1. A Report by: Kenneth Pierre M.
Lopez

3. • Nose or Mouth: entry
point into the
respiratory system.
The nose filters,
humidifies and
warms air.
• Pharynx: common
area used for both
respiratory and
digestive systems.
• Larynx: connects the
pharynx to the
trachea, including the
epiglottis and vocal

4. • The conducting
airways, trachea to
terminal bronchioles,
only transport air. No
gas exchange
occurs.
• The respiratory unit:
respiratory
bronchioles, alveolar
ducts, alveolar sacs,
and alveoli. Diffusion
of gas occurs through
all these structures.

5. • Parietal pleura covers
the inner surface of the
thoracic cage,
diaphragm, and
mediastinal border of the
lung
• Visceral pleura wraps the
outer surface of the lung
including fissure lines
• Intrapleural space is the
potential space between
the two pleurae that
maintains the
approximation of the rib
cage and lungs, allowing
forces to be transmitted
from one structure to
another.

7. Primary Secondary
• Produces a normal resting • Used when a more rapid
tidal volume or deeper inhalation is
• Diaphragm required
• External Intercostals • Scalenes and SCM
• Levator Costarum and
Serratus
• Expiration
• Quadratus Lumborum
• Internal intercostals
• Abdominals

8. • Expiratory Reserve • Inspiratory Capacity: The
Volume: Maximal volume amount of air that can be
expired after Normal inspired after a normal
Respiration; 1000mL exhalation 3500mL
• Forced Expiratory Volume: • Inspiratory Reserve
the amount of air exhaled Volume: Maximal volume
in 1st-3rd second of forced inspired after normal
vital capacity test inspiration 3000mL
• Forced Vital Capacity: the • Residual Volume: Lung
amount of air forcefully volume remaining in the
expired after a maximal lungs 1200mL
inspiration • Tidal Volume: Total volume
• Functional Residual inspired and expired per
Capacity: Volume in the breath; 500mL
lungs after normal • Total Lung Capacity: Lung
exhalation 2300mL Volume measured at the
end of maximal inspiration
5800mL
• Vital Capacity: Maximal

9. • Total Lung Capacity = IRV + TV + ERV +
RV
• Vital Capacity = IRV + TV + ERV
• Inspiratory Capacity = TV + IRV
• Functional Residual Capacity = ERV + RV

10. - A disease characterized by airflow limitation that is not
fully reversible. Limitation is usually both progressive
and associated with an abnormal inflammatory response
of the lungs to noxious particles or gasses.

11. • Increased reactivity of the trachea and bronchi to
various stimuli (allergens, exercise, cold) and
manifests by widespread narrowing of the airways
due to inflammation, smooth muscle constriction,
and increased secretions that is reversible in
nature.
• 15 million are affected in all age groups and gender
in the USA; women are affected more than men,
hormones are thought to be the possible cause
• Lungs become hyperactive, responding to irritants
in an exaggerated way. Muscles around the airways
constrict and inflammation causes air passages to
swell and produce excess mucus impairing

12. Signs and Symptoms Contributing Factors
• Wheezing, possible • Respiratory infections,
crackles, decreased breath colds
sounds • Cigarette Smoke
• Increased mucus • Allergic Reactions to pollen,
secretions mold, animal dander,
• Dyspnea feather, dust, food, insects
• Increased accessory • Air pollutants
muscle use • Physical exertion
• Anxiety • Exposure to sudden
• Tachycardia, Tachypnea, temperature change (cold)
Hypoxemia • Excitement or strong
• Cyanosis emotion, psychological or
emotional stress

13. Listen For Look For
• Wheezing, however light • Skin retraction (clavicles,
• Irregular breathing with ribs, sternum)
prolonged expiration • Hunched-over body
posture; inability to stand,
• Noisy, difficult breathing sit straight or relax
• Clearing the throat • Pursed-lip breathing
• Cough with or without • Nostrils Flaring
sputum production, • Unusual pallor or
especially in the absence of unexplained sweating
a cold and/or occurring 5 – • Spirometry will show
10 minutes after exercise impaired flow rates
• CXR shows hyperlucency
and flattened diaphragms
during exacerbation

15. • An inflammation of the trachea and bronchi that is
self-limiting and of short duration with few pulmonary
signs. This condition may result from chemical
irritation or may occur with viral infections such as
influenza, measles, chickenpox or whooping cough.
• Signs and Symptoms
• Mild fever (1-3 days)
• Malaise
• Back and Muscle Pain
• Sore Throat
• Cough with sputum production, followed by wheezing
• Possible Laryngitis

16. • A condition associated with prolonged exposure to
nonspecific bronchial irritants and is accompanied
by mucus hypersecretion and structural changes in
the bronchi, anyone who coughs for at least 3
months per year for 2 consecutive years without
having had a precipitating disease
• Results from exposure to cigarette smoke, long-
term inhalation of dust or air pollution and causes
hypertrophy of mucus-producing cells in the
bronchi
• Partial or complete blockage of the airways from
mucus secretions causes insufficient oxygenation
in the alveoli
• Common in older clients and with chronic lung or

17. Signs and Symptoms Tests
• Persistent cough with • Sputum analysis
production of sputum • Spirometry
• Reduced chest expansion
• Wheezing
• Fever
• Dyspnea
• Cyanosis
• Decreased exercise
tolerance

19. • May develop in a person after a long history of
chronic bronchitis in which alveolar walls are
destroyed, leading to permanent over-distention of
the air spaces and loss of normal elastic tension in
the lung tissue.
• Air passages are obstructed as a result of these
changes. Difficult expiration in emphysema is due to
the destruction of the walls between the alveoli,
partial airway collapse and loss of elastic recoil.
• The work of breathing is increased because there is
less functional lung tissue to exchange oxygen and
CO2. Capillaries are also destroyed further reducing
perfusion and ventilation

20. Centriacinar Emphysema
• Centrilobular Emphysema
• Most common type, destroys bronchioles, usually
in upper lung regions
• Panlobular Emphysema
• Destroys the more distal alveolar walls, most
commonly involving the lower lung. May occur
secondary to infection or to irritants
Paraseptal (panacinar) Emphysema
• Destroys the alveoli in the lower lobes of the lungs,
resulting in isolated blebs along the lung periphery

21. Signs and Symptoms Tests
• Shortness of Breath • Spirometry
• Dyspnea on Exertion • ABG (low arterial oxygen
• Orthopnea levels)
• Chronic Cough
• Barrel Chest
• Weight Loss
• Malaise
• Use of accessory muscles
of respiration
• Prolonged expiratory period
• Wheezing
• Pursed lip breathing
• Increased respiratory rate
• Peripheral Cyanosis

23. • An inherited disease of the exocrine glands
primarily affecting the digestive and respiratory
systems.
• Most common genetic disease in the US, inherited
as a recessive trait: both parents must be carriers,
each having a defective copy of the CF gene.
Each time two carriers conceive a child there is a
25% chance the child will have it, 50% chance the
child will be a carrier, 25% of the child not having
it.
• 12 million people, carry a single copy of the gene
5% of the total population

24. • In healthy people a protein called cystic fibrosis
transmembrane conductance regulator provides a
channel by which chloride can pass in and out of
cells.
• Persons with CF have a defective copy of the gene
causing accumulation of salts in the cells lining the
lungs and digestive tissues, making the surrounding
mucus abnormally thick and sticky. This obstructs
the ducts of the pancreas, liver and lungs and
causes abnormal sweat and salivary secretions.
• Diagnosis is made postnatally by a blood test
showing the presence of trypsinogen or later by a
positive sweat electrolyte test

25. Signs and Symptoms Other Tests
• Onset of symptoms usually in • Abnormal PFT’s showing
early childhood
• Dyspnea an obstructive pattern,
• Productive cough restrictive pattern or both
• Hypoxemia, hypercapnea • CXR shows increased
• Cyanosis markings and findings of
• Clubbing bronchiectasis and/or
• Use of accessory muscles in pneumonitis
breathing – Barrel Chest
• Tachypnea
• Crackles, wheezes and/or
decreased breath sounds
• Recurrent pneumonia
• Poor weight gain
• Salty skin/sweat
• Bulky foul smelling stools

27. - Diseases typified by difficulty expanding the lungs
causing a reduction in lung volumes

28. • An inflammation of the lungs and can be caused by (1)
aspiration of food, fluids or vomitus; (2) inhalation of toxic or
caustic chemicals, smoke, dust or gases; or (3) a bacterial,
viral, or mycoplasmal infection
• It is an inflammatory pulmonary response to the offending
organism or agent. It may involve one or both lungs at the
level of the lobe (lobar pneumonia) or more distally
beginning in the terminal bronchioles and alveoli
(bronchopneumonia)
• Pneumocystis carinii is a protozoan organism that rarely
causes pneumonia in a healthy individual. This is the most
common life-threatening opportunistic infection in persons
with AIDS.
• Nosocomial Pneumonia is a hospital-acquired pneumonia
usually in patients who are using a respirator machine to
help them breathe this type can be very severe and

29. Signs and Symptoms Tests
• Sudden and sharp pleuritic • Sputum and/or blood
chest pain that is aggravated
by chest movement cultures
• Shoulder pain • CXRAY
• Hacking, productive cough pneumonitis/infiltration
(rust-colored or green,
purulent sputum) • WBC count
• Dyspnea, Tachypnea • CBC (Pneumocytis carinii;
• Cyanosis shows now sign of
• Headache infection)
• Fever and chills
• Generalized aches and
myalgia that may extend to
the thighs and calves
• Knees may be painful and
swollen
• Fatigue
• Confusion in older adults

31. • Collapsed or airless alveolar unit, caused by
hypoventilation secondary to pain during the ventilatory
cycle (pleuritis, postoperative pain or rib fracture), internal
bronchial obstruction (aspiration, mucus plugging),
external bronchial compression (tumor or enlarged lymph
nodes), low tidal volumes (narcotic overdose,
inappropriately low ventilator settings), or neurologic
insult.
• Physical findings include
• Decreased breath sounds
• Dyspnea
• Tachycardia
• Increased temperature
• CXR with platelike streaks

33. • Mycobacterium tuberculosis infection spread by aerosolized
droplets from an untreated infected host. Incubation period is
2-10 weeks. It is characterized by the growth of nodules
(tubercles) in the tissues commonly in the lungs.
• May be diagnosed by Tuberculin Skin tests, Xrays and
sputum cultures.
• Signs and Symptoms Include
• Fatigue, Malaise
• Anorexia
• Weight Loss
• Low-grade fevers
• Night sweats
• Frequent productive cough
• Dull Chest pain, tightness, or discomfort
• Dyspnea

34. • Risk Factors • Rheumatoid arthritis
• Health care workers secondary to
• Older adults immunosuppresive
• Overcrowded housing treatements
• Incarcerated people • Diabetes mellitus/ end
• Immigrants from Asia, stage renal disease
Ethiopia, Mexico, Latin
• People with a history of
America, Eastern Europe
GI diseases
• Dependent on alcohol or
other chemicals with
resultant malnutrition
• Infants and children under
5 years of age
• HIV positive or Cancer
positive patients

36. • An atypical respiratory illness caused by a
coronavirus. It is a new type of atypical pneumonia
that infects the lungs. Initial outbreak in southern
mainland China with worldwide spread to other
areas such as Singapore, Toronto, Vietnam and
Hongkong
• Physical Findings
• High Temperature
• Dry Cough
• Decreased WBC, platelets and lymphocytes
• Increased liver function tests
• Abnormal CXR with borderline breath sounds and
changes

39. • Bronchodilator Agents
• Relieve bronchospasm, increase size of the airway,
and reduce resistance and subsequent obstruction; 3
subsets include anticholinergics, beta-adrenergics,
methylxanthine
• Albuterol, Epinephrine, Pirbuterol acetate,
Aminophylline
• Inhaled Corticosteroid Agents
• Controls inflammation of the airways; decrease
bronchospasm and stabilize inflammatory response
in the respiratory tract
• Beclomethasone, Budesonide, Dexamethasone
• Mucolytic Agents
• Thin mucous secretions by altering the composition
and consistency of mucus

40. • Expectorant Agents
• Increase removal of mucus through transport from
the lungs
• Guaifenesin, Iodinated glycerol, Terpin hydrate
• Antiasthmatic Agents
• Stabilize mast cells; inhibit the release of
inflammatory substances
• Cromolyn sodium, Nedocromil sodium

42. • Breathing exercises
• Coughing techniques
• Postural Drainage, Chest PT
• Endurance/ Exercise training
• Relaxation techniques
• Mobility Training

43. • Patients who have acute or chronic respiratory problems
• The inability to expel pulmonary secretions
• An ineffective cough
• Patients with increased secretions
• Patients with pneumonia
• Patients with atelectasis
• Patients with neurological impairments that cause
swallowing difficulties

44. Postural Drainage Percussion
• Congestive heart failure • Over a fracture site
• Significant pulmonary • Over a spinal fusion site
edema • Over osteoporotic bone
• Significant pleural effusion • Unstable angina
• Pneumothorax • Low platelet count
• Cardiac arrhythmia • Anticoagulation therapy
• History of recent • Pulmonary embolism
myocardial infarction
• Unstable angina
• Pulmonary embolism

45. • Percussion
• A force rhythmically applied with the therapist’s cupped hands to
the specific area of the chest wall that corresponds to the involved
lung segment. Percussion is used to increase the amount of
secretions cleared form the tracheobronchial tree. It is usually
used in conjunction with postural drainage.
• Shaking (Vibration)
• Following a deep inhalation, shaking is a bouncing maneuver
applied to the rib cage throughout exhalation. Shaking hastens the
removal of secretions from the tracheobronchial tree. Commonly
used following percussion in the appropriate postural drainage
position. Modification of this technique may be necessary for
patient tolerance.

46. Treatment Protocol Goals for Retraining
• Teach proper use of • Improve overall ventilation
inspiratory muscles and respiration
• 2-4 sessions of 30 to 50
• Decrease accumulation of
minutes of deep breathing with
proper diaphragmatic secretions and prevent
breathing complications
• Use sniffing to increase • Decrease the work of
awareness regarding the breathing
proper use of the diaphragm • Improve the efficiency of
when breathing coughing
• Strength training through • Strengthening respiratory
resisted inhalation for patients
muscles
that have TV > 500ml
• Strength training through • Improve chest wall mobility
active breathing exercises for

47. • Diaphragmatic Breathing
• Attempts to enhance movement of the diaphragm upon
inspiration and expiration and diminish accessory muscle
use. Used with patient’s with obstructive or restrictive
pulmonary ailments
• Low Frequency Breathing
• Low-frequency breathing is slow deep breathing designed to
improve alveolar ventilation and oxygenation. Used with
patients who have pleuritic, incisional or posttrauma pain that
is causing decreased movement in a portion of the thorax
and are risk for developing atelectasis
• Pursed Lip Breathing
• Attempts to improve ventilation by decreasing the respiratory
rate and increasing the tidal volume. This technique assists
with shortness of breath that is commonly encountered in
patients with COPD who experience dyspnea at rest or with

48. • Cough
• The patient should be asked to cough in the upright sitting position, if
possible, after each area of lung has been treated. Coughing is
effective in clearing secretions from the major central airways.
• Huff
• Huffing is more effective in patients with collapsible airways, such as
patients with chronic obstructive diseases; it prevents the high
intrathoracic pressure which causes premature airway closure
• Assisted Cough
• The therapist’s hand or fist becomes the force behind the patient’s
exhaled air. Assisted cough is used when the patients abdominal
muscles cannot generate effective cough. The amount of force by the
therapist is dependent upon patient tolerance and abdominal
sensation
• Tracheal Stimulation
• Used with patients who are unable to cough on command, such as
infants, patients following brain injury or stroke