CONDITIONS OF THE

LOWER RESPIRATORY
TRACT
By
Mr Chitala
 Tracheitis
• Tracheitis is inflammation of the trachea causing
pain in the chest, with coughing.
• It often occurs together with laryngitis and acute
pharyngitis.

Cause
• It is caused by viruses
• Bacterial infections of the throat
Signs and symptoms

• Sore throat
• Pain on swallowing
• Hoarse voice
• Irritating cough.
Treatment

• Symptomatic relief will include

• Steam inhalations,
• Gargles
• Simple linctus/thick liquid medicine
• Rarely antibiotics
Bronchitis
• This is inflammation of the
bronchi
• Can be acute or chronic

Acute Bronchitis: an
inflammation of the bronchial
tubes following upper respiratory
tract infection caused by
infections or allergy characterized
by cough, fever and dyspnea
Causes
• Viruses e.g rhino virus, paramyxole virus and adeno
vius
• Bacteria: mycoplasma pnuemoniae, chlymedia,
heamophylus infleunza
• Allergens e.g fumes from strong acids, dust,
ammonia, sulphadioxide, some organic solvents
• Air pollutants: nitrogen dioxide, tobacco and other
smoke
 Predisposing factors
• Age: old age and infants are more affected
• Chronically ill patients
• Patients with lung and heart disease
• Smoke e.g tobacco and other smokes
• Stuffy and dust areas
• Measles and whooping cough infections
 s/s
• Substernal lightness and discomfort
• Wheezing respirations (sound)
• Shortness of breath (Dyspnea) due to broncho spasms
• High grade Fever
• Soreness or pain beneath the sternum resulting from
involvement of trachea
• Abnormal breath
• Dry cough which letter becomes expectorating cough-this may
continue for some weeks even after are symptoms have subsided
Cont’
• Angina (chest pains)
• General body malaise
• Chills
• Sore throat
• Backache
• Muscle ache
• Rattle(short respirations with crackling sound)
sensation in chest
Complications
• Chronic bronchitis
• Bronchiectasis
• Atelectasis
• Respiratory failure
• Pneumonia
• Otitis media systemic infections
Chronic bronchitis
• It’s the prolonged inflammation of the bronchi
and the trachea resulting from resulting from
infection or environmental pollutants chronically
irritating the airway causing hyper section of
mucus characterized by a productive cough for
months in 2 consecutive months
• Chronic bronchitis is considered to be one of the
two forms of COPD
Causes/predisposing factors

•Tobacco smoking
•Pneumoconiosis
•Long term fume inhalation allergies
 s/s

•Expectorating/productive cough
•Dyspnea (shortness of breath)
•Chest pains
•Wheezing
•Fever
Cont’
• Fatigue or malaise
• Green or yellow, pink or orange mucus depending
on the condition
• Pedal oedema
• Distended neck veins
• Prolonged expiration time
• Rhonchi (low pitched sound)
investigations
• Physical exam often reveal decreased intensity of
breath sound(rhochi) or wheezing
• History of persistent dry or wet cough
• Sputum for MCS may reveal presence of
causative agents
• Chest X-ray may reveal inflamed airway and
collapsed lungs
Treatment
• Antibiotics:
Cotrimoxxzole 960mg 12 hourly for 14-21 days or
Amoxicillin 500mg 6 hourly for 7-14 days
• Anti-histamines
Pititon 4mg od PRN
• Analgesics
Paracetamol 1g bd or tds or aspirin 75mg od
Cont’

• Additionally expectorant like ammonium

chloride, broncho dilators like salbutamol
and corticosteroids like prednisolone are
also considered
• Cough suppressants may also be given
• Smoking cessation is of benefit
Bronchietasis

• Is a chronic respiratory disease state defined

by localized, irreversible or permanent
dilation of part of the bronchial tree
resulting from airway obstruction, airway
injury or pulmonary infection characterized
by a productive cough, wheezing sounds
and dyspnea
Cont

• The involve bronchi are

inflamed, dilated and
easily collapsible,
resulting in airflow
obstruction and
impaired clearance of
secretions
Causes
• The exact cause of bronchiectasis is idiopathic
(unknown), however its associated with the following:
Bacterial infections e.g staphylococcus species, TB
infections
Airway obstruction by foreign body, tumor or stenosis
Infections like measles, whooping cough, fungal
infections
Bronchiectasis can sometimes be an usual
complication of inflammatory bowel disease, especially
ulcerative colitis
Cont’

• HIV/AIDS is the leading cause of bronchiectasis

especially in children
• Its also associated with congenital causes
 s/s
• Green/yellow sputum (excessive
sputum)
• Bad breath and rarely diarrhoea
• Haemoptasis
• Clubbing of fingers
• pulmonary infections e.g
pneumonia
• Wheezing sounds due to presence
of accumulation of secretions
Cont

• Shortness of breath
• Weight loss
• General body malaise
• Cyanosis
Investigation

• History
• Physical exam
• CT scan
Treatment

• Treatment of bronchiectasis include controlling

infections and bronchial secretions, relieving airway
obstructions, removal affected portions of the lungs
 Atelectasis

• Atelectasis is the partial

or complete collapse or
closure of the lung
resulting in reduced or
absent gas exchange.
• It may affect part or all of
one lung.
Causes
• Post surgery of the chest
• bronchogenic carcinoma
• Asthma (mucus plugging)
• Inhaled foreign body
• Retention of secretions which may occur as a
post-operative complication or as a result of
surfactant deficiency.
 Cont’
• Endotracheal tube inserted too far
• In premature neonates-this leads to infant respiratory distress
syndrome
• Poor surfactant spreading during inspiration, causing the
surface tension to be at its highest which tends to collapse
smaller alveoli.
• Atelectasis may also occur during suction, air is withdrawn
from the lungs.
• Obstruction of a bronchus by a foreign body or thick exudates
 classification
• Atelectasis may be classified as an acute or chronic
condition.
• In acute atelectasis, the lung has recently collapsed and is
primarily notable only for airlessness.
• In chronic atelectasis, the affected area is often
characterized by a complex mixture of airlessness, infection,
widening of the bronchi (bronchiectasis, destruction, and
scarring (fibrosis).
s/s
• Cough, but not prominent
• Chest pain (not common)
• Breathing difficulty which is fast and shallow
• Low oxygen saturation pleural effusion
• Cyanosis
• Increased heart rate
Investigations

• Chest X-ray Post-surgical atelectasis

• Computed tomography
• Bronchoscopy
Treatment
• Treatment is directed at correcting the
underlying cause.
• In Post-surgical atelectasis chest
physiotherapy is used focusing on deep
breathing and encouraging coughing.
• An incentive spirometer is often used as part
of the breathing exercises.
Cont’
• Ambulation is also highly encouraged to improve lung
inflation.
• The primary treatment for acute massive atelectasis is
correction of the underlying cause.
• A blockage that cannot be removed by coughing or by
suctioning the airways often can be removed by
bronchoscopy
 Cont’
• Antibiotics are given for an infection.
• Chronic atelectasis is often treated with antibiotics because
infection is almost inevitable.
• In certain cases, the affected part of the lung may be surgically
removed when recurring or chronic infections become disabling
or bleeding is significant.
• If a tumor is blocking the airway, relieving the obstruction by
surgery, radiation therapy, chemotherapy, or laser therapy may
prevent atelectasis from progressing and recurrent obstructive
pneumonia from developing.
 Pleurisy

• Is also known as pleuritis,

is the inflammation of the
pleural membranes
• Pleural membranes are
thin layers (one layer lines
inside the chest and the
other covers the lungs)
 Causes
• Bacterial infections e.g pneumonia and TB
• A chest wound that punctures the plueral cavity
• A pleural tumor
• Sickle cell anaemia
• Pulmonary embolism
• Heart surgery complications
• Lung cancer
• a fungal infection
s/s
• Chest pains that becomes severe, sharp and knife-like
on inspiration (pleuritic pain)
• May become minimal or absent when breath is held
• Pain may be localized or radiate to the shoulder or
abdomen
• Intercostal pain on palpation
• Evidence of infection e.g fever and increased WBC
count
Investigation

• Chex X-ray
• may show pleural thickening
• Sputum examination may indicate infectious microbes
• Pleural biopsy to R/o other conditions
Treatment

• treatment of the underlying primary cause (infection).

The condition usually resolves when the primary
disease subsides
• Analgesics such as aspirin and brufen
Complications

• Severe pleural effusion

• Atelectasis due to shallow breathing to avoid pain
 Tension pneumothorax
• Develops when a lung or chest wall
injury is such that it allows air into the
pleural space but not out of it, results
into air accumulation and compression
of the lungs
• Eventually the trachea shifts towards
the injured side with increased
intrathoracic pressure enough to
decrease venous return to the heart
causing a shock
 causes
• Air flow into the pleural space without coming out due to lung
or chest wall injury

S/S
• Sudden or gradual chest pain (sharp or stabbing)
• Diminished or absent breath sounds on the affected side
• Tracheal diversion toward injured side
• Distended neck vein
• Hypotension or hypoperfusion
Investigations

• Physical exam may reveal signs of hypoperfusion e.g

cyanosis, sweating and fainting
• Chest X-ray may reveal presence of air in the pleural
space on one side with shifted trachea
Treatment
• Aspiration of air with the needle or water seal drainage
• Ensure a patent airway and administer oxygen if
necessary
• Put the patient in upright position
• Administer some pain killer e.g paracetamol to relieve
the pain
• Give antibiotics like amoxyl to prevent infections
Pleural effusion

• This is the build up or presence of excess fluid in the

pleural space/cavity
• This large presence of fluid within the pleural space
can push pleural against the lung until the lung or part
of it collapse
• This can make it very difficult to breath
Pneumothorax
• This is the build up or presence of air in the pleural
space/cavity
• It can result from acute lung injury or lung disease
like emphysema
• it presents with sudden chest pains in one side and
shortness of breath
Heamothorax
• This is the collection of blood in the pleural
space/cavity
• The most common cause is injury to the chest from
blunt object or surgery on the heart
• Haemothorax can also occur in patients with lung or
pleural cancer
• This condition puts pressure on the lung and forces it
to collapse
Empyema

• Empyema refers to accumulation of thick,

purulent fluid (pus) within the pleural space,
often with fibrin development and a
loculated (walled-off) area where infection
is located
Causes

• Bacterial pneumonia
• Lung abscess
• Penetrating chest trauma
• Infection of the pleural space
• Esophageal rapture
 Signs and symptoms
 Fever and chills
 Night sweats
 Chest pains which worsens during inspiration due to inflammation
 Dry cough
 Dyspnea
 Anorexia
 Weight loss
Investigations
• Physical examination – on auscultation, there
will be decreased or absent breath sounds over
the affected area and percussion will reveal
dullness on as well as decreased fremitus.
• Chest x-ray to rule out pneumonia and lung
abscess
cont’

•Blood culture to identify causative

organism
•Thoracentesis- sample of fluid is
withdrawn to identify causative
organism.
 Treatment
Intravenous antibiotics such as septrin, ampicillin
Intravenous fluids
Under seal water drainage where pus is drained from the
pleural cavity
Analgesics for pain
Antipyretics such as aspirin
Emphysema

• Is a condition that involves break

up/damage to the air sacs (aveoli) of the
lungs associated with irritations caused by
chemical found in tobacco smoke
Lung abscess

• Lung abscess is a localized lung infection

accompanied by accumulation of pus and
tissue destruction
Causes

• Microorganisms – Bacteria, Fungi and Parasites

• Lung tumor
• Septic embolism
• Necrotic lesions from silicosis
• Infected cysts(an abnormal growth filed with
liquid)
Signs and symptoms

Coughing which may be blood stained or

purulent
Foul smelling sputum
Pleuretic chest pains
Dyspnea
General body malaise
Cont’

Headache
Anorexia

Weight loss

Diaphoresis (excessive sweating)

 Investigations
History taking where patient will reveal the symptoms
Physical examination- on percussion areas of dullness over
affected tissue will be noted. On auscultation, crackles will
be heard.
Chest x-ray often reveals an abscess which will look like a
solid mass.
 Cont’
Percutaneous aspiration of an abscess provide a specimen
which can be used for culture to identify causative organism
Sputum examination to dertemine the causative organism
Full blood count will show raised levels of white blood
cells.
Computed tomography scan (CT scan) will help to
differentiate the type
 Treatment

• Prolonged use of antibiotics therapy

• Postural drainage may help drain the necrotic material
of the upper airway where the patient can cough it up.
• Oxygen therapy to relieve hypoxia
• Lesion resection or removal of diseased lung section
s