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Respiratory System Diseases and Disorders 187
Healthy Highlight
Tuberculosis
Skin Test
T
he TB skin test (TST) works on the principle that after an individual is exposed to
Mycobacterium tuberculosis, the immune system will develop antibodies. These
antibodies will be present in all cells of the body (cellular immunity) from that point
on. Introduction of the bacillus or a derivative, through injection or re-exposure, will
cause a cellular reaction. The Mantoux (man-TOO) test uses this principle. A small
amount of purified protein derivative (PPD) is injected intradermally. PPD contains
modified tuberculin bacteria that are no longer infectious. If the individual has been
exposed to TB and has developed antibodies, the immune system will react. A reac
tion will also occur if the individual has been previously immunized with Bacillus
Calmette-Guerin (BCG) tuberculin vaccine. A reaction is shown by the formation of an
intradermal wheal. An 8-10 mm wheal within 48-72 hours of injection is considered
a positive, now called significant, reaction. The Centers for Disease Control and Pre
vention (CDC) recommends using the QuantiFERON®-TB test (an interferon-gamma
release assay [IGRA] test that uses whole blood) to detect TB in health care workers
and suspected cases or when the patients are not compliant with returning to the clinic
to get the test read. The CDC recommends using the TST for children under age 5.
After an individual has a positive skin test (significant reaction) once, that individual
will always have a reaction, so a skin test is no longer beneficial in determining whether
the individual has active TB. Individuals exhibiting a positive skin test need to be edu
cated in the symptoms of TB, which include unexpected weight loss, persistent cough,
night sweats, and malaise. If these symptoms occur and persist, the individual will need
a chest X-ray and possible sputum culture to determine the presence of the disease.
■ Symptoms. Tuberculosis in an otherwise healthy
individual is often asymptomatic, so testing is needed
to determine the presence of the disease. If symptoms
appear, they are often vague and include loss of weight,
energy, and appetite. As the disease progresses, the indi
vidual might become symptomatic with a chronic pro
ductive cough, dyspnea, fever, and night sweats.
■ Diagnosis. TB is diagnosed by skin testing, chest
X-ray, and sputum culture.
■ Treatment. Extended antibiotic therapy is needed to
rid the individual of the infection. Standard treatment
is a 6-month course of antimicrobial drugs. Some indi
viduals may be diagnosed with multi-drug resistant
(MDR-TB), a form of TB caused by bacteria that do
not respond well to anti-TB drugs. MDR-TB is treat
able and curable by using second-line drugs. These drug
options are often limited and require extensive chemo
therapy for up to 20 months with medications that are
toxic and expensive.
■ Prevention. TB is preventable with skin testing in
high-risk populations or for individuals who might have
been exposed, such as health care workers.
Adult Respiratory Distress Syndrome (ARDS)
■ Description. ARDS is also called shock lung. It is a
sudden, life-threatening lung failure—a syndrome, not
a specific disease, that usually develops within 24 to
48 hours of a major injury or illness.
■ Etiology. ARDS is primarily caused by sepsis, a
serious infection of the blood. Other conditions that
can cause the syndrome include severe chest trauma,
inhalation of smoke or toxic fumes, near-drowning,
fat emboli, aspiration pneumonia, major burns, mas
sive blood transfusion, and acute pancreatitis. In most
cases, these conditions do not lead to the development
of ARDS. It is unclear why some people develop the
syndrome but others do not.
Following the trauma, the individual might be
progressing smoothly when a sudden, life-threatening
attack of ARDS occurs. ARDS is characterized by fluid
escaping the vascular system and filling the alveoli,
leading to acute respiratory failure.
■ Symptoms. Symptoms develop suddenly and include
extreme dyspnea, severe hypoxemia, tachypnea,
188 Chapter 9
cyanosis, and pulmonary hypertension (high blood
pressure in the pulmonary arteries).
■ Diagnosis. History and physical examination along
with a chest X-ray and ABGs aid in diagnosis.
■ Treatment. Individuals suffer extreme dyspnea and
need mechanical ventilation. Even with prompt and
proper treatment, ARDS has a high mortality rate.
This rate has declined in recent years due to improved
supportive care strategies. Still, approximately 40% of
patients die in the hospital. Those who do survive may
have permanent respiratory damage and are more prone
to respiratory-related illnesses thereafter.
■ Prevention. ARDS is prevented by avoiding diseases
and conditions that damage the lung, for instance, pre
venting aspiration, treating with as low a level of oxygen
as possible, and treating infection promptly.
Sudden Acute Respiratory Syndrome (SARS)
■ Description. SARS was the first severe, easily trans
missible new disease to emerge in the twenty-first cen
tury. SARS is a respiratory illness that was first reported
in Asia but spread to people in Europe, South America,
and North America in February 2003. Public health
officials worked quickly to halt the spread of the disease
and actually contained it by July 2003. Worldwide, 8,098
people became sick with SARS, and 774 died in the 2003
outbreak. In the United States, only eight people were
infected, and all of these had traveled outside the United
States to areas with SARS infection. Since 2004, there
have not been any known cases of SARS reported any
where in the world (CDC, 2017).
■ Etiology. World experts determined that SARS is
caused by a previously unknown type of coronavirus,
a family of viruses that usually causes only mild-to-
moderate illness such as the common cold. This new
virus was named the SARS coronavirus.
The SARS virus is spread by respiratory droplets.
Persons who have close person-to-person contact with
an infected individual are most at risk.
■ Symptoms. SARS usually begins with a high fever.
Other symptoms include malaise, chills, headache,
myalgia, dizziness, rigors, cough, sore throat, and
runny nose. Incubation of the SARS virus appears to be
approximately 7-10 days.
■ Diagnosis. Diagnosis is suspected in any person who
exhibits symptoms and has a history of travel to a foreign
country where SARS has been identified. Positive chest
X-rays showing small, patchy shadows that progress to
generalized interstitial infiltrates are indicative of SARS.
■ Treatment. Antibiotics are ineffective against SARS
because it is a viral disease. Treatment of symptoms
includes antipyretic medications, oxygen administra
tion, and ventilator support if needed.
■ Prevention. Prevention includes avoiding contact
with infected individuals and use of isolation procedures
if contact is necessary. Respiratory isolation—including
the use of gown, gloves, goggles, and an approved respi
ratory mask—is essential.
Lung Cancer
■ Description. Lung cancer is a disease of uncontrolled
cell growth in the tissues of the lung. The majority of
primary lung cancers are derived from epithelial cells—
cells lining the air passages. There are two types of pri
mary tumors, called small-cell and non-small-cell.
Small-cell tumors, also called oat cell, occur less
frequently (13%) but grow rapidly and are often met
astatic by the time they are discovered. They usually
respond better to chemotherapy and radiation but
still carry a much worse prognosis than non-small-cell
tumors.
Non-small-cell tumors are more frequent (80%) and
are usually treated surgically. This type of lung cancer is
strongly associated with smoking.
Metastatic lung cancer is common and often due to
metastasis from tumors in other parts of the body. Pri
mary lung cancers also commonly metastasize to other
areas, including the brain, bone, and liver.
Lung cancer is the leading cause of cancer deaths in
the United States in both men and women. Most lung
cancers can be prevented because approximately 90%
are due to smoking. Lung cancer claims more lives than
colon, prostate, and breast cancers combined.
■ Etiology. Lung cancer is rare among those under
40 and, in most cases, is caused by cigarette smoking.
Ninety percent of lung cancer victims are smokers. Men
are affected more commonly than women, although the
increase in female smokers has increased the number of
female lung cancer victims.
■ Symptoms. Lung cancer is often asymptomatic until
metastasis has occurred. Often, the first symptoms are
those related to other organs affected by metastasis.
Discovery by metastasis makes for a very poor prog
nosis; approximately 7% of lung cancer victims survive
five years. Symptoms related to the lung tumor are dys
pnea, coughing, and hemoptysis.
■ Diagnosis. Diagnosis is made by X-ray and tissue
biopsy.
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Respiratory System Diseases and Disorders 189
■ Treatment. Treatment includes chemotherapy, sur
gery, and radiation. If the tumor is discovered early,
surgical removal might confer cure, but this is rarely
the case.
■ Prevention. To never smoke or to quit smoking is the
best preventive action.
Diseases of the Pleura and Chest
Diseases of the pleura and chest can be caused by infec
tion, trauma, or other diseases. Pain and shortness of
breath are the common symptoms. The severity of such
disorders can range from mild to severe, depending on
the cause, the individual’s age, medical history, and
other complicating factors.
Pleurisy (Pleuritis)
■ Description. Pleurisy is inflammation of the mem
branes covering the lung (visceral pleura) and lining
the chest cavity (parietal pleura).
■ Etiology. Pleurisy can be due to bacterial infection
of the pleura. Secondary pleurisy often follows trauma,
pneumonia, TB, and neoplasm.
■ Symptoms. The main symptom of pleurisy is a sharp,
chest-area pain that increases with inspiration and
coughing. Pain can be so severe that it limits movement
in the affected area.
■ Diagnosis. A distinctive pain with breathing is a clas
sic symptom of pleurisy. This symptom, combined with
auscultation of a characteristic friction rub or squeaky,
rubbing sound with inspiration, confirm the diagnosis.
Identifying the cause of the pleurisy might be more dif
ficult. Identification efforts can include chest X-ray, CT
scan, analysis of fluid in the pleural space, and biopsy.
■ Treatment. Treatment is aimed at the cause and
includes symptomatic treatment with analgesics, heat
application, and taping the chest to restrict movement
and, thus, decrease pain.
■ Prevention. Preventing or treating the various causes,
maintaining a healthy lifestyle, and avoiding respiratory
allergens are helpful.
Pneumothorax
■ Description. Pneumothorax is a collection of air in
the pleural cavity, often resulting in partial or com
plete collapse of the lung on the affected side (Figure
9-14). Spontaneous pneumothorax occurs when air is
leaked into the pleural space from the inside or from
the lung.
Outside air enters due to
(A)
due to disruption—due to disruption
of visceral pleura
Collapsed lung
Air
Lung air enters
disruption of chest wall
and parietal pleura
(B)
Figure 9-14 (A) Diagram of pneumothorax. (B) X-ray of pneumothorax.
■ Etiology. Common causes include pulmonary dis
ease, tumor, or pulmonary tissue tear. Traumatic pneu
mothorax occurs when air enters the pleural cavity
from outside the chest. Causes include gunshot wound,
stabbing, or crushing of the chest. A rib fracture often
causes a traumatic pneumothorax.
■ Symptoms. No matter the cause of the pneumotho
rax, symptoms are related to the degree of lung collapse.
Complete lung collapse causes a sudden, severe chest
pain, followed by severe dyspnea and symptoms of shock.
Respirations are weak and shallow. Sucking breath sounds
might be heard at the site of a traumatic wound. Increased
air pressure on the affected side can cause a shift of the
mediastinum toward the unaffected side. The condition
of mediastinal shift is a medical emergency. Emergency
treatment includes placing an occlusive dressing, clean
hand, or plastic material over the sucking chest wound to
prevent additional air from entering the chest.
■ Diagnosis. Auscultation of the chest reveals decreased
or absent breath sounds. Diagnosis is confirmed by
chest X-ray.
■ Treatment. Further treatment can include perform
ing a thoracentesis (THOR-rah-sen-TEE-sis; thora =
chest, centesis = puncture) to insert a chest tube to
withdraw air and assist in re-expanding the lung.
Oxygen therapy and analgesics might also be pre
scribed (Figure 9-15).
■ Prevention. Preventative measures for noninjury-
related pneumothorax include not smoking and having
respiratory problems treated promptly.
Hemothorax
Hemothorax is the collection of blood in the chest
cavity. Cause, symptoms, diagnosis, and treatments
are the same as for a pneumothorax. Blood pressure
and blood loss are monitored and treated as necessary.
Pleural Effusion (Hydrothorax)
■ Description. Pleural effusion, or hydrothorax, is a col
lection of fluid in the chest cavity.
■ Etiology. Causes of hydrothorax can include conges
tive heart failure, TB, or pneumonia.
■ Symptoms. The affected individual might be asymp
tomatic or can exhibit signs of dyspnea and chest or
pleuritic pain.
■ Diagnosis. Diagnosis is confirmed by X-ray.
■ Treatment. Treatment can include thoracentesis to
remove the excess fluid.
■ Prevention. Correction of the condition causing
hydrothorax is needed to prevent reoccurrence.
Empyema
■ Description. Empyema is the collection of pus (py =
pus) in the chest cavity.
■ Etiology. Empyema can be the result of a ruptured
lung abscess or an ulcerated tumor. Empyema is not as
common as it was prior to the development of antibiotics.
■ Symptoms. Symptoms include coughing, dyspnea,
and chest pain on the affected side.
Patient
Intercostal
chest
drainage
Collection
Air in
pleural
space
Tube
Air vent
container
' -
Water seal
Blebs or bullae
Collapsed
lung
Normal lung
Figure 9-15 Chest tube.
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Respiratory System Diseases and Disorders 191
Healthy Highlight
The Harmful Effects he 2020 U.S. Surgeon General’s Report stated, “(Cigarette smoking) ... is still the
leading cause of preventable disease, disability, and death in the United States”
Of S
moking
(American Cancer Society, 2020).
Smoking is responsible for nearly one in five deaths in the United States. Because
cigarette smoking and tobacco use are acquired behaviors—activities that people choose
to do—smoking is the most preventable cause of premature death in our society.
Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders,
and suicides combined (TFK, 2021).
The preceding facts stress how detrimental cigarette smoking is to the individual
and to society. Some other harmful effects of smoking include:
■
■
■
■
■
■
■
■
■
■
■
Its link to cancer, particularly cancer of the lung, larynx, esophagus, pancreas, bladder,
kidney, and mouth
Heart and cardiovascular disease, especially myocardial infarction and stroke
Bone thinning and hip fracture
Chronic bronchitis and emphysema
Decreased rate of lung tissue growth
Impaired level of lung function
Shortness of breath, especially with exercise, and increased phlegm production
Heartburn and peptic ulcers
Premature birth and low birth weight if used during pregnancy
Shortened life span with increased risk of morbidity: on average smokers die 10 years
earlier than non-smokers
Addiction to nicotine
Source: American Cancer Society (2020)
Healthy Highlight
Are Electronic
Cigarettes Safe?
E
lectronic cigarettes are also called vapes, e-cigs, or vaping products. According to
the Centers for Disease Control and Prevention (CDC), e-cigarettes have some
potential to assist adults who are trying to quit smoking cigarettes or other tobacco
products. However, they have not been approved by the FDA as an aid to quit smoking.
They are not safe for youth, young adults, or pregnant women. Non-smokers should
not use e-cigarettes either. E-cigarettes generally contain fewer toxic chemicals than
regular cigarettes but that does not mean they are harmless. They often contain harm
ful substances such as nicotine, metals like lead, and cancer-causing agents. In addition,
e-cigarettes batteries have exploded causing burns and serious injuries.
Source: Centers for Disease Control and Prevention (2020)
■ Diagnosis. Diagnosis is by X-ray and thoracentesis.
■ Treatment. Microbiologic cultures can be performed
on the fluid to identify the infective organism. Antibiotic
therapy is a common treatment for bacterial infections.
■ Prevention. Rapid and appropriate treatment of cause
prevents this condition.
Diseases of the Cardiovascular
and Respiratory Systems
The cardiovascular and respiratory systems are so
closely related that many diseases affect both systems.
The degree to which each system is affected also is often
so similar that it becomes difficult to classify the disease
by one system over the other. For this reason, these dis
eases need further consideration.
Pulmonary Embolism (PE)
■ Description. PE is a sudden blockage of an artery in
the pulmonary system by an embolism (Figure 9-16).
■ Etiology. Chapter 8, “Cardiovascular System Diseases
and Disorders,” discussed the pathology of an embo
lism. Remember that the floating material can be a
blood clot, fat globule, or piece of tissue. Commonly,
a blood clot or thrombus develops in the veins of the
lower legs, thighs, or pelvis. This clot then breaks loose,
floats in the vascular system, and sticks in a pulmonary
artery, resulting in a pulmonary embolism.
■ Symptoms. Symptoms of a PE vary greatly, depend
ing on the size of the clot and the size of the area
affected. Dyspnea, cough, chest pain, and apprehension
are common symptoms. If the PE is severe, cyanosis,
shock, and death can result.
Factors that contribute to the development of an
embolism are immobility, dehydration, prolonged bed
rest, obesity, and trauma or fractures of the legs or pelvis.
■ Diagnosis. Diagnosis is confirmed by X-ray examina
tion and lung scans.
■ Treatment. Treatment is aimed at maintaining car
diopulmonary function by administering oxygen and
anticoagulation medications.
■ Prevention. Prevention includes ambulation, antiem-
bolic stockings, and leg exercises to improve blood flow
and prevent clotting.
Pulmonary Edema
■ Description. Pulmonary edema, if severe, can be a
life-threatening medical emergency. It affects the tis
sue and air spaces of the lungs by filling them with
fluid. This fluid leaks out of the vascular system due to
increased vascular pressure.
■ Etiology. Cardiovascular disease is the common cause
of pulmonary edema. It is commonly seen as a result of
congestive heart failure and resulting fluid buildup, but
any disease that affects blood pressure, heart function,
and blood fluid levels can lead to pulmonary edema.
These diseases include hypertension, pulmonary embo
lism, and renal failure.
■ Symptoms. Pulmonary edema is characterized by
dyspnea, orthopnea (ortho = straight, pnea = breath),
or difficulty breathing when lying down, and a blood-
tinged frothy sputum.
Pulmonary Embolism
(A)
Inferior vena cava
Embolism
Figure 9-16 (A) Diagram of pulmonary embolism. (B) X-ray of pulmonary emboli.
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Respiratory System Diseases and Disorders 193
■ Diagnosis. Diagnosis is determined by ABGs and
chest X-ray. ABGs will show an increased carbon diox
ide level, and chest X-rays will exhibit increased opacity
(whiteness).
■ Treatment. Treatment is aimed at reducing pressure
and blood volume. Diuretics to increase urine output,
cardiogenics to increase the contraction of the heart,
and morphine to bring about venous dilatation might
be prescribed. Mechanical respiratory ventilation might
also be needed.
■ Prevention. Pulmonary edema might not be pre
ventable. Reducing the risk of cardiovascular disease
is helpful and includes not smoking, controlling blood
pressure, limiting cholesterol, limiting salt intake,
exercising daily, eating a heart-healthy diet, and man
aging stress.
Cor Pulmonale
Cor pulmonale has been discussed in Chapter 8. Remem
ber that it is a right-sided heart failure related to acute or
chronic pulmonary disease. Increased pulmonary blood
pressure causes enlargement of the right ventricle and
decreased pumping ability. Polycythemia (poly = many,
cyt = cell - red cell, emia = blood) develops as the body
tries to compensate for hypoxemia (hypo = not enough,
ox = oxygen, emia = blood), leading to a thickening of
the blood and further increasing workload on the heart.
Consider This...
Individuals inhale approximately 700,000
of their own skin flakes daily.
Trauma
Pneumothorax and Hemothorax
Pneumothorax and hemothorax often occur due
to some type of trauma. Examples of trauma that
often cause these conditions are fractured ribs, gun
shot wounds, stabbings, and crushing chest injuries.
Collapse of the lung, shock, and death are potential
outcomes.
Suffocation
Suffocation is the condition of not breathing to the
point of unconsciousness and, eventually, death due to
the lack of oxygen and the high level of carbon dioxide
in the body tissues. The brain and heart are immedi
ately affected.
Accidental suffocation often occurs with infants
and small children playing with plastic bags. Criminal
suffocation of homicide victims might be a common
finding in forensic pathology. Suffocation can also be
caused in a variety of other ways.
■ Aspiration Aspiration of food that occludes or
blocks the airway is common. This type of suffoca
tion leads to the death of approximately one person
a day in the United States! Treatment of food aspira
tion requires immediate attention and can include
the performance of an abdominal thrust, previously
known as the Heimlich maneuver.
■ Strangulation Accidental, suicidal, or criminal
strangulation can occur by hanging or squeezing the
neck with the hands, rope, wire, or a variety of other
objects.
Healthy Highlight
Avoid Blood Clots
While Traveling
T o reduce the risk of developing blood clots:
1. Be an active traveler. If driving, stop every hour, walk around the car, do knee
bends, or rise up and down on your toes. In a plane, try to get up and walk
around the cabin every hour and perform toe rises if space permits.
2. Avoid crossing your legs. Crossing your legs slows blood flow.
3. Exercise while seated. Flex and relax different muscle groups in your legs.
Rotate, flex, and extend your ankles. Ask your physician about wearing com
pression stockings when traveling.
4. Drink plenty of fluids. Immobility and dehydration can contribute to blood
clot formation.
194 Chapter 9
■ Drowning Drowning is a common cause of
accidental death, especially in children and
male adolescents. Drowning may be classified
as wet or dry. Wet drowning is the most com
mon (approximately 90%) and is characterized
by water entering the airways and lungs, pre
venting the entry of oxygen into the system. Dry
drowning is less common and is characterized
by a reflex laryngospasm that closes the glottis
and does not allow water or air to enter. Treat
ment of either type of drowning is immediate
resuscitation and transport to an emergency
department.
Consider This...
If an individual is locked in a completely
airtight room, they will die of carbon diox
ide poisoning before they die of oxygen
deprivation.
Healthy Highlight
Abdominal Thrust
T
he abdominal thrust is a technique used to remove foreign material—usually food—
from the respiratory tract of a choking victim. It is not to be used for a drowning or
near drowning victim. If you can see the foreign object in the person’s mouth and can
remove it, do that first. If you cannot see or remove the foreign object, the abdominal
thrust may clear the airway. Choking is a medical emergency and is a common prevent
able cause of cardiac arrest. First call 911 emergency medical services and then start the
procedure. If the victim is able to talk or has wheezing breath sounds, this maneuver
should not be performed; the abdominal thrust is performed only on individuals who
are unable to breathe. Treatment for a choking person, who cannot speak, turns blue, or
stops breathing is based on age. The procedure described here is for an adult. The pro
cedure can be performed with the victim in a standing or sitting position.
(continued)
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Respiratory System Diseases and Disorders 195
Healthy Highlight (continued)
To perform the abdominal thrust on a victim in a sitting or standing position, the
rescuer assumes a position behind the victim. The rescuer wraps his or her arms around
the victim’s waist, allowing the victim’s head, arms, and upper body to fall forward. The
rescuer makes a fist with one hand and holds it in place with the other hand. The fist
should be placed against the victim’s abdomen at a point slightly above the umbilicus
and below the rib cage. The maneuver calls for the rescuer to perform an upward thrust
forcefully to this area. This maneuver can be repeated until the airway is cleared.
If the victim is or becomes unconscious, the rescuer should begin the steps for car
diopulmonary resuscitation (CPR).
If the victim is pregnant or obese, a chest thrust can be performed. The rescuer places
both hands under the victim’s armpits with the thumb side of the fist on the middle of
the breast bone. The fist is covered with the other hand and thrust backward until the
object is coughed out. If the victim is or becomes unconscious, the rescuer should begin
the steps for CPR.
Rare Diseases
Pneumoconioses
Pneumoconioses (new-mo-cone-ee-OH-sees) refer to a
group of environmentally induced diseases that cause
progressive, chronic inflammation and infection. This
condition is caused by frequently inhaling the small
dust particles of the offending agent for extended peri
ods of time. Pneumoconiosis can occur within a few
years, or it might take 20 or 30 years to develop. Types
of pneumoconiosis, cause, and related occupations
include:
■ Asbestosis, the most frequently occurring form
of the disease, related to insulating and
fireproofing.
■ Anthracosis from inhaling carbon and coal, often
called coal miner’s disease and black lung.
■ Silicosis from inhaling silicone affects glass
cutters, sand blasters, and stonemasons.
Fungal Diseases
Fungal diseases affecting the lungs are caused by inhal
ing an airborne fungus. The lung lesions caused by fun
gal diseases form granulomatous inflammations like
TB, but they do not cavitate (cause cavities in the lung
tissue). The fungus can spread through the lung tissue
and cause acute illness with symptoms of dyspnea and
fever. Treatment consists of rest and antifungal medi
cations. Two forms include:
1. Histoplasmosis, which occurs primarily in the
Midwestern United States. This fungus is har
bored in bird droppings such as those found in
chicken houses, bat caves, and pigeon roosts.
2. Coccidioidomycosis (cox-sid-ee-OYD-o-my-
co-sis), which occurs primarily in the south
western United States. This fungus grows in
hot, dry areas and produces spores that become
windborne. It is also known as desert fever and
valley fever.
Legionnaires’ Disease
Legionnaires’ disease is a bacterial pulmonary infection
so named as the result of an outbreak in 1976 at a con
vention of the American Legion held in Philadelphia.
The causative bacterium is Legionella pneumophila.
This bacterium lives in water storage tanks and cooling
systems. Legionnaires’ disease can also be called Legion
naires’ pneumonia because it produces typical pneumo
nia symptoms. It differs from other types of pneumonia
in that it does not respond to the usual treatment, and
it might cause permanent lung damage. Legionnaires’
disease is not limited to the pulmonary system like typ
ical pneumonia is; it can cause complications such as
196 Chapter 9
liver damage and renal dysfunction. Severe cases might
need mechanical ventilation and can have a fatal
outcome.
Effects of Aging on the System
The effects of aging on the respiratory system increase
the risk for the older adult to develop respiratory dis
ease. Over time, the respiratory system loses some of its
elasticity, becomes less efficient, and has less reserve.
Weakened respiratory muscles contribute to the
ineffectiveness of the system. It can also be adversely
affected by changes in posture occurring with aging, by
the long-term effects of chronic diseases such as COPD,
and by the changes occurring in other systems. The
older adult usually has a lower tolerance for exercise
due to the increased need for oxygen during exercise
and the inability of the body to meet that demand.
Changes in the immune responses that occur with
aging put the older adult at increased risk for acute
respiratory infections. Influenza and pneumonia are
common but very serious diseases affecting older
adults. Pneumonia is the leading cause of death due
to infections in the older population. Another respi
ratory disease that older people are at increased risk
of developing is TB. Their reduced immunity contrib
utes to the high incidence of TB among older adults.
Chronic respiratory diseases are particularly difficult
for older people. The nature of the disease, symptoms,
effects, and treatments can all contribute to the increased
respiratory dysfunction, and thus, the debilitation of the
individual. Many older individuals have been heavy
smokers for years. The effects of smoking might have
already severely damaged respiratory function and will
continue to inhibit effective breathing if the individual
continues to smoke. Smoking is the major cause of the
high incidence of cancer of the lung in older people.
Summary
T
he respiratory system is responsible for the intake of oxygen for the body and the removal of carbon dioxide.
Decreased respiratory function greatly limits the ability of other systems because oxygen is necessary at the
cellular level for all activities to occur. Diagnostic tests for respiratory diseases include physical examination, chest
X-rays, ABGs, and PFTs. Respiratory diseases are a major cause of disability and death in the United States. Acute
respiratory diseases such as the common cold, pneumonia, and influenza occur in all age groups. An increased
incidence of influenza, and now COVID-19 as well as other communicable respiratory diseases is causing con
cern among public health officials. Most chronic respiratory diseases are found in the older adult. Smoking is the
greatest contributor to chronic respiratory disease, especially to cancer of the lung.
Review Questions
Short Answer
1. What are the functions of the respiratory system?
2. Which signs and symptoms are associated with common respiratory system disorders?
3. Which diagnostic tests are most commonly used to determine the type and cause of respiratory system disorders?
4. What is the most effective preventive technique against the common cold?
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