to progressive, chronic, or recurrent airflow limitation.

Question 10

What are the three main types of COPD?

Answer 10

• Emphysema
• Bronchiectasis
• Chronic Bronchitis

Question 11

What are the key characteristics of COPD?

Answer 11

• Prolonged forced exhalations.
• Predominantly irreversible lung damage.

Question 12

What are the primary causes of COPD?

Answer 12

• Cigarette smoking (most common; many patients are pack-a-day smokers for 20+ years).
• Secondhand smoke exposure.
• Potential relationship with air pollution and environmental factors.

Question 13

Where do pathological changes in COPD primarily occur?

Answer 13

• Large airways.
• Small bronchioles.
• Lung parenchyma (in some cases).

Question 14

What are the pathological features of COPD?

Answer 14

• Inflammation and edema of lung mucosa.
• Thickened basement membrane.
• Mucus gland hypertrophy.
• Goblet cell hyperplasia.
• Bronchial smooth muscle hypertrophy/constriction.
• Airway wall remodeling (chronic inflammation causes thickening of mucosa).

Question 15

What is emphysema?

Answer 15

Emphysema is the destruction of alveolar walls and capillary beds supplying the alveoli, leading to abnormal, permanent enlargement of air spaces distal to the terminal bronchioles. This results in distention and expansion of alveoli into larger air sacs, making gas exchange inefficient.

Question 16

What happens to lung elasticity in emphysema?

Answer 16

Damage to elastic fibers that hold airways open leads to loss of lung elastic recoil and impaired gas exchange.

Question 17

Why do small airways collapse in emphysema?

Answer 17

Why do small airways collapse in emphysema?

Question 18

How does emphysema affect lung compliance and recoil?

Answer 18

Lung compliance increases, meaning the lung becomes easier to distend, but recoil decreases, so airways empty slowly.

Question 19

How does emphysema impact exhalation?

Answer 19

As the patient exhales, airways collapse before all the air is expelled, leading to chronic lung over-inflation.

Question 20

How does emphysema affect the diaphragm?

Answer 20

Over-inflation of the lungs can impair diaphragm function, making it harder for the patient to expand an already over-expanded thorax.

Question 21

What are bulla in emphysema?

Answer 21

Abnormal enlargements of air spaces distal to the terminal bronchioles.

Question 22

What happens when bulla grow larger than 1 cm?

Answer 22

They can compress adjacent healthy lung tissue, further impairing ventilation and perfusion.

Question 23

They can compress adjacent healthy lung tissue, further impairing ventilation and perfusion.

Answer 23

To reduce compression and prevent them from bursting, which could lead to pneumothorax.

Question 24

What are the causes of emphysema?

Answer 24

• Smoking (primary and secondary)
• Genetic defects in the structure of the respiratory unit (small percentage)
• Repeated respiratory infections (especially chronic bronchitis)
• Atmospheric pollution

Question 25

What are the two types of emphysema?

Answer 25

1. Centriacinar (Centrilobular) and 2. Panacinar (Panlobular)

Question 26

Describe Centriacinar emphysema.

Answer 26

• Focal destruction of the respiratory bronchiole and central portions of the acinus. • Associated with edema, inflammation, and thickening of the bronchiolar wall. • Most common in upper lobes. • Rare in non-smokers; almost exclusively seen in smokers. • Begins at the alveolar duct.

Question 27

Describe Panacinar emphysema.

Answer 27

• Destructive enlargement of the entire alveoli distal to the terminal bronchiole. • Can occur throughout the entire lung, but more severe in the lower lung. • Most commonly found in smokers, but also has a genetic correlation.

Question 28

What are the key signs and symptoms of emphysema?

Answer 28

• Slow, insidious onset of dyspnea • Tachypnea – rapid, shallow breathing • Orthopnea – difficulty breathing except when upright • Labored inhalation • Forced exhalation due to loss of lung elastic recoil • Hyperventilation in advanced stages to maintain normal blood oxygen levels • Pursed-lip breathing with audible exhalation • Prominent use of accessory respiratory muscles • Pink Puffers – patients with advanced emphysema who hyperventilate to compensate for oxygen loss

Question 29

How does emphysema affect musculoskeletal posture?

Answer 29

• Typical forward-seated posture (tripod position), hands on knees, shoulders elevated. • Over-recruitment of accessory muscles of inspiration (linked to TOS, head-forward posture, headaches). • Barrel chest due to lung hyper-inflation and flattened diaphragm. • Thoracic hyperkyphosis and compression of abdominal contents (including liver in advanced stages). • Compensatory lumbar and cervical hyperlordosis. • Thoracic hypomobility, rib fixation, increased risk of osteoarthritis.

Question 30

How does emphysema affect the cardiovascular system?

Answer 30

• Increased risk of hypertension and heart failure. • Cor Pulmonale – right-side heart failure due to increased resistance in the lungs, forcing the right heart to work harder.

Question 31

What emotional and psychological effects can emphysema have?

Answer 31

• Fear due to dyspnea and complications. • Fatigue due to chronic hypoxia limiting activities of daily living (ADLs). • Frustration, anger, and low self-esteem.

Question 32

How does emphysema affect tissue health?

Answer 32

• Increased tissue fragility and poor healing. • Nail bed changes. • Severe emphysema may cause significant weight loss due to lack of energy to eat, leading to immune suppression and muscle atrophy.

Question 33

What is pursed-lip breathing, and why is it beneficial?

Answer 33

A technique that prolongs exhalation, increasing back pressure in the airways to prevent airway collapse.

Question 34

How do you perform pursed-lip breathing?

Answer 34

1. Sit comfortably, relax shoulders and neck. 2. Inhale through the nose for 1, 2. 3. Pucker lips (as if blowing on a hot drink or about to whistle). 4. Exhale and count 1, 2, 3, 4.

Question 35

What is the definition of chronic bronchitis?

Answer 35

A chronic, persistent cough with sputum production for 3 months in at least 2 consecutive years, with other causes of cough excluded.

Question 36

Where are the pathological changes of chronic bronchitis found?

Answer 36

In the bronchi and/or bronchioles.

Question 37

What are the three types of chronic bronchitis?

Answer 37

1. Simple chronic bronchitis – no airway obstruction 2. Chronic asthmatic bronchitis – increased wheezing and hyperactive airway 3. Obstructive chronic bronchitis – abnormal airflow

Question 38

What are the key pathological changes in the airways in chronic bronchitis?

Answer 38

• Squamous metaplasia of bronchiolar epithelium • Ciliary dysfunction & loss of ciliated cells • Thickened bronchiolar mucosa • Hyperplasia & hypertrophy of goblet cells and mucous glands • Hyperplasia of airway smooth muscle • Inflammation & disrupted mucociliary blanket • Increased thick mucus secretion → airway narrowing & chronic cough • Airway scarring → remodeling → thickening → airflow limitation (↑ resistance)

Question 39

What are the causes of chronic bronchitis?

Answer 39

• Idiopathic (persistent inflammation of bronchial walls) • Long-term smoking (10x increased incidence) • Exposure to irritants/environmental pollution • History of recurrent acute bronchitis

Question 40

What are the signs and symptoms of chronic bronchitis?

Answer 40

• Thick, tenacious, purulent sputum • Chronic cough • Tachypnea (↑ respiratory rate; accessory muscle use) • Worsens with concomitant infections • Advanced stages: failure to maintain normal O2/CO2 → cyanosis • ↓ QOL: withdrawal from activity → obesity • Known as "Blue Bloaters"

Question 41

What musculoskeletal changes are associated with chronic bronchitis?

Answer 41

• Overuse of accessory respiratory muscles → TOS, TrPs, FHP, headaches • Barrel chest, ↑ thoracic hyperkyphosis • Compensatory lumbar/cervical hyperlordosis • Thoracic hypomobility (especially posterior/inferior) → OA risk • Fatigue/weakness of diaphragm and accessory muscles → weak cough

Question 42

What cardiovascular issues may develop with chronic bronchitis?

Answer 42

• ↑ risk of hypertension and heart failure (from ↑ resistance in lungs/pulmonary vessels) • Chronic hypoxia from mucous → ↑ heart stress • ↑ heart rate to meet O2 demands • Sedentary lifestyle → rapid weight gain, diabetes, HBP

Question 43

What self-care and exercises are helpful for chronic bronchitis?

Answer 43

• Facial steams with essential oils (e.g. Eucalyptus, Tea Tree, Chamomile, Thyme, Oregano) • Deep coughing exercise: - Hands on lower chest - Deep breath - Open mouth - Exhale forcefully using abdominal muscles while saying “Ha Ha Ha”

Question 44

What is bronchiectasis?

Answer 44

A chronic obstructive pulmonary disease involving abnormal, permanent dilation of medium-sized bronchi due to damage of their muscular and elastic walls.

Question 45

What usually causes bronchiectasis?

Answer 45

Previous chronic necrotizing infection that weakens the bronchial walls → dilation.

Question 46

How can bronchiectasis present?

Answer 46

• Focal (one lobe/segment) • Diffuse (both lungs; common in systemic illnesses like cystic fibrosis)

Question 47

What cycle contributes to bronchiectasis progression?

Answer 47

Vicious cycle of bronchial damage → dilation → recurrent infection

Question 48

Describe how bronchiectasis develops.

Answer 48

• Mucosa becomes edematous & ulcerated • Elastic tissue and smooth muscle damaged → dilation & scarring • Hyperplasia of bronchiolar walls → non-ciliated mucus-secreting cells replace ciliated ones • Loss of mucociliary blanket → retained mucus • Dilated airways + pockets of stretched mucosa → infected secretion pooling • Possible abscess formation • Distal lung damage from persistent infection/pneumonia • Pulmonary resistance ↑ → may lead to Cor Pulmonale

Question 49

What are common causes of bronchiectasis?

Answer 49

• Post-infection (e.g., pneumonia, TB – most common worldwide cause) • Childhood illness → permanent scarring • Bacteria/viruses: S. aureus, TB, Mycoplasma, measles, pertussis, influenza, HSV, adenovirus • Foreign body obstruction • Smoking → chronic bronchitis/emphysema → bronchiectasis • Inherited immunodeficiency (→ recurrent lung infections) • HIV/AIDS → repeated infections → bronchial damage • Autoimmune/inflammatory disorders: • IBD, RA, Ankylosing spondylitis, SLE

Question 50

What are the clinical symptoms of bronchiectasis?

Answer 50

• Chronic, violent, disabling mucoid cough (can last years) • Dyspnea (80%), worse with comorbid illness • Chronic sinusitis (30%) During exacerbations: • Purulent sputum with offensive odor • Fever • Hemoptysis (60%) from dilated vessels and damage Additional: • Difficulty breathing, fatigue, weakness, weight loss • Pleuritic chest pain, crackles, wheezing • Cor Pulmonale, peripheral edema, hepatomegaly, hypoxia, respiratory failure

Question 51

What should massage therapists consider with bronchiectasis patients?

Answer 51

• Contraindicated if infection is present Patients may be on: • Antibiotics • Bronchodilators, corticosteroids • Oxygen therapy • Dietary supplementation • Recent or upcoming surgery • Also likely receiving physical therapy

Question 52

What type of cough is commonly seen in COPD, and when is it often worse?

Answer 52

A productive cough, often worse in the morning.

Question 53

What type of breathing difficulty do COPD patients experience?

Answer 53

Dyspnea; the patient may be breathless after minimal exertion.

Question 54

What causes wheezing and prolonged expiration in COPD?

Answer 54

Increased effort and the sound of air being forced through the narrowed lumens due to increased resistance.

Question 55

What happens during acute exacerbations of COPD?

Answer 55

COPD can present with acute exacerbations that become more frequent and severe as the disease progresses.

Question 56

What is a "barrel chest" in COPD?

Answer 56

It refers to hyper-inflated lungs and flattening of the diaphragm.

Question 57

How does tachypnea relate to COPD severity?

Answer 57

It is proportional to disease severity; patients with severe disease can experience tachypnea and respiratory distress during simple activities like bending down or reaching up.

Question 58

Why does fatigue occur in COPD?

Answer 58

Breathing takes more energy—inhale is difficult due to air trapping, and exhale is forced due to loss of lung elastic recoil and increased respiratory rate.

Question 59

What signs may be seen in advanced COPD?

Answer 59

Cyanosis and pitted peripheral edema.

Question 60

What muscular pattern is commonly overused in COPD?

Answer 60

The accessory muscles of respiration.

Question 62

Name some systemic manifestations of COPD.

Answer 62

• Anemia • Muscle weakness • Osteoporosis • Depression • Pulmonary hypertension • Cor pulmonale (enlargement and failure of the right ventricle due to increased pulmonary vascular resistance)

Question 63

What are the key components of pulmonary rehab in COPD?

Answer 63

• Physical therapy and exercise for aerobic endurance and reduced dyspnea • Breathing retraining (e.g., diaphragmatic breathing) • Patient and family education to improve QOL and prevent symptoms • Smoking cessation, the most important therapeutic intervention

Question 64

What medications might a COPD patient use to help with dyspnea or exercise tolerance?

Answer 64

Bronchodilators: • Short-acting (episodic use) • Long-acting (taken regularly) Beta-agonists: relax smooth muscle to relieve symptoms Other drugs: • Anticholinergics • Anti-inflammatory drugs • Mucolytic agents (reduce sputum viscosity) • Antibiotics (due to common chronic infections)

Question 65

What questions should you ask a COPD patient about their medications before treatment?

Answer 65

"Are you on any medications? Which ones and do you have them with you here (e.g., puffer)?"

Question 66

What are some manual therapy treatment goals for a COPD patient?

Answer 66

• Maintain thoracic ROM, mobility, and joint health • Normalize respiratory function by addressing compensatory structures • Promote drainage of secretions via postural drainage and percussion/tapotement • Promote general relaxation

Question 67

What should you assess in terms of respiratory muscles in COPD?

Answer 67

Tone, length, and strength of respiratory muscles.

Question 68

What positional modifications may be necessary for COPD patients during treatment?

Answer 68

Avoid positions that inhibit diaphragm function, such as prone or excessive pillowing.

Question 69

What educational components can support a COPD patient’s self-care?

Answer 69

• Smoking cessation • Diaphragmatic breathing techniques • Deep coughing (to increase effectiveness of cough and clear secretions)

Question 70

What kind of exercise modifications might be needed for COPD patients?

Answer 70

Modified therapeutic exercises that accommodate their respiratory limitations.