Respiratory Pathophysiology
B. Pimentel, M.D.
University Of Makati
College of Nursing
Respiratory Infections - Pneumonia
TRANSMISSION Microbial pathogens may enter the lung
by one of several routes
Aspiration of Organisms That Colonize the
Oropharynx
Most pulmonary pathogens originate in the
oropharyngeal flora
Aspiration of these pathogens is the most common
mechanism for the production of pneumonia
Asthma
Chronic inflammatory disease of airways
Increased responsiveness of the
tracheobronchial tree
Manifested physiologically by a widespread
narrowing of the air passages
Clinically by paroxysms of dyspnea, cough, and
wheezing
Relieved spontaneously or as a result of therapy
Respiratory Infections - Pneumonia
Inhalation of Infectious Aerosols
Transmission of an infectious agent in the form of an
aerosol is particularly efficient
Particles >10 um in diameter are deposited mostly in
the nose and upper airways
Particles <5 um in diameter (also called airborne droplet
nuclei) and containing one or perhaps two
microorganisms fail to settle out by gravity but rather
remain suspended in the atmosphere
Respiratory Infections - Pneumonia
Hematogenous Dissemination from an
Extrapulmonary Site
Usually with Staphylococcus aureus
Disseminates hematogenously to the lungs in patients
(such as intravenous drug users) who have either right-
or left-sided bacterial endocarditis
Patients with intravenous catheter infections
Respiratory Infections - Pneumonia
Direct Inoculation and Contiguous
Spread
Result of either tracheal intubation or stab
wounds to the chest
As contiguous spread from an adjacent site
of infection
Age Risk Factors
Chlamydia trachomatis and respiratory syncytial virus are
common among infants < 6 months of age
H. influenzae among children 6 months to 5 years of age
M. pneumoniae, C. pneumoniae, and hantavirus among
young adults
H. influenzae and M. catarrhalis among elderly individuals
with chronic lung disease
L. pneumophila among elderly persons, smokers, and
persons with compromised cell-mediated immunity, renal
or hepatic failure, diabetes, or systemic malignancy
Typical vs. Atypical Pneumonias
Typical pneumonia syndrome is usually caused by
the most common bacterial pathogen in
community-acquired pneumonia, S. pneumoniae
Atypical pneumonia is classically produced by M.
pneumoniae
Clinical Manifestation
The "typical" pneumonia syndrome
Sudden onset of fever
Cough
Purulent sputum
Shortness of breath
Pleuritic chest pain
Signs of pulmonary consolidation
dullness, increased fremitus, bronchial breath sounds,
and rales
Clinical Manifestation
The "atypical" pneumonia syndrome
More gradual onset
Dry cough
Shortness of breath
Rales
Prominence of extrapulmonary symptoms
Headache, myalgias, fatigue, sore throat, nausea,
vomiting, and diarrhea
Abnormalities on chest radiographs despite
minimal signs of pulmonary involvement
Aspiration Pneumonia and Anaerobic
Lung Abscess
Aspiration of a sufficient volume of gastric acid
chemical pneumonitis
Acute dyspnea
Wheezing
Hypoxemia
Infiltrates on chest radiographs