Respiratory CHAPTER

System 7

Chapter Outline
Objectives
Objectives Upon completion of this chapter, you will be able to:
Anatomy and Physiology • Locate and describe the structures of the respirato-
Anatomy and Physiology Key Terms ry system.
Upper Respiratory Tract • Describe the functional relationship between the
Lower Respiratory Tract respiratory system and other body systems.
Respiration
• Pronounce, spell, and build words related to the res-
Connecting Body Systems–Respiratory System
piratory system.
Medical Word Elements
• Describe pathological conditions, diagnostic and
Pathology
Chronic Obstructive Pulmonary Disease therapeutic procedures, and other terms related to
Asthma the respiratory system.
Chronic Bronchitis • Explain pharmacology related to the treatment of
Emphysema respiratory disorders.
Influenza • Demonstrate your knowledge of this chapter
Pleural Effusions by completing the learning and medical record
Tuberculosis
activities.
Pneumonia
Cystic Fibrosis
Acute Respiratory Distress Syndrome
Oncology
Diagnostic, Symptomatic, and Related Terms
Diagnostic and Therapeutic Procedures
Pharmacology
Abbreviations
Learning Activities
Medical Record Activities
SOAP Note: Respiratory evaluation
SOAP Note: Chronic interstitial lung disease
148 CHAPTER 7 • Respiratory System

Anatomy and Physiology Failure or deficiency in either system has the same
effect on the body: disturbance of homeostasis and
The respiratory system is responsible for the O2 starvation in tissues that may cause death.
exchange of oxygen (O2) and carbon dioxide (CO2). The lungs and airways bring in fresh, oxygen-
Oxygen is essential for life. It is carried to all cells of enriched air and expel waste CO2 by a process
the body in exchange for CO2, a waste product. The called breathing, or ventilation. Breathing helps
cardiovascular system helps in this vital function by regulate the pH (acidity-alkalinity) of the blood,
providing blood vessels for carrying these gases. thereby maintaining homeostasis.

Anatomy and Physiology Key Terms

This section introduces important respiratory system terms and their definitions. Word analyses for
selected terms are also provided.
Term Definition

carbon dioxide (CO2) Tasteless, colorless, odorless gas produced by body cells during the meta-
KĂR-bŏn dı̄- ŎK-sı̄d bolic process
A product of cell respiration, CO2 is carried by the blood to the lungs and
exhaled.

cartilage Tough, elastic connective tissue that is more rigid than ligaments but less
KĂR-tı̆-lı̆j dense than bone
The tip of the nose and the outer ear are composed of cartilage.

cilia Any hairlike structure

SĬL-ē-ă Cilia in the trachea move particles upward to the pharynx, where they are
removed by coughing, sneezing, or swallowing. This mechanism is called the
cilia escalator. Habitual smoking destroys the cilia escalator.

diffuse Moving or spreading out of a substance at random, rather than by chemi-

dı̆-F ŪZ̆ cal reaction or application of external forces

homeostasis State in which the regulatory mechanisms of the body maintain a con-
hō-m ē-ō-STĀ-sı̆s stant internal environment
homeo-: same, alike The regulatory mechanisms of the body control temperature, acidity, and the
-stasis: standing still concentration of salt, food, and waste products.

mucous membrane Moist tissue layer lining hollow organs and cavities of the body that open
M Ū-kŭs MĔM-brān to the environment; also called mucosa
muc: mucus
-ous: pertaining to

oxygen (O2) Tasteless, odorless, colorless gas essential for human respiration
ŎK-sı̆-jĕn O2 makes up about one f ifth (by volume) of the atmosphere.

pH Symbol that indicates the degree of acidity or alkalinity of a substance

Increasing acidity is expressed as a number less than 7; increasing alkalinity as
a number greater than 7, with 7 being neutral.

septum Wall dividing two cavities, such as the nasal septum, which separates the
SĔP-tŭm two nostrils
 Anatomy and Physiology 149

Anatomy and Physiology Key Terms—cont’d

Term Definition

serous membrane Thin layer of tissue that covers internal body cavities, the cells of which
SĒR-ūs MEM-brān secrete a fluid that keeps the membrane moist; also called serosa
ser: serum
-ous: pertaining to, relating to

Pronunciation Help Long Sound ā—rate ē—rebirth ı̄—isle ō—over ū—unite

Short Sound ă—lone ĕ—ever ı̆—it ŏ—not ŭ—cut

Upper Respiratory Tract Lower Respiratory Tract

The breathing process begins with inhalation. (See The trachea divides into two branches called
Figure 7–1.) Air is drawn into the (1) nasal cavity, (10) bronchi (singular, bronchus). One branch leads
a chamber lined with mucous membranes and tiny to the (11) right lung and the other to the (12) left
hairs called cilia (singular, cilium). Here, air is lung. The inner walls of the trachea and bronchi are
filtered, heated, and moistened to prepare it for its composed of mucous membrane (mucosa) embed-
journey to the lungs. The nasal cavity is divided ded with cilia. This membrane traps incoming parti-
into a right and left side by a vertical partition of cles, and the cilia move the entrapped material
cartilage called the nasal septum. upward into the pharynx, where it is coughed out,
Olfactory neurons are receptors for the sense sneezed out, or swallowed. Like the trachea, bronchi
of smell. They are covered with a layer of mucus contain C-shaped rings of cartilage.
and located deep in the nasal cavity, embedded Each bronchus divides into smaller and smaller
among the epithelial cells lining the nasal tract. branches, eventually forming (13) bronchioles. At
Because they are located higher in the nasal pas- the end of the bronchioles are tiny air sacs called
sage than air normally travels during breathing, a (14) alveoli (singular, alveolus). An alveolus resem-
person must sniff or inhale deeply to identify weak bles a small balloon because it expands and contracts
odors. Air passes from the nasal cavity to the with inflow and outflow of air. The (15) pulmonary
throat (pharynx), a muscular tube that serves as a capillaries lie next to the thin tissue membranes of
passageway for food and air. The pharynx consists the alveoli. Carbon dioxide diffuses from the blood
of three sections: the (2) nasopharynx, posterior within the pulmonary capillaries and enters the alve-
to the nose; the (3) oropharynx, posterior to the olar spaces, while O2 from the alveoli diffuses into
mouth; and the (4) laryngopharynx, superior to the blood. After the exchange of gases, freshly oxy-
the larynx. genated blood returns to the heart. It is now ready
Within the nasopharynx is a collection of lym- for delivery to all body tissues.
phoid tissue known as (5) adenoids (pharyngeal The lungs are divided into lobes: three lobes in
tonsils). The (6) palatine tonsils, more common- the right lung and two lobes in the left lung. The
ly known as tonsils, are located in the oropharynx. space between the right and left lungs is called the
They protect the opening to the respiratory tract (16) mediastinum. It contains the heart, aorta,
from microscopic organisms that may attempt esophagus, and bronchi. A serous membrane, the
entry by this route. The (7) larynx (voice box) pleura, covers the lobes of the lungs and folds over
contains the structures that make vocal sounds to line the walls of the thoracic cavity. The mem-
possible. A leaf-shaped structure on top of the brane lying closest to the lung is the (17) visceral
larynx, the (8) epiglottis, seals off the air passage pleura; the membrane that lines the thoracic cavi-
to the lungs during swallowing. This function ty is the (18) parietal pleura. The space between
ensures that food or liquids do not obstruct the these two membranes is the (19) pleural cavity. It
flow of air to the lungs. The larynx is a short pas- contains a small amount of lubricating fluid, which
sage that joins the pharynx with the (9) trachea permits the visceral pleura to glide smoothly over
(windpipe). The trachea is composed of smooth the parietal pleura during breathing.
muscle embedded with C-shaped rings of carti- Ventilation depends on a pressure differential
lage, which provide rigidity to keep the air pas- between the atmosphere and chest cavity. A large
sage open. muscular partition, the (20) diaphragm, lies
150 CHAPTER 7 • Respiratory System

(5) Adenoids
(1) Nasal cavity
(2) Nasopharynx
Nose
(3) Oropharynx
(6) Palatine tonsils
(4) Laryngopharynx

(8) Epiglottis (7) Larynx

Glottis and vocal cords
Thyroid cartilage
(9) Trachea
Apex of lung (10) Bronchi

(13) Bronchiole
(16) Mediastinum

(11) Right lung

(12) Left lung
(17) Visceral pleura Base of lung
(20) Diaphragm

(19) Pleural cavity

(18) Parietal pleura

Deoxygenated
blood from heart
(13) Bronchiole

(14) Alveoli

Alveolus O2

CO2

Pulmonary capillary
Oxygenated
blood to heart Exchange of gases between an
alveolus and a pulmonary capillary
(15) Pulmonary capillaries

Figure 7-1. Anterior view of the upper and lower respiratory tracts.
 Anatomy and Physiology 151

between the chest and abdominal cavities. The erated by these cells, are returned to the environ-
diaphragm assists in changing the volume of the ment. Respiration includes four separate processes:
thoracic cavity to produce the needed pressure dif-
• pulmonary ventilation, more commonly
ferential for ventilation. When the diaphragm con-
called breathing, which is a largely involun-
tracts, it partially descends into the abdominal cavi-
tary action that moves air into (inspiration)
ty, thus decreasing the pressure within the chest and
and out of (expiration) the lungs in response
drawing air into the lungs (inspiration). When the
to changes in blood O2 and CO2 levels and
diaphragm relaxes, it slowly reenters the thoracic
nervous stimulation of the diaphragm and
cavity, thus increasing the pressure within the chest.
intercostal muscles
As the pressure increases, air leaves the lungs (expi-
• external respiration, which is the exchange of
ration).The intercostal muscles assist the diaphragm
oxygen and carbon dioxide between the alve-
in changing the volume of the thoracic cavity by ele-
oli and the blood in the pulmonary capillaries
vating and lowering the rib cage. (See Figure 7–2.)
• transport of respiratory gases, which occurs
when blood, aided by the cardiovascular system,
Respiration transports CO2 to the lungs and O2 to body cells
Respiration is the overall process by which O2 is • internal respiration, which is the exchange
taken from air and carried to body cells for their of O2 and CO2 between body cells and the
use, while CO2 and water, the waste products gen- blood in systemic capillaries.

A. Inspiration: Sternocleidomastoid
Air drawn into lungs muscle elevates sternum B. Expiration:
Air forced out of lungs

Pectoralis minor Pectoralis minor

muscles contract muscles relax
Lungs expand
Lungs contract

Intercostal muscles
contract Intercostal muscles
relax

Diaphragm relaxes
and moves up
Diaphragm contracts
and flattens

Figure 7-2. Breathing muscles.

Connecting Body Systems–Respiratory System

The main function of the respiratory system is to provide oxygen to the entire body and expel car-
bon dioxide from the body. Specific functional relationships between the respiratory system and
other body systems are summarized below.

Blood, lymph, and immune Digestive

• Tonsils, adenoids, and other immune struc- • Respiratory system provides O2 needed
tures in the respiratory tract protect for digestive functions.
against pathogens that enter through res- • Respiratory system removes CO2
piratory passageways. produced by the organs of digestion.
• Respiratory and digestive system share a
Cardiovascular common anatomic structure.
• Respiratory system provides O2 and
removes CO2 from cardiac tissue.
(continued)
152 CHAPTER 7 • Respiratory System

Connecting Body Systems–Respiratory System—cont’d

Endocrine Integumenary
• Respiratory system helps maintain a stable • Respiratory system furnishes O2 and dis-
pH required for proper functioning poses of CO2 to maintain healthy skin.
of the endocrine glands.
Musculoskeletal
Female reproductive • Respiratory system provides O2 for
• Respiration rate increases in response to muscle contraction.
sexual activity. • Respiratory system eliminates CO2 pro-
• Fetal respiration occurs during pregnancy. duced by muscles.
• Respiratory system provides O2 for bone
Genitourinary development.
• Respiratory system supplies O2 and
Nervous
removes CO2 to maintain proper
• Respiratory system provides O2 for brain,
functioning of urinary structures.
spinal cord, and sensory organ
• Respiratory system helps maintain pH
functions.
for gonadal hormone function.
• Respiratory system helps maintain a stable
• Respiratory system assists the urinary struc-
pH for neural function.
tures in regulating pH by removing CO2.

It is time to review respiratory structures by completing Learning Activity 7–1.

Medical Word Elements

This section introduces combining forms, suffixes, and prefixes related to the respiratory
system. Word analyses are also provided.
Element Meaning Word Analysis
Combining Forms
Upper
Respiratory
Tract

nas/o nose nas/al (NĀ-zl): pertaining to the nose

-al: pertaining to

rhin/o rhin/o/plasty (R Ī-nō-plăs-t ē): surgical repair of the nose

-plasty: surgical repair
Rhinoplasty is performed to correct birth defects or for cosmetic purposes.

sept/o septum sept/o/plasty (SĔP-tō-plăs-tē): surgical repair of the septum

-plasty: surgical repair
Septoplasty is commonly performed to correct a deviated septum.

sinus/o sinus, cavity sinus/o/tomy (sı̄-nŭs-ŎT-ō-mē): incision of any of the sinuses

-tomy: incision
Sinusotomy is performed to improve ventilation or drainage in unresponsive
sinusitis.

adenoid/o adenoids adenoid/ectomy (ăd-ĕ-noyd-ĔK-tō-mē): excision of adenoids

-ectomy: excision, removal
 Anatomy and Physiology 153

Medical Word Elements—cont’d

Element Meaning Word Analysis

tonsill/o tonsils peri/tonsill/ar (pĕr-ı̆-TŎN-sı̆-lăr): pertaining to (the area) around the tonsils
peri-: around
-ar: pertaining to

pharyng/o pharynx (throat) pharyng/o/scope (f ăr-ĬN-gō-skōp): instrument for examining the pharynx
-scope: instrument for examining

epiglott/o epiglottis epiglott/itis (ĕp-ı̆-glŏt-Ī-tı̆s): inflammation of the epiglottis

-itis: inflammation
Because the epiglottis seals the passageway traveled by air to and from the lungs,
inflammation can lead to severe airway obstruction and death. Epiglottitis is
treated as a medical emergency.

laryng/o larynx (voice laryng/o/plegia (lă-rı̆n-gō-PLĒ-jē-ă): paralysis of the (vocal cords and) larynx
box) -plegia: paralysis

trache/o trachea trache/o/plasty (TR Ā-kē-ō-plăs-tē): surgical repair of the trachea

(windpipe) -plasty: surgical repair
Tracheoplasty is performed to correct a narrow or stenotic trachea.

Lower
Respiratory
Tract

bronchi/o bronchus bronchi/ectasis (br ŏng-kē-ĔK-tă-sı̆s): dilation of (one or more) bronchi

(plural, bronchi) -ectasis: dilation, expansion
Bronchiectasis is associated with various lung conditions and is commonly accom-
panied by chronic infection.

bronch/o bronch/o/scope (BRŎNG-kō-sk ōp): instrument for examining the bronchus

or bronchi
-scope: instrument for examining
A bronchoscope is a flexible tube that is passed through the nose or mouth and enables
inspection of the lungs and collection of tissue biopsies and secretions for analysis.

bronchiol/o bronchiole bronchiol/itis (brŏng-k ē-ō-LĪ-tı̆s): inflammation of the bronchioles

-itis: inflammation

alveol/o alveolus; air sac alveol/ar (ăl-VĒ-ō-lăr): pertaining to the alveoli

-ar: pertaining to

pleur/o pleura pleur/o/centesis (ploo-rō-s ĕn-TĒ-sı̆s): surgical puncture of the pleural cavi-
ty; also called thoracocentesis or thoracentesis
-centesis: surgical puncture

pneum/o air; lung pneum/ectomy (nūm-ĔK-tō-m ē): excision of (all or part of ) a lung
-ectomy: excision

pneumon/o pneumon/ia (nū-MŌ-nē-ă): condition of inflammation of the lungs

-ia: condition
The usual causes of pneumonia are infections due to bacteria, viruses, or other
pathogenic organisms. (continued)
154 CHAPTER 7 • Respiratory System

Medical Word Elements—cont’d

Element Meaning Word Analysis

pulmon/o lung pulmon/o/logist (pŭl-mŏ-NŎL-ŏ-jı̆st): specialist in the study (and

treatment) of lungs (and respiratory diseases)
-logist: specialist in the study of

Other

anthrac/o coal, coal dust anthrac/osis (ăn-thră-KŌ-sı̆s): abnormal condition of coal dust (in the lungs)
-osis: abnormal condition; increase (used primarily with blood cells)
Anthracosis is a chronic occupational disease found in coal miners and those associ-
ated with the coal industry.

atel/o incomplete; atel/ectasis (ăt-ĕ-LĔK-tă-sı̆s): incomplete expansion of the lung; also called
imperfect airless lung or collapsed lung
-ectasis: dilation, expansion

coni/o dust pneum/o/coni/osis (nū-mō-kō-nē-Ō-sı̆s): condition of dust in the lungs

pneum/o: air; lung
-osis: abnormal condition; increase (used primarily with blood cells)
Pneumoconiosis is usually caused by mineral dusts of occupational or environmen-
tal origin. Forms of pneumoconiosis include silicosis, asbestosis, and anthracosis.

cyan/o blue cyan/osis (sı̄-ă-NŌ-sı̆s): abnormal condition of blueness

-osis: abnormal condition; increase (used primarily with blood cells)
Cold temperatures, heart failure, lung diseases, and smothering cause unusual blueness
of the skin and mucous membranes due to the build-up of carbon dioxide in the blood.

lob/o lobe lob/ectomy (lō-BĔK-tō-mē): excision of a lobe

-ectomy: excision
Lobectomies are performed when a malignancy is conf ined to a single lobe of any
lobed organ, such as the lungs, liver, brain, and thyroid gland.

orth/o straight orth/o/pnea (or-THŎP-n ē-ă): breathing in a straight (or upright position)
-pnea: breathing
Various lung disorders cause a patient to experience diff iculty breathing in any
position other than sitting or standing erect.

ox/i oxygen ox/i/meter (ŏk-SĬM-ĕ-tĕr): instrument used for measuring oxygen

-meter: instrument for measuring
An oximeter is usually attached to the tip of a f inger but may also be placed on a toe
or ear lobe. It provides a measurement of the oxygen saturation level of the blood.

ox/o hyp/ox/emia (hı̄-p ŏks-Ē-mē-ă): deficiency of oxygen in blood

hyp-: under, below, deficient
-emia: blood condition

pector/o chest pector/algia (pĕk-tō-R ĂL-j ē-ă): pain in the chest; also called thoracalgia,
thoracodynia, and pectorodynia
-algia: pain

steth/o steth/o/scope (STĔTH-ō-skōp): instrument used for examining the chest

-scope: instrument for examining
A stethoscope enables evaluation of sounds in the chest as well as the abdomen.
 Anatomy and Physiology 155

Medical Word Elements—cont’d

Element Meaning Word Analysis

thorac/o thorac/o/pathy (thō-răk-ŎP-ă-thē): disease of the chest

-pathy: disease

phren/o diaphragm; phren/o/spasm (FRĔN-ō-spăzm): involuntary contraction of the diaphragm

mind -spasm: involuntary contraction, twitching

spir/o breathe spir/o/meter (spı̄-RŎM-ĕt-ĕr): instrument for measuring breathing

-meter: instrument for measuring
A spirometer measures how much air the lungs can hold (vital capacity) as well as
how much and how quickly air can be exhaled.
Suffixes

-capnia carbon dioxide hyper/capnia (hı̄-pĕr-K ĂP-nē-ă): excessive CO2

(CO2) hyper-: excessive, above normal

-osmia smell an/osmia (ăn-ŎZ-mē-ă): without (the sense of ) smell

an-: without, not

-phonia voice dys/phonia (dı̆s-FŌ-nē-ă): bad (impaired) voice quality

dys-: bad; painful; difficult
Dysphonia includes hoarseness, voice fatigue, or decreased projection.

-pnea breathing a/pnea (ăp-NĒ-ă): not breathing

a-: without, not
Apnea is a temporary loss of breathing and includes sleep apnea, cardiac apnea,
and apnea of the newborn.

-ptysis spitting hem/o/ptysis (h ē-MŎP-tı̆-sı̆s): (coughing up or) spitting of blood

hem/o: blood
Bloody sputum is usually a sign of a serious condition of the lungs.

-thorax chest py/o/thorax (pı̄-ō-THŌ-răks): pus in the chest (cavity); also called empyema
py/o: pus
Pyothorax is usually caused by a penetrating chest wound or spreading of infection
from another part of the body.
Prefixes

brady- slow brady/pnea (brăd-ı̆p-NĒ-ă): slow breathing

-pnea: breathing

dys- bad; painful; dys/pnea (dı̆sp-NĒ-ă): difficult breathing

difficult -pnea: breathing
Dyspnea includes any discomfort or signif icant breathlessness.

eu- good, normal eu/pnea (ūp-NĒ-ă): normal breathing

-pnea: breathing
The normal range for a resting adult respiratory rate is 12 to 20 breaths/minute.

tachy- rapid tachy/pnea (tăk-ı̆p-NĒ-ă): rapid breathing

-pnea: breathing

It is time to review word elements by completing Learning Activity 7–2. For audio pronunciations of the
above-listed key terms, you can visit www.davisplus.fadavis.com/gylys/systems to download this chapter’s
Listen and Learn! exercises or use the book’s audio CD (if included).
156 CHAPTER 7 • Respiratory System

Pathology respiratory system. The physician who treats these

disorders is called a pulmonologist.
Common signs and symptoms of many respirato-
ry disorders include cough (dry or productive),
chest pain, altered breathing patterns, shortness of Chronic Obstructive
breath (SOB), cyanosis, and fever. Many disorders Pulmonary Disease
of the respiratory system, including bronchitis and
emphysema, begin as an acute problem but Chronic obstructive pulmonary disease
become chronic over time. Chronic respiratory (COPD) includes respiratory disorders that pro-
diseases are usually difficult to treat. Their damag- duce a chronic partial obstruction of the air pas-
ing effects are commonly irreversible. sages. The patient finds it difficult to breath (dys-
For diagnosis, treatment, and management of pnea) especially upon exertion and usually
respiratory disorders, the medical services of a spe- exhibits a chronic cough. The three major disor-
cialist may be warranted. Pulmonology is the ders included in COPD are asthma, chronic
medical specialty concerned with disorders of the bronchitis, and emphysema. (See Figure 7–3.)

A. Chronic bronchitis
Excess mucus
production

Distended Extra mucus

bronchiole

Inflamed Figure 7-3. COPD.

airway
(A) Chronic bronchitis with
Enlarged Constricted inflamed airways and exces-
alveoli smooth
muscle sive mucus. (B) Emphysema
with distended bronchioles
and alveoli. (C) Asthma with
narrowed bronchial tubes
and swollen mucous
B. Emphysema C. Asthma membranes.
 Pathology 157

Asthma organism is highly infectious (virulent). Influenza

Asthma produces spasms in the bronchial pas- type A epidemics occur about every 2 to 3 years.
sages (bronchospasms) that may be sudden and Type B is usually limited geographically and tends
violent (paroxysmal) and lead to dyspnea. Asthma to be less severe than type A. Both viruses undergo
is commonly caused by exposure to allergens or antigenic changes; consequently, new vaccines must
irritants. Other causes include stress, cold, and be developed in anticipation of outbreaks. Type C
exercise. During recovery, coughing episodes pro- is a mild flu and is not associated with epidemics.
duce large amounts of mucus (productive cough). The onset of the flu is usually rapid. Symptoms
Over time, the epithelium of the bronchial pas- include fever, chills, headache, generalized muscle
sages thickens, and breathing becomes more diffi- pain (myalgia), and loss of appetite, but recovery
cult. Treatment includes agents that loosen and occurs in about 7 to 10 days. The flu virus rarely
break down mucus (mucolytics) and medications causes death. If death occurs, it is usually the result
that expand the bronchi (bronchodilators) by of a secondary pneumonia caused by bacteria or
relaxing their smooth muscles. If usual measures viruses that invade the lungs. Children should not
do not reverse the bronchospasms, the condition use aspirin for relief of symptoms caused by virus-
is referred to as status asthmaticus. es because there appears to be a relationship
between Reye syndrome and the use of aspirin by
Chronic Bronchitis children 2 to 15 years of age.
Chronic bronchitis is an inflammation of the
bronchi caused mainly by smoking and air pollu- Pleural Effusions
tion. However, other agents, such as viruses and
bacteria may also cause the disorder. Bronchitis is Any abnormal fluid in the pleural cavity, the space
characterized by swelling of the mucosa and a between the visceral and parietal pleura, is called a
heavy, productive cough, commonly accompanied pleural effusion. Normally, the pleural cavity con-
by chest pain. Patients usually seek medical help tains only a small amount of lubricating fluid.
when they suffer exercise intolerance, wheezing, However, some disorders may cause excessive fluid
and shortness of breath (SOB). Bronchodilators to collect in the pleural cavity. Two initial tech-
and medications that aid in the removal of mucus niques used to diagnose pleural effusion are aus-
(expectorants) help to widen air passages. Steroids cultation and percussion. Auscultation is the lis-
may be prescribed if the disease progresses or tening of sounds made by organs of the body using
becomes chronic. a stethoscope. Percussion is the gentle tapping the
chest with the fingers and listening to the resultant
Emphysema sounds to determine the position, size, or consis-
Emphysema is characterized by decreased elastic- tency of the underlying structures. Chest x-ray
ity of the alveoli. The alveoli expand (dilate) but (CXR) or magnetic resonance imaging (MRI)
are unable to contract to their original size. The air confirms the diagnosis.
that remains trapped in the chest results in a char- Effusions are classified as transudates and exu-
acteristic “barrel-chested” appearance. This disease dates. A transudate is a noninflammatory fluid
commonly occurs with another respiratory disor- that resembles serum but with slightly less pro-
der, such as asthma, tuberculosis, or chronic bron- tein. It results from an imbalance in venous-
chitis. It is also found in long-term heavy smokers. arterial pressure or decrease of protein in blood.
Most emphysema sufferers find it easier to breathe Both of these conditions allow serum to leak
when sitting upright or standing erect (orthop- from the vascular system and collect in the pleu-
nea). As the disease progresses, relief even in the ral space. Common causes include left ventricular
orthopneic position is not possible. Treatment for heart failure and liver disorders. An exudate is
emphysema is similar to that of chronic bronchitis. usually high in protein and often contains blood
and immune cells. Common causes include
tumors, infections, and inflammation. Various types
Influenza of pleural effusions include serum (hydrothorax),
Influenza (flu) is an acute infectious respiratory pus (empyema or pyothorax), and blood (hemo-
viral disease. Three major viral types are responsi- thorax). Although not considered a pleural
ble: type A, type B, and type C. Type A is of pri- effusion, air can enter the pleural space (pneu-
mary concern because it is associated with world- mothorax), resulting in a partial or complete
wide epidemics (pandemics) and its causative collapse of a lung. (See Figure 7–4.)
158 CHAPTER 7 • Respiratory System

A.

Normal lung

B. C.

Parietal
pleura
Air Air
Visceral
pleura

Parietal
pleura

Visceral
pleura
Pleural
cavity

Pneumothorax on Pneumothorax on
inspiration expiration

Figure 7-4. Pneumothorax. (A) Normal. (B) Open pneumothorax during inspiration. (C) Open pneumothorax during
expiration.

Treatment consists of correcting the underlying tious for 6 to 8 months outside the body. It also
cause of the effusion. Often a surgical puncture of makes laboratory staining of this organism more
the chest using a hollow-bore needle (thoracocen- challenging. Hence TB is also known as the acid-fast
tesis, thoracentesis) is undertaken to remove bacillus (AFB), a reference to its more complex
excess fluid for diagnostic or therapeutic purposes. method of laboratory staining.
(See Figure 7–5.) Sometimes chest tubes are insert- The first time the TB organism enters the body
ed to drain fluid or remove air in pneumothorax. (primary tuberculosis), the disease develops slow-
ly. It eventually produces typical inflammatory
Tuberculosis nodules (granulomas) called tubercles. These
granulomas usually remain dormant for years, dur-
Tuberculosis (TB) is a communicable disease ing which time the patient is asymptomatic. When
caused by the bacterium Mycobacterium tuberculosis. the immune system becomes impaired (immuno-
TB spreads by droplets of respiratory secretions compromised) or when the patient is reexposed to
(droplet nuclei) from an infected individual when the bacterium, a full-blown disease may develop.
he/she coughs, laughs, or sneezes. The waxy coat of Although primarily a lung disease, TB can infect
the TB organism keeps it alive (viable) and infec- the bones, genital tract, meninges, and peritoneum.
 Pathology 159

Ribs

Lung

Syringe with catheter Pleural

removing pleural fluid effusion
from around lung
Visceral
pleura
Parietal
pleura

Collecting bottle

Figure 7-5. Thoracentesis.

Some TB strains that infect AIDS patients have by a fungus that resides in or on most people
become resistant and do not respond to standard (normal flora) but causes no harm as long as the
medications. Treatment may include using several individual remains healthy. When the immune
antibiotics (combination therapy) at the same time. system begins to fail, this organism becomes
infectious (opportunistic). Diagnosis relies on
Pneumonia examination of biopsied lung tissue or bronchial
washings (lavage).
Pneumonia is any inflammatory disease of the
lungs that may be caused by bacteria, viruses, or
fungi. Chemicals or other agents can cause the
Cystic Fibrosis
lungs to become inflamed. A type of pneumonia Cystic fibrosis is a hereditary disorder of the
associated with influenza is sometimes fatal. exocrine glands that causes the body to secrete
Other potentially fatal pneumonias may result extremely thick (viscous) mucus. This thickened
from food or liquid inhalation (aspiration pneu- mucus clogs ducts of the pancreas and digestive
monias). Some pneumonias affect only a lobe of tract. As a result, digestion is impaired and the
the lung (lobar pneumonia), but some are more patient may suffer from malnutrition. It also blocks
diffuse (bronchopneumonia). Chest pain, muco- ducts of the sweat glands, causing the skin to
purulent sputum, and spitting of blood (hemop- become highly “salty.” In the lungs, mucus blocks
tysis) are common signs and symptoms of the airways and impedes natural disease-fighting mech-
disease. If the air in the lungs is replaced by fluid anisms, causing repeated infections. Medication in
and inflammatory debris, the lung tissue looses the form of mists (aerosols) along with postural
its spongy texture and become swollen and drainage provide relief.
engorged (consolidation). Consolidation is asso- An important diagnostic test called the sweat
ciated primarily with bacterial pneumonias, not test measures the amount of salt excreted in sweat.
viral pneumonias. When elevated, it indicates cystic fibrosis.
Pneumocystis carinii pneumonia (PCP) is a Although the disease is fatal, improved methods of
type of pneumonia closely associated with treatment have extended life expectancy, and
AIDS. Recent evidence suggests that it is caused patient survival is approximately 30 years.
160 CHAPTER 7 • Respiratory System

Acute Respiratory Distress during exhalation. Radiography shows a mem-

brane that has a ground-glass appearance (hyaline
Syndrome membrane), bilateral decrease in volume, and alve-
Acute respiratory distress syndrome (ARDS) is a olar consolidation. Although severe cases of HMD
condition in which the lungs no longer function result in death, some forms of therapy are effective.
effectively, threatening the life of the patient. It
usually occurs as a result of very serious lung con- Oncology
ditions, such as trauma, severe pneumonia, and
other major infections that affect the entire body The most common form of lung cancer is bron-
(systemic infections) or blood (sepsis). In ARDS, chogenic carcinoma; also called primary pul-
the alveoli fill with fluid (edema) caused by monary cancer. This cancer is usually associated
inflammation, and then collapse, making oxygen with tobacco use. Cells of the bronchial epithelium
exchange impossible. Mechanical ventilation is divide repeatedly until the entire epithelium is
commonly required to save the life of the patient. involved. Within a short time, the epithelium
Hyaline membrane disease (HMD), sometimes begins to invade underlying tissues. As masses
called infant respiratory distress syndrome (IRDS), is form, they block air passages and alveoli.
a form of respiratory distress syndrome. It is most Bronchogenic carcinoma spreads (metastasizes)
commonly seen in preterm infants or infants born rapidly to other areas of the body, including the
to diabetic mothers. It is caused by insufficient lymph nodes, liver, bones, brain, and kidneys. Only
surfactant, a phospholipid substance that helps about 10% of lung cancers are found in the early
keep alveoli open. With insufficient surfactant, the stages when the cure rate is high. Treatment of
alveoli collapse and breathing becomes labored. lung cancer includes surgery, radiation, and
Clinical signs may include blueness (cyanosis) of chemotherapy or a combination of these methods
the extremities. Flaring of the nostrils (nares) depending on specific cell type, how far the disease
and central cyanosis are typically present. Other has spread, and the general health of the patient.
signs include rapid breathing (tachypnea), inter- Nevertheless, lung cancer is difficult to control and
costal retraction, and a characteristic grunt audible survival rates are very low.

Diagnostic, Symptomatic, and Related Terms

This section introduces diagnostic, symptomatic, and related terms and their meanings. Word
analyses for selected terms are also provided.
Term Definition

acidosis Excessive acidity of body fluids

ăs-ı̆-DŌ-sı̆s Respiratory acidosis is commonly associated with pulmonary insuff iciency and
the subsequent retention of carbon dioxide

anosmia Absence of the sense of smell

ăn-ŎZ-mē-ă Anosmia usually occurs as a temporary condition resulting from an upper respi-
an-: without, not ratory infection or a condition that causes intranasal swelling.
-osmia: smell
 Pathology 161

Diagnostic, Symptomatic, and Related Terms—cont’d

Term Definition

apnea Temporary loss of breathing

ăp-NĒ-ă There are three types of apnea: obstructive (enlarged tonsils and adenoids),
a-: without, not central (failure of the brain to transmit impulses for breathing), and mixed
-pnea: breathing (combination of obstructive and central apnea).
sleep Sleeping disorder in which breathing stops repeatedly for more than
10 seconds, causing measurable blood deoxygenation. (See Figure 7-6.)

Uvula

Enlarged
tonsil causing
obstructive
sleep apnea
Epiglottis

Trachea

A.

Nasal mask (pillows)

Positive pressure
provided by a fan

B.

Figure 7-6. Sleep apnea. (A) Airway obstruction caused by enlarged tonsils, eventually leads to obstructive
sleep apnea. (B) Continuous positive airway pressure (CPAP) machine used to treat sleep apnea.
(continued)
162 CHAPTER 7 • Respiratory System

Diagnostic, Symptomatic, and Related Terms—cont’d

Term Definition

asphyxia Condition caused by insufficient intake of oxygen

ăs-FĬK-s ē-ă Some common causes of asphyxia are drowning, electric shock, lodging of a for-
a-: without, not eign body in the respiratory tract, inhalation of toxic smoke, and poisoning.
-sphyxia: pulse

atelectasis Collapsed or airless state of the lung, which may be acute or chronic and
ăt-ĕ-LĔK-tă-sı̆s affect all or part of a lung
atel: incomplete; imperfect Atelectasis is a potential complication of some surgical procedures, especially
-ectasis: dilation, expansion those of the chest because breathing is commonly shallow after surgery to avoid
pain from the surgical incision. In fetal atelectasis, the lungs fail to expand
normally at birth.
cheyne-Stokes respiration Repeated breathing pattern characterized by fluctuation in the depth of
chān-stōks respiration, first deeply, then shallow, then not at all
Cheyne-Stokes respirations are usually caused by diseases that affect the
respiratory centers of the brain (such as heart failure and brain damage).

compliance Ease with which lung tissue can be stretched

kŏm-PLĪ-ăns Low compliance means lungs are less elastic; therefore, more effort is required
to inflate the lungs.
coryza Head cold; upper respiratory infection (URI)
kŏ-RĪ-ză

crackle Abnormal respiratory sound heard on auscultation, caused by exudates,

KR ĂK-ĕl spasms, hyperplasia, or when air enters moisture-filled alveoli; also called rale

croup Common childhood condition involving inflammation of the larynx, tra-

croop chea, bronchial passages and, sometimes, lungs
Signs and symptoms include a resonant, barking cough with suffocative, diffi-
cult breathing; laryngeal spasms, and, sometimes, the narrowing of the top of
the air passages.
deviated nasal septum Displacement of cartilage dividing the nostrils
DĒ-v ē-āt-ĕd N Ā-zl SĔP-t ŭm

epiglottitis Severe, life-threatening infection of the epiglottis and supraglottic structures

ĕp-ı̆-glŏt-Ī-tı̆s that occurs most commonly in children between 2 and 12 years of age
epiglott: epiglottis Signs and symptoms of epiglottitis include fever, dysphagia, inspiratory stridor,
-itis: inflammation and severe respiratory distress. Intubation or tracheostomy may be required to
open the obstructed airway.

epistaxis Nosebleed; nasal hemorrhage

ĕp-ı̆-STĂK-sı̆s

finger clubbing Enlargement of the terminal phalanges of the fingers and toes, commonly
KLŬB-ı̆ng associated with pulmonary disease

hypoxemia Deficiency of oxygen in the blood

hı̄-p ŏks-Ē-mē-ă Hypoxemia is usually a sign of respiratory impairment.
hyp-: under, below, deficient
ox: oxygen
-emia: blood condition
 Pathology 163

Diagnostic, Symptomatic, and Related Terms—cont’d

Term Definition

hypoxia Deficiency of oxygen in tissues

hı̄-PŎKS-ē-ă Hypoxia is usually a sign of respiratory impairment.
hyp-: under, below, deficient
-oxia: oxygen
pertussis Acute infectious disease characterized by a cough that has a “whoop”
p ĕr-TŬS-ı̆s sound; also called whooping cough
Immunization of infants as part of the diphtheria-pertussis-tetanus (DPT)
vaccination is effective in the prevention of pertussis.

pleurisy Inflammation of the pleural membrane characterized by a stabbing pain

PLOO-rı̆s- ē that is intensified by coughing or deep breathing; also called pleuritis
pleur: pleura
-isy: state of; condition
pneumoconiosis Disease caused by inhaling dust particles, including coal dust (anthraco-
nū-mō-kō-n ē-Ō-sı̆s sis), stone dust (chalicosis), iron dust (siderosis), and asbestos particles
pneum/o: air; lung (asbestosis)
coni: dust
-osis: abnormal condition; increase
(used primarily with blood cells)
pulmonary edema Accumulation of extravascular fluid in lung tissues and alveoli, caused
P ŬL-mō-nĕ-rē ĕ-DĒ-mă most commonly by heart failure
pulmon: lung Excessive fluid in the lungs induces coughing and dyspnea.
-ary: pertaining to
pulmonary embolus Blockage in an artery of the lungs caused by a mass of undissolved matter
PŬL-mō-nĕ-rē ĔM-bō-lŭs (such as a blood clot, tissue, air bubbles, and bacteria)
pulmon: lung
-ary: pertaining to
embol: plug
-us: condition, structure
rhonchus Abnormal breath sound heard on auscultation
RŎNG-k ŭs
A rhonchus is described as a course, rattling noise that resembles snoring, com-
monly suggesting secretions in the larger airways.

stridor High-pitched, harsh, adventitious breath sound caused by a spasm or

STRĪ-dor swelling of the larynx or an obstruction in the upper airway
The presence of stridor requires immediate intervention.

sudden infant death syndrome Completely unexpected and unexplained death of an apparently normal,
(SIDS) healthy infant, usually less than 12 months of age; also called crib death
The rate of SIDS has decreased more than 30% since parents have been instruct-
ed to place babies on their backs for sleeping rather than on their stomachs.
wheeze Whistling or sighing sound heard on auscultation that results from
HWĒZ narrowing of the lumen of the respiratory passageway
Wheezing is a characteristic of asthma, croup, hay fever, obstructive emphysema,
and other obstructive respiratory conditions.

It is time to review pathological, diagnostic, symptomatic, and related terms by completing Learning Activity 7–3.
164 CHAPTER 7 • Respiratory System

Diagnostic and Therapeutic Procedures

This section introduces procedures used to diagnose and treat respiratory disorders. Descriptions are
provided as well as pronunciations and word analyses for selected terms.
Procedure Descripton
Diagnostic Procedures
Clinical

Mantoux test Intradermal test to determine tuberculin sensitivity based on a positive

măn-TŪ reaction where the area around the test site becomes red and swollen
A positive test suggests a past or present exposure to TB or past TB vaccination. How-
ever, the Mantoux test does not differentiate between active and inactive infection.

oximetry Noninvasive method of monitoring the percentage of hemoglobin (Hb)

ŏk-SĬM-ĕ-trē saturated with oxygen; also called pulse oximetry
ox/i: oxygen In oximetry, a probe is attached to the patient’s finger or ear lobe and linked to
-metry: act of measuring a computer that displays the percentage of hemoglobin saturated with oxygen.

polysomnography Test of sleep cycles and stages using continuous recordings of brain waves
p ŏl-ē-s ŏm-NŎG-ră-fē (EEGs), electrical activity of muscles, eye movement (electro-oculogram),
poly-: many, much respiratory rate, blood pressure, blood oxygen saturation, heart rhythm
somn/o: sleep and, sometimes, direct observation of the person during sleep using a
-graphy: process of recording video camera

pulmonary function tests Multiple tests used to evaluate the ability of the lungs to take in and expel
(PFTs) air as well as perform gas exchange across the alveolocapillary membrane
PŬL-mō-nĕ-r ē
pulmon: lung
-ary: pertaining to

spirometry Measurement of ventilatory ability by assessing lung capacity and flow,

spı̄-RŎM-ĕ-tr ē including the time necessary for exhaling the total volume of inhaled air
spir/o: breathe A spirometer produces a graphic record for placement in the patient’s chart.
-metry: act of measuring

Endoscopic

bronchoscopy Visual examination of the bronchi using an endoscope (flexible fiberoptic

br ŏng-KŎS-kō-pē or rigid) inserted through the mouth and trachea for direct viewing of
bronch/o: bronchus structures or for projection on a monitor (See Figure 7-7.)
-scopy: visual examination Attachments on the bronchoscope can be used to suction mucus, remove foreign
bodies, collect sputum, or perform biopsy.

laryngoscopy Visual examination of the larynx to detect tumors, foreign bodies, nerve
lăr-ı̆n-G ŎS-k ō-pē or structural injury, or other abnormalities
laryng/o: larynx (voice box)
-scopy: visual examination

mediastinoscopy Visual examination of the mediastinal structures including the heart, tra-
mē-dē-ăs-tı̆-NŎS-kō-p ē chea, esophagus, bronchus, thymus, and lymph nodes
mediastin/o: mediastinum The mediastinoscope is inserted through a small incision made above the sternum.
-scopy: visual examination The attached camera projects images on a monitor. Additional incisions may be made
if nodes are removed or other diagnostic or therapeutic procedures are performed.
 Pathology 165

Diagnostic and Therapeutic Procedures—cont’d

Procedure Descripton

Viewing
piece

Bronchoscope

Channel in the flexible tube to

accommodate biopsy forceps
and instruments

Left
bronchus

Visual
examination
of left bronchus

Figure 7-7. Bronchoscopy of the left bronchus. (continued)

166 CHAPTER 7 • Respiratory System

Diagnostic and Therapeutic Procedures—cont’d

Procedure Descripton

Laboratory

arterial blood gas (ABG) Test that measures partial pressure of oxygen (Po2), carbon dioxide (Pco2),
ăr-TĒ-r ē-ăl pH (acidity or alkalinity), and bicarbonate level of an arterial blood
sample
ABG analysis evaluates pulmonary gas exchange and helps guide treatment of
acid-base imbalances.

sputum culture Microbial test used to identify disease-causing organisms of the lower res-
SPŪ-tŭm piratory tract, especially those that cause pneumonias

sweat test Measurement of the amount of salt (sodium chloride) in sweat

A sweat test is used almost exclusively in children to conf irm cystic f ibrosis.

throat culture Test used to identify pathogens, especially group A streptococci

Untreated streptococcal infections may lead to serious secondary complications,
including kidney and heart disease.

Radiographic

radiography Process of producing images using an x-ray passed through the body or
r ā-dē-ŎG-ră-fē area and captured on a film
radi/o: radiation, x-ray; radius
(lower arm bone on thumb
side)
-graphy: process of recording

thoracic (chest) Images of the chest taken from anteroposterior (AP) projection, posteroante-
thō-RĂS-ı̆k rior (PA) projection, lateral projection, or a combination of these projections
thorac: chest Chest radiography is used to diagnose rib fractures and lung diseases, including
-ic: pertaining to, relating to atelectasis, masses, pneumonia, and emphysema.

scan Imaging procedure that gathers information about a specific organ or

structure of the body. In some cases, small amounts of injected radionu-
clide (tracer) are used to enhance images

lung Nuclear scanning test primarily used to detect pulmonary emboli

Lung scan is commonly performed to detect the presence of a blood clot that may
be interfering with blood flow in or to the lung.
 Pathology 167

Diagnostic and Therapeutic Procedures—cont’d

Procedure Descripton
Therapeutic Procedures

Clinical

aerosol therapy Lung treatment using various techniques to deliver medication in mist
ĀR-ō-s ŏl THĔR-ă-p ē form directly to the lungs or air passageways. Techniques include nebuliz-
ers, metered-dose inhalers (MDIs), and dry powder inhalers (DPIs)
Nebulizers change liquid medications into droplets to be inhaled through a mouth-
piece. (See Figure 7-8.) MDIs deliver a specif ic amount when activated. Children
and the elderly can use a spacer to synchronize inhalation with medication release.
(See Figure 7-9.) A DPI is activated by a quick inhalation by the user.

Nebulizer

Figure 7-8. Nebulizer.

Metered-dose
inhaler

Spacer

Metered-dose
inhaler without
a spacer

Figure 7-9. Metered-dose inhaler. (continued)

168 CHAPTER 7 • Respiratory System

Diagnostic and Therapeutic Procedures—cont’d

Procedure Descripton

lavage Irrigating or washing out of an organ, stomach, bladder, bowel, or body

lă-VĂZH cavity with a stream of water or other fluid
Lavage of the paranasal sinuses is usually performed to remove mucopurulent
material in an immunosuppressed patient or one with known sinusitis that has
failed medical management.

antral Irrigation of the antrum (maxillary sinus) in chronic or nonresponsive

ĂN-trăl sinusitis

postural drainage Positioning a patient so that gravity aids in the drainage of secretions
P ŎS-t ū-răl from the bronchi and lobes of the lungs

Surgical

pleurectomy Excision of part of the pleura, usually parietal

ploor-ĔK-tō-m ē Pleurectomy is performed to reduce pain caused by a tumor mass or to prevent
pleur: pleura the recurrence of pleural effusion but is generally ineffective in the treatment of
-ectomy: excision, removal malignancy of the pleura.

pneumectomy Excision of a lung

n ūm-ĔK-tō-m ē The removal of a lobe of the lung is called a lobectomy
pneum: air; lung
-ectomy: excision, removal

rhinoplasty Reconstructive surgery of the nose to correct deformities or for cosmetic

RĪ-nō-plăs-tē purposes
rhin/o: nose
-plasty: surgical repair

septoplasty Surgical repair of a deviated nasal septum usually performed when the
sĕp-tō-PLĂS-tē septum is encroaching on the breathing passages or nasal structures
sept/o: septum Common complications of a deviated septum include interference with breath-
-plasty: surgical repair ing and a predisposition to sinus infections.

thoracentesis Surgical puncture and drainage of the pleural cavity; also called pleurocen-
thō-ră-sĕn-TĒ-sı̆s tesis or thoracocentesis
Thoracentesis is performed as a diagnostic procedure to determine the nature
and cause of an effusion or as a therapeutic procedure to relieve the discomfort
caused by the effusion. (See Figure 7–5.)

tracheostomy Surgical procedure in which an opening is made in the neck and into the
trā-kē-ŎS-tō-mē trachea into which a breathing tube may be inserted (See Figure 7–10.)
 Pharmacology 169

Diagnostic and Therapeutic Procedures—cont’d

Procedure Descripton

Epiglottis
Trachea
Thyroid
gland

Tracheostomy
tube

A. B.
Expanding
balloon

Figure 7-10. Tracheostomy. (A) Lateral view with tracheostomy tube in place. (B) Frontal view.

Pharmacology delivered as a fine mist directly to the airways via

aerosol delivery devices, including nebulizers and
In addition to antibiotics used to treat respiratory metered-dose inhalers (MDIs). Another method
infections, there are several classes of drugs that of delivering medications directly to the lungs is
treat pulmonary disorders. (See Table 7–1.) dry-powder inhalers (DPIs) that dispense med-
Bronchodilators are especially significant in the ications in the form of a powder. Steroidal and
treatment of COPD and exercise-induced asth- nonsteroidal anti-inflammatory drugs are impor-
ma. They relax smooth muscles of the bronchi, tant in the control and management of many pul-
thus increasing airflow. Some bronchodilators are monary disorders.
170 CHAPTER 7 • Respiratory System

Table 7-1 Drugs Used to Treat Respiratory Disorders

This table lists common drug classifications used to treat respiratory disorders, their therapeutic actions,
and selected generic and trade names.
Classification Therapeutic Action Generic and Trade Names
antihistamines Block histamines from binding with histamine fexofenadine
receptor sites in tissues f ĕks-ō-F ĔN-ă-dēn
Histamines cause sneezing, runny nose, itchiness, Allegra
and rashes. loratadine
lor-ĂH-tă-dēn
Claritin
antitussives Relieve or suppress coughing by blocking the hydrocodone
cough reflex in the medulla of the brain hı̄-drō-KŌ-d ōn
Antitussives alleviate nonproductive dry coughs and Hycodan
should not be used with productive coughs. dextromethorphan
dĕk-strō-MĔTH-or-făn
Vicks Formula 44
bronchodilators Stimulate bronchial muscles to relax, thereby albuterol
expanding air passages, resulting in increased ăl-B Ū-t ĕr-ăl
air flow Proventil,Ventolin
Bronchodilators are used to treat chronic symp- salmeterol
toms and prevent acute attacks in respiratory dis- săl-mē-TĔR-ŏl
eases, such as asthma and COPD. Pharmacological Serevent
agents may be delivered by an inhaler either orally
or intravenously.
corticosteroids Act on the immune system by blocking pro- beclomethasone dipropionate
duction of substances that trigger allergic and bĕ-klō-MĔTH-ă-sōn
inflammatory actions dı̄-PRŌ-pĕ-ō-năt
Corticosteroids are available as nasal sprays, in Vanceril, Beclovent
metered-dose-inhalers (inhaled steroids) and in oral triamcinolone
forms (pills or syrups) to treat chronic lung condi- trı̄-ăm-S ĬN-ō-lōn
tions such as asthma and COPD. Azmacort
decongestants Constrict blood vessels of nasal passages and oxymetazoline
limit blood flow, which causes swollen tissues to ŏks-ē-mĕt-ĂZ-ō-lēn
shrink so that air can pass more freely through Dristan
the passageways pseudoephedrine
Decongestants are commonly prescribed for aller- soo-dō-ĕ-F ĔD-rı̆n
gies and colds and are usually combined with anti- Drixoral, Sudafed
histamines in cold remedies.They can be adminis-
tered orally or topically as nasal sprays and nasal
drops.
expectorants Liquify respiratory secretions so that they are guaifenesin
more easily dislodged during coughing episodes gwı̄-F ĔN-ĕ-sı̆n
Expectorants are prescribed for productive coughs. Robitussin, Organidin
 Pharmacology 171

Abbreviations
This section introduces respiratory-related abbreviations and their meanings.
Abbreviation Meaning Abbreviation Meaning

ABG arterial blood gas(es) MRI magnetic resonance imaging

AFB acid-fast bacillus NMT nebulized mist treatment

(TB organism)

AP anteroposterior O2 oxygen

ARDS acute respiratory distress PA posteroanterior; pernicious anemia

syndrome

CO2 carbon dioxide PCO2 partial pressure of carbon dioxide

COPD chronic obstructive pul- PCP Pneumocystis carinii pneumonia;

monary disease primary care physician; phencyclidine
(hallucinogen)

CPAP continuous positive airway PFT pulmonary function test

pressure

CPR cardiopulmonary resuscitation pH symbol for degree of acidity or alkalinity

CT computed tomography PND paroxysmal nocturnal dyspnea

CXR chest x-ray, chest radiograph PO2 partial pressure of oxygen

DPI dry power inhaler RD respiratory distress

DPT diphtheria, pertussis, tetanus RDS respiratory distress syndrome

EEG encephalogram, encephalog- SaO2 arterial oxygen saturation

raphy

FVC forced vital capacity SIDS sudden infant death syndrome

Hb, Hgb hemoglobin SOB shortness of breath

HMD hyaline membrane disease T&A tonsillectomy and adenoidectomy

Hx history TB tuberculosis

IPPB intermittent positive-pressure TPR temperature, pulse, and respiration

breathing

IRDS infant respiratory distress URI upper respiratory infection

syndrome

MDI metered dose inhaler VC vital capacity

It is time to review procedures, pharmacology, and abbreviations by completing Learning Activity 7–4.