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Respiratory System Diseases and Disorders 177
Echinacea
for Colds
and Influenza
Prevention
Complementary and Alternative Therapy
E
xtracts of echinacea have been shown to have a positive effect on the immune sys
tem and thereby, helping prevent colds and influenza. It helps the body increase
the number of white blood cells which fight infection. One extensive study showed
taking echinacea reduced the number of cold episodes if taken three times per day over
a four-month period of time. However, not all echinacea products are the same, so the
consumer should be aware. Dried echinacea was not as effective as using preparations
made with fresh echinacea. Even if the individual gets a cold, echinacea might lessen the
length of the symptoms or the severity of them. It is an over-the-counter medicine, so it
is available if and when one needs it.
Source: Halton (2020)
$1
Consider This...
The human nose is not as sensitive as a
dog’s nose, but it can distinguish approxi
mately 500 different scents.
Pharyngitis
■ Description. Pharyngitis is an inflammation of the
throat (pharynx = throat, itis = inflammation) com
monly called a sore throat (Figure 9-8).
■ Etiology. The most common cause is viral infection.
Bacterial infection by Streptococcus can also occur and
is more common in children. Irritation to the mucous
Figure 9-8 Pharyngitis.
membranes, such as breathing extremely hot or cold air,
chemical fumes, or smoke, can also lead to pharyngitis.
■ Symptoms. Symptoms include sore throat, fever,
headache, swollen lymph glands in the neck, and pain
with swallowing.
■ Diagnosis. Physical examination, including viewing
the pharynx (throat), eyes, skin, and lymph nodes, is
useful. A streptococcal throat swab culture might be
taken to diagnose strep infection.
■ Treatment. Treatment depends on the cause. Viral
infections are treated with comfort care and throat loz
enges, antiseptic or salt-water gargles, and analgesics.
Bacterial infections, such as strep throat, also need anti
biotic treatment. Chronic pharyngitis due to tonsillitis
and adenoiditis can be treated by surgical removal of
the tonsils and adenoids, called a tonsillectomy and ade
noidectomy (T&A), respectively.
■ Prevention. Good handwashing, maintaining general
health, and avoiding close contact with anyone who is
contagious aid in prevention of pharyngitis. Using a
new toothbrush after the symptoms disappear also aids
in prevention.
Laryngitis
■ Description. Laryngitis is an inflammation of the lar
ynx (LAR-inks) and vocal cords.
■ Etiology. Laryngitis can be caused by viral or bacterial
infections or by breathing irritants such as extremely
hot or cold air, chemical fumes, and smoke. Laryngitis
frequently follows other URIs such as the common cold,
pharyngitis, and sinusitis. Another cause can be overuse
of the voice for an extended time.
178 Chapter 9
■ Symptoms. Most individuals are familiar with the
hoarse-voice quality caused by laryngitis. Other symp
toms include difficulty swallowing (dysphagia), throat
pain, and fever.
■ Diagnosis. A history of a recent cold or flu followed
by hoarseness is a common clue for diagnosis. A harsh
wheezing sound in the throat area is usually indicative
of laryngitis. A laryngoscope can be used to view the
airway and vocal cords for other signs of disease.
■ Treatment. Treatment can include voice rest,
increased fluid intake, analgesics, throat lozenges, and
removal of causative factors.
■ Prevention. Frequent handwashing, avoiding those
with infections, and avoiding breathing irritants aid in
prevention.
Diseases of the Bronchi and Lungs
Diseases of the bronchi and lungs are usually more
severe than diseases of the upper respiratory system.
Many of these can be life threatening, such as influenza,
especially in the older population.
Asthma
■ Description. Asthma is a hypersensitivity reaction
that causes constriction of the bronchi, leading to dif
ficulty breathing.
■ Etiology. Asthma, also called bronchial asthma, was
discussed in detail as a hypersensitivity disorder in
Chapter 5.
■ Symptoms. Asthma is characterized by episodes of
wheezing and dyspnea.
■ Diagnosis. A diagnosis of asthma usually is based
on the patient’s symptoms, medical history, a physical
examination, and laboratory tests that measure pulmo
nary (lung) function.
■ Treatment. Treatment includes avoidance of causative
allergens, desensitization, education, and medications
to treat symptoms.
■ Prevention. Prevention is aimed at identification and
control of allergic factors and use of bronchodilators.
Acute Bronchitis
■ Description. Acute bronchitis is inflammation of
the mucous membrane lining of the bronchus. It often
involves the trachea (tracheobronchitis).
■ Etiology. Acute bronchitis is a short-term disorder
commonly following a URI. Other causes include inhal
ing fumes, smoke, dust, cold air, and other irritants.
■ Symptoms. Symptoms include fever, a tight feeling
behind the sternum, and a dry cough that later pro
gresses to a productive cough (coughing up or expecto
rating mucus or sputum).
■ Diagnosis. Tests are usually unnecessary in diagnosis
because this disease is easy to determine from a history
and physical examination; however, an X-ray can be
ordered.
■ Treatment. Treatment consists of drinking increased
amounts of fluids to help liquefy secretions, rest, cough
syrup, analgesics, and antipyretics. Antibiotics are help
ful only if secondary bacterial infections occur. Prog
nosis is generally good for most individuals. Infants
and small children can become seriously ill because the
bronchioles are very small and can become obstructed
by swollen tissue or mucus plugs. Older people and the
chronically ill might have a poor prognosis because they
have an increased risk for developing secondary bacte
rial infections such as pneumonia.
■ Prevention. Preventive activities include:
■ Washing hands frequently
■ Not smoking and avoiding secondhand smoke
■ Avoiding allergens such as dust and household fumes
■ Not sharing eating utensils with others
■ Maintaining a healthy lifestyle
Influenza (Flu)
■ Description. Influenza is an acute, highly contagious
respiratory infection. Influenza can be a serious disease,
especially in the elderly, young children, and people
with certain health conditions. Yearly flu seasons can
vary from year to year in duration and in severity of
illness. Flu season may be short or long, and the symp
toms may range from mild to very severe.
■ Etiology. Influenza is a viral infection commonly
spread by coughing of respiratory secretions. There are
many strains of influenza virus, the primary of which
are identified as A, B, and C. Substrains, or subtypes,
include H0N1, H1N1, H2N2, H3N2, and several others.
Avian (bird) flu is an influenza A virus that usually does
not affect humans. However, recent diagnosed cases
in humans have caused concern among public health
workers. Deaths have been attributed to avian influenza
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Respiratory System Diseases and Disorders 179
Nutritional
Supplements as
a Treatment for
COVID-19?
Complementary and Alternative Therapy
C
ould nutritional supplements help prevent or at least reduce the severity of the
COVID-19 infection? Researchers are struggling to answer this question in a timely
manner. Since individuals with COVID-19 show a variety of symptoms from very mild
to life threatening, it is difficult to recommend one herbal preparation that might help
all who are infected. However, previous studies have demonstrated the positive effects
of many nutritional supplements along with a well-balanced diet to boost the immune
system, so it might be that nutritional-based treatments could be used for COVID-19
prevention or treatment. Possible worthy herbal products include echinacea, curcumin
(turmeric), chinchona (the tree bark produces quinine), and vitamins A, B, C, and D.
The precise dose and frequency of use of these products to be of maximum benefit can
vary from user to user. Further research is needed to make recommendations about
these supplements.
Sources: Goldman (2020) and Nugraha et al. (2020)
in children and adults. Most human infections have
occurred following direct contact with infected poultry.
The flu virus has great genetic variation, and the
number of strains and variations help explain how this
virus causes epidemics year after year. Unfortunately,
like the common cold, immunity to one viral strain does
not provide immunity to another, so an individual can
have the flu multiple times. Flu epidemics commonly
occur in the winter and early spring.
■ Symptoms. Influenza is characterized by sudden
onset of fever, chills, headache, and back muscle pain.
Other symptoms can include cough, runny nose, sore
throat, sneezing, hoarseness, nausea, vomiting, and
diarrhea.
■ Diagnosis. The flu can be difficult to distinguish from
many other types of common cold viruses and bacterial
infections. A history and physical exam that reveals a
sudden onset of symptoms can assist in diagnosis. Rapid
diagnostic tests are available that can detect influenza
viruses in 30 minutes.
■ Treatment. The treatment of influenza is symptom
atic and can include bed rest, analgesics, and antipyret
ics. Oseltamivir (Tamiflu) and zanamivir (Relenza) are
Food and Drug Administration (FDA)-approved anti
viral medications recommended for treatment of both
influenza A and B viruses. These medications must be
started within two days of symptoms to be effective.
Antibiotics are not indicated unless secondary bacterial
infections occur.
■ Prevention. Vaccination is the best way to prevent
influenza. Antiviral medications are also effective in
prevention.
Healthy Highlight
Comparison of
Seasonal Influenza
and a Widespread
Epidemic of
Influenza
(Pandemic)
T
here is concern in the United States that another catastrophic outbreak of influenza
could occur in the near future, as it did in the 1900s. Individuals need to be aware
of the differences, similarities, and preventive methods so they can stay healthy. Fol
lowing the CDC guidelines for prevention is the best strategy for staying well. This is
a comparison of seasonal influenza characteristics and those common to a widespread
epidemic of influenza. A widespread epidemic of a disease is also called a pandemic
event. (As an example, COVID-19 is considered to be a pandemic event.)
(continued)
180 Chapter 9
Healthy Highlight (continued)
Seasonal Influenza Pandemic Influenza
Outbreaks follows patterns
May have some immunity from previous
exposure
Healthy adults are at low risk; young and
elderly are at high risk
Health systems can meet the needs
Vaccine available
Considerable deaths
Modest impact
Occurs rarely (only three times in
twentieth century)
May not have immunity because no
previous exposure
Healthy adults may be at risk; young
and elderly are at high risk
Health systems may be overwhelmed
Vaccine may not be available
Deaths are much more extensive
Severe impact
Coronavirus 2019 (COVID 19)
■ Description. In February 2020 the World Health Orga
nization officially named a new novel coronavirus that
caused a 2019 outbreak leading to a global pandemic. The
new name of this disease is Coronavirus Disease 2019.
Coronaviruses are a large family of different viruses
that infect certain animals and humans. Scientists first
identified a human coronavirus in 1965. In humans, this
virus family causes the common cold, Sudden Respira
tory Syndrome (SARS-CoV2), and Middle Eastern
Respiratory Syndrome (MERS-CoV). COVID 19 is a new
coronavirus that was first identified in Wuhan, China.
More recently, this virus has developed variants includ
ing Delta and Omicron. Since its onset, to date, COVID
has led to the death of over 5.8 million people worldwide
and of this, over 900,000 in the United States alone. Since
this is a rapidly evolving disease, the most recent infor
mation can be accessed at www.CDC.gov/coronavirus
■ Etiology. There is still much to be learned about how
the virus spreads, but it is thought to spread primarily
through close person-to-person contact. People who are
infected, but do not show symptoms, can also spread the
virus. How easily the virus spreads varies. It is thought
that the virus spreads faster than influenza, but not as
fast as the measles.
■ Symptoms. The most common symptoms include:
■ Fever
■ Dry cough
■ Tiredness
Other symptoms include aches, pains, diarrhea,
sore throat, headache, loss of taste, and loss of smell.
Serious symptoms need emergency treatment and
include
■ Chest pain
■ Difficulty breathing or shortness of breath
■ Loss of speech or loss of movement
■ Diagnosis. COVID 19 is diagnosed by a positive nasal
or saliva COVID 19 test. Testing is under the guidance
of state and local health departments. Persons who test
positive are asked to stay at home in self-quarantine for
a minimum of 10 days.
■ Treatment. Many people will develop mild-to-mod-
erate symptoms that can be treated at home with rest,
hydration, and over-the-counter medications such as
acetaminophen. Patients with more serious symptoms
should seek emergency medical treatment.
■ Prevention. To prevent getting infected and infect
ing others, CDC recommends five basic guidelines.
These guidelines include washing of hands frequently
and thoroughly, wearing a mask, social distancing of at
least six feet, avoiding crowds, and getting a vaccination
and booster.
Currently, there are two vaccines available to pre
vent COVID 19. These include Pfizer-BioNTech and
Moderna’s COVID 19. Three other vaccines are in
clinical trials and include AstraZeneca’s, Janssen’s, and
Novavax’s COVID 19 vaccine.
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Respiratory System Diseases and Disorders 181
Chronic Obstructive Pulmonary Disease (COPD)
■ Description. COPD is the name for two distinct dis
eases characterized by the inability to get air into or
out of the lungs. Chronic bronchitis and emphysema
frequently coexist, hence the preference to call them,
collectively, COPD. There can be pure forms of either,
but usually, the individual has predominantly one or the
other coexisting with the second. This term does not
include other obstructive diseases such as asthma.
Both chronic bronchitis and emphysema cause
excessive inflammation that leads to abnormalities in
the lung that permanently obstruct airflow (thus the
term chronic obstructive). With COPD, the loss of nor
mal respiratory response is not unusual.
Normally, individuals are stimulated to breathe by
an increase of carbon dioxide in the blood. A secondary
or backup stimulus is a decrease of oxygen in the blood.
Individuals with COPD commonly have high levels of
carbon dioxide in the blood. Initially, the body attempts
to correct this by increasing breathing in an effort to
blow out excessive carbon dioxide (CO
2
). When this
effort fails, the respiratory system adapts to the high
CO
2
levels and begins responding to the secondary
stimulus of low blood oxygen levels. Giving oxygen to
these individuals can be fatal because high oxygenation
removes the stimulus to breathe.
Millions of people suffer from this disease, and it is
the third most significant cause of death in the United
States (American Lung Association, 2021).
■ Etiology. Cigarette smoking is the main cause of this
disease. Other causes include air pollution and chronic
respiratory infections. Exposure to certain industrial pol
lutants can also increase the risk of developing COPD.
■ Symptoms. Symptoms of COPD usually occur late
in the disease process and are due to lung damage. In
smokers, it might take 40 to 50 years for symptoms to
occur. Symptoms can occur many years after the indi
vidual actually quits smoking, quite simply because the
lungs have a large amount of reserve capacity.
As we age, we normally lose lung function, but
not enough to cause symptoms unless our lungs are
damaged or diseased. Smokers lose function at a rate
approximately five times faster than normal. Even at
this rate, it commonly takes decades for a smoker to
lose enough lung function to experience symptoms.
If an individual quits smoking, the loss of function
slows back to approximately normal. However, if smok
ing has already destroyed a large portion of the lung
tissue, symptoms of COPD will appear as the individual
ages and continues to lose function at a normal rate. If
one continues to smoke, decline continues at an accel
erated rate. Quitting smoking at any time in one’s life
can slow loss of function and improve quality of life.
Common symptoms include the following:
■ Dyspnea (difficulty breathing) is the most common
symptom. Onset is usually gradual and often noticed
only with exercise. As the disease progresses and the
individual ages into his or her sixties and seventies,
Healthy Highlight
Influenza
Immunization
(Flu Shots)
B
ecause influenza is a viral infection, antiviral medications can be given, but there
is no major treatment other than supportive treatment of symptoms in most cases.
An individual is dependent on the immune system to build antibodies to kill the virus.
Antibiotics can be helpful for secondary bacterial infections but do not kill the influ
enza virus.
The best course in dealing with flu is prevention, which includes frequent hand
washing, avoiding crowds of people during flu season or when there is a local epidemic,
avoiding individuals infected with influenza, and leading a healthy lifestyle to keep
resistance high.
An immunization is available and is recommended for all individuals but especially
for older people, those with chronic diseases, pregnant women, children, and health care
workers. Reactions to the flu immunization are rare but do occur. Individuals allergic to
eggs should not take the immunization because the virus is grown in eggs. Allergic hyper
sensitivity reactions usually occur immediately after receiving the injection, although a
reaction to the antigen can occur 6 to 12 hours after the injection. Reaction symptoms
mimic the flu and include fever, muscle pain, and malaise.
182 Chapter 9
dyspnea becomes increasingly prominent as lung
function declines.
■ Chronic cough usually begins in the morning but
slowly progresses to an all-day cough. This progres
sion can be so slow the individual does not even rec
ognize the fact that he or she is coughing all the time.
■ Wheezing appears and is due to air passing through
tight or narrow airways.
■ Hemoptysis, or coughing up blood, usually occurs
during acute attacks. This hemoptysis is usually
blood-streaked sputum, not active bleeding. Bloody
sputum in an individual with COPD also can be
indicative of lung cancer.
■ Cyanosis, a bluish discoloration of the skin, nail beds,
and lips, is common, especially during acute attacks.
Cyanosis indicates a low blood oxygen level.
■ Weight loss is common because individuals with
COPD work hard and burn increased calories in the
activity of breathing. Shortness of breath caused by
the activity of eating often interrupts meals, leading
to malnutrition.
■ Pursed-lip breathing is an acquired breathing pat
tern that forces air out of the lungs. By pursing the
lips together during exhalation, the backpressure or
positive pressure holds airways open to allow forced
exhalation of the air through narrowed passageways.
This breathing pattern is hard work, burns increased
calories, and weakens the already damaged airways.
■ Barrel chest describes a bulging, rounded chest that
resembles the shape of a barrel. This is a symptom of
late-stage COPD. The lungs are chronically overin
flated with air, causing the rib cage to stay partially
expanded. This change in physical structure of the
chest makes breathing less efficient and leads to more
shortness of breath.
■ Diagnosis. Diagnosis of COPD is made by history
and physical examination and by ruling out other pul
monary diseases. Chest X-rays, pulmonary function
tests (PFTs), and ABGs help confirm the diagnosis.
■ Treatment. Symptomatic treatment includes use of
bronchodilator medications, inhalers, mucolytics, and
cough medications. Avoiding exposure to individuals
with respiratory tract infections is important because
these diseases aggravate COPD. Influenza vaccina
tion is recommended. Cessation of smoking can slow
or reverse the disease in the early stages and will ease
symptoms in the later stages.
There is no cure for end-stage COPD. Individu
als often become debilitated in the final stages of the
disease, and prognosis is poor due to progressive dete
rioration of pulmonary function, often leading to respi
ratory failure and death.
■ Prevention. Not smoking is the best preventive
action. Other preventive measures include avoiding
respiratory irritants and infections and maintaining a
healthy lifestyle.
Chronic Bronchitis
■ Description. Chronic bronchitis is a long-term
inflammation and scarring of the lining of the bronchial
tubes. It is characterized by increased mucus production
with a productive cough. Chronic inflammation leads
to hypertrophy of the mucus-secreting glands, thick
ening of the mucous membrane, and bronchiectasis
(BRONG-kee-ECK-tah-sis), a chronic dilatation of the
bronchus.
■ Symptoms. Bronchiectasis allows mucus to pool in the
bronchus, producing a foul-smelling cough. This cough
is commonly called smoker’s cough and occurs primar
ily in the morning hours. As the disease progresses,
obstruction of the bronchi and bronchioles becomes
more pronounced, leading to difficulty getting air into
the lungs. Coughing, dyspnea, and hypoxia (HIGH-
POCK-see-ah; hypo = low, oxia = oxygen) occur.
During bouts of hypoxia, the individual often becomes
cyanotic (blue condition). In the final or end stage, the
symptoms are more continuous, causing lung damage,
debilitation of the individual, and eventual death.
Emphysema
■ Description. Emphysema comes from the Greek word
emphysana, meaning, “to inflate.” This chronic disease
is characterized by an increased production of mucus,
causing trapping of air in the tiny alveoli or air sacks
of the lung. As air becomes trapped in the alveoli, they
become overinflated, leading to destruction of the alve
oli wall. Destruction of the alveoli wall allows the alveoli
to fuse with other alveoli, forming a larger air sack and
trapping more air (Figure 9-9).
■ Symptoms. The individual with emphysema is able
to get air in, but the air becomes trapped and must
be forced out before more air can be taken in. These
enlarged alveoli have a decreased surface area, thus
decreasing oxygenation of the blood. Air trapping and
decreased oxygen exchange lead to dyspnea, tachypnea,
wheezing, and coughing.
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Respiratory System Diseases and Disorders 183
Figure 9-9 Normal versus emphasematous alveoli.
Individuals with emphysema often lean over a table
or chair to use accessory respiratory muscles to blow
out the trapped air more effectively. Pursing the lips
also helps hold the alveoli open while pushing the air
out (Figure 9-10). This extra pressure often causes the
face and skin to become reddened. Extra pressure on
the chest muscles also produces a characteristic barrel
chested appearance.
Figure 9-10 Pursed lips and barrel chest of emphysema.
Individuals with emphysema use large amounts of
energy in their respiratory efforts, so a supplemented
diet is often needed. Food is eaten in small, frequent
feedings to allow time for respiratory efforts. Even with
a supplemented diet, these individuals are often unable
to get adequate nutrition and commonly are quite thin.
Atelectasis
■ Description. Atelectasis (ah-tel-EK-teh-sis) is the
collapse or airless state of part or all of a lung. More
commonly, it affects only a small section of the lung.
■ Etiology. Atelectasis is often related to inadequate
breathing patterns related to pain. Surgical pain and
fractured ribs often cause inadequate breathing, leading
to atelectasis. Blockage of the airway by a mucus plug
can also cause atelectasis.
■ Symptoms. Dyspnea, cyanosis, and anxiety are com
mon symptoms.
■ Diagnosis. Diagnosis is confirmed after a positive
chest X-ray and physical examination.
■ Treatment. Ambulation (walking), frequent deep
breathing and coughing, and analgesics for pain help
open the airway, expand the alveoli, and avoid atelec
tasis. Prognosis is good if complications do not occur.
Pneumonia is a common complication.
■ Prevention. Prevention is aimed at relieving the cause
if possible.
Pneumonia
■ Description. Pneumonia is an inflammation of the
bronchioles and alveoli due to infection by bacteria,
virus, or other pathogens. Pneumonia is the term spe
cifically related to infection. Inflammation without
infection is termed pneumonitis and is generally caused
by hypersensitivity to dusts and chemicals.
Pneumonia can be identified in several ways. The
cause might be included in the name, as in “pneumo
coccal,” “aspiration,” and “tuberculous pneumonia.”
The location might be identified in the name, as in
“lobar,” “bilateral,” and “double pneumonia.” Sec
ondary pneumonia indicates a connection to another
cause. Often, the location and cause can be combined to
describe the pneumonia, as in “bilateral pneumococcal
pneumonia.”
Bacterial pneumonias tend to be the most serious,
whereas viral pneumonias are the most common. Peo
ple who have difficulty swallowing, as is common in
Chapter 9
those with throat surgery or stroke, are at risk for aspi
ration pneumonia.
Pneumonia affects millions of individuals each year
and can range from mild to life threatening. It occurs
more often among older people, the chronically ill, and
those who are immunosuppressed and is a significant
cause of death in these individuals.
■ Etiology. Actions that inhibit the normal protective
mechanisms of the respiratory system, such as smoking,
immobility, general anesthesia, and endotracheal intu
bation, allow the invasion of pathogens into lung tissue.
Pathogens that cause pneumonia can reach the lung
tissue through the respiratory system or through the
blood as a result of septicemia. Invasion of pathogens
into the alveoli leads to inflammation of the alveolar
tissue, causing the classic outpouring of blood fluid and
white cells from the capillaries into the tissues, filling
the alveolus. This causes a decrease in gas exchange,
leading to hypoxia (Figure 9-11). This inflammation
and infection of the lungs is pneumonia.
■ Symptoms. Symptoms of pneumonia are related to
the area involved and the amount of tissue involved.
Symptoms include dyspnea, weakness, fever, chills,
chest pain, and cough.
■ Diagnosis. Diagnosis is made after completion of a
chest X-ray, history, physical examination, and sputum
culture to determine the infective pathogen.
■ Treatment. Treatment depends on cause. Bacterial
infection is treated with antibiotics. Viral infection is
treated symptomatically. Rest, analgesics, oxygen ther
apy, increased fluid intake, and high-calorie diet are
common treatments for all types of pneumonia.
■ Prevention. Preventive activities include not smoking,
frequent handwashing, and wearing a mask when work
ing with fumes, dust, or mold. Vaccines can also prevent
pneumonia. Taking deep breaths and use of a breathing
device aid in prevention of pneumonia after surgery.
Pulmonary Abscess
■ Description. Pulmonary abscess, also called lung abscess,
is a collection of infectious material contained within a
capsule (Figure 9-12). Abscess formation was discussed
in detail in Chapter 4, “Inflammation and Infection.”
■ Etiology. Lung abscess is often related to a number of
other diseases, including pneumonia, tuberculosis, and
lung cancer. It can also be caused by aspiration of food
or foreign objects.
■ Symptoms. Symptoms include chills, fever, chest
pain, and cough. Coughing of bloody or foul-smelling
sputum and foul-smelling breath can also be indicative
of a pulmonary abscess.
■ Diagnosis. Diagnosis is made by completion of a his
tory and physical examination, chest X-ray, and sputum
cultures.
— Macrophage
Type I---------
Pneumocyte
Capillary
Cells are destroyed
Red blood
cell A
Inflammatory
signals
Hyaline
membrane
O
CO2
Pulmonary
alveolus
Scar-------
tissue
formation
Fluid
accumulates
Endothelial
cell
'—Type II
Pneumocyte
Increased—
vascular
permeability
Thrombus
formation
HEALTHY PNEUMONIA
Figure 9-11 Pneumonia: alveoli filling with fluid.
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Respiratory System Diseases and Disorders 185
Healthy Highlight
Prevent Pneumonia neumonia can be prevented with vaccines. The Centers for Disease Control and
Prevention (CDC) recommends the pneumococcal conjugate vaccine PCV13
with Vaccines (Prevnar 13®) for children 5 years of age or less. The CDC recommends pneumococcal
polysaccharide vaccine PPSV23 (Pneumovax®) for all adults over age 65 and for those
2 years of age or older who are at high risk because of a concurrent disease, and for
adults age 19 to 64 who smoke or have been diagnosed with asthma.
Source: CDC (2016)
(A) (B)
Figure 9-12 (A) Pulmonary abscess. (B) X-ray view of pulmonary abscess.
■ Treatment. Pulmonary abscesses are commonly
treated with long-term antibiotic therapy. Surgical
resection might be indicated if the abscess is quite large
or if antibiotic therapy is unsuccessful.
■ Prevention. Preventing aspiration is the most import
ant preventive measure.
Pulmonary Tuberculosis
■ Description. Pulmonary tuberculosis is often called
tuberculosis (TB). It is a contagious bacterial infection
that mainly involves the lungs but can spread to other
organs such as the kidneys, bones, and brain.
Current facts according to the World Health Orga
nization (WHO) include the following:
■ TB is the top infectious disease killer worldwide.
■ In 2019, approximately 1.2 million children became
ill with TB.
■ In 2019 alone, 10 million people fell ill with TB and
1.4 million died.
■ About one-quarter of the world’s population has a TB
infection, which means people are infected but not
yet ill with TB and cannot transmit it.
In 2006, the WHO declared TB a global health
emergency and developed a global plan to stop TB.
Between the years 2000 and 2019, the WHO reports
that 60 million lives were saved through effective
diagnosis and treatment. The WHO is continuing to
move forward with “The End TB Strategy” with the
goal to end TB by the year 2030. Estimates show that
implementation of this goal will cost an estimated
186 Chapter 9
13 billion a year with a plan to secure these funds
through the United Nations.
■ Etiology. TB is a bacterial infection caused by Myco
bacterium tuberculosis. It is acquired by breathing air
that is infected with the bacteria and is spread by cough
ing and sneezing.
Mycobacterium tuberculosis is protected in a
strong coating that enables it to live outside the body
for a lengthy amount of time. Infected droplets that are
coughed or sneezed can dry up and remain on inani
mate objects as dust but can be killed by bactericidal
solutions or by direct sunlight.
TB is often prevalent in areas of overcrowding
and poor sanitation. The incidence of TB was greatly
reduced decades ago with the introduction of effec
tive antibiotics. In 1992, the number of TB cases in the
United States increased significantly due to the influx
of high numbers of infected immigrants, the homeless,
individuals with AIDS who have poor resistance to
infection, and the development of drug-resistant bac
teria. Since that time, however, the number of cases has
declined every year (WHO, 2017).
The infection begins with a primary lesion in the
lungs. Mycobacterium tuberculosis does not attract
polymorphic nuclear cells (PMNs) and thus does not
cause an acute inflammation. Lymphocytes and mac
rophages are attracted to these encapsulated bacteria.
These immune cells begin producing antibodies and
walling off the infection by forming a type of granu
loma called a tubercle; hence the name, tuberculosis.
The inside of the tubercle contains dead bacteria, lung
tissue, and immune cells that together exhibit a cheesy
appearance called caseous necrosis.
After necrosis, the tubercles change by fibrosing and
calcifying. If the immune system is effective in walling
off the bacteria, the disease can be arrested or rendered
inactive for a long period of time (months to years).
During this time, the individual is often asymptomatic
and not aware that he or she has TB. If the disease is
not arrested, the individual will become symptomatic
with progressive primary TB. The antibodies that are
produced during this time circulate in the blood for the
remainder of the infected individual’s life in readiness to
attack future TB bacteria. These circulating antibodies
are the basis for the positive reaction to a TB skin test.
Secondary TB occurs when an individual is reinfected
with Mycobacterium tuberculosis, or the primary disease
is reactivated due to a decline in the individual’s resis
tance. Antibodies formed during the primary stage of the
disease activate quickly and lead to larger areas of necrosis
in the lung tissue. During secondary TB, the individual
becomes symptomatic. The tubercle mass becomes lique
fied and is coughed up, leaving a cavity in the lung tissue
(Figure 9-13). Frequent coughing often ruptures capil
laries in the lung tissue, leading to hemoptysis (coughing,
spitting of blood, or both). Coughing by the infected indi
vidual fills the surrounding air with disease.
As large cavities are formed in the lung tissue, the
ability of the tissue to oxygenate the blood is decreased.
The individual becomes dyspneic and cachectic with a
general appearance of being consumed by the disease.
For this reason, historically, this disease was called con
sumption. During that time, individuals were placed in
sanitariums to prevent the spread of TB and to provide
much-needed rest. Without effective treatment, many
infected individuals died from TB.
Figure 9-13 (A) 3-D illustration of secondary tuberculosis
forming in the lungs. (B) X-ray of tuberculosis cavities.
Courtesy of Mark L. Kuss Kateryna Kon/Shutterstock.com
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