Respiratory System

What is Respiration?

Respiration is the act of breathing.

Inhaling (Inspiration):Taking in oxygen.

Exhaling (Expiration):Giving off carbon dioxide.

Anatomy of the Respiratory System

The respiratory system is made up of the organs involved in the interchanges of gases, and consists of :

  Mouth (oral cavity)
  Pharynx (throat)
  Larynx (voice box)
  Trachea (windpipe)

The upper respiratory tract includes the:

  Nasal cavity
  Ethmoidal air cells
  Frontal sinuses
  Maxillary sinus
  Sphenoidal sinus

The lower respiratory tract includes the:

  Airways (bronchi and bronchioles)
  Air sacs (alveoli)

What are the functions of the lungs?

The lungs take in oxygen, which the body's cells need to live and carry out their normal functions. The lungs also get rid of carbon dioxide, a waste product of the cells. The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).
The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an area that contains the following:

  Heart and its large vessels
  Tachea (windpipe)
  Frontal sinuses
  Lymph nodes

The right lung has three sections, called lobes. The left lung has two lobes. When you breathe, the air:

  1. Enters the body through the nose or the mouth
  2. Travels down the throat through the larynx (voice box) and trachea (windpipe)
  3. Goes into the lungs through tubes called main-stem bronchi
One main-stem bronchus leads to the right lung and one to the left lung
In the lungs, the main-stem bronchi divide into smaller bronchi
And then into even smaller tubes called bronchioles
Bronchioles end in tiny air sacs called alveoli

Mechanics of Breathing

To take a breath in, the external intercostal muscles contract, moving the ribcage up and out. The diaphragm moves down at the same time, creating negative pressure within the thorax. The lungs are held to the thoracic wall by the pleural membranes, and so expand outwards as well. This creates negative pressure within the lungs, and so air rushes in through the upper and lower airways.

Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if they are not held against the thoracic wall. This is the mechanism behind lung collapse if there is air in the pleural space (pneumothorax).

Physiology of Gas Exchange

Each branch of the bronchial tree eventually sub-divides to form very narrow terminal bronchioles, which terminate in the alveoli. There are many millions of alveloi in each lung, and these are the areas responsible for gaseous exchange, presenting a massive surface area for exchange to occur over.

Each alveolus is very closely associated with a network of capillaries containing deoxygenated blood from the pulmonary artery. The capillary and alveolar walls are very thin, allowing rapid exchange of gases by passive diffusion along concentration gradients.

CO2 moves into the alveolus as the concentration is much lower in the alveolus than in the blood, and O2 moves out of the alveolus as the continuous flow of blood through the capillaries prevents saturation of the blood with O2 and allows maximal transfer across the membrane.

Lung Disorders and Diseases

Persons who are having a difficult time breathing often show signs that they are not getting enough oxygen, indicating respiratory distress. Below is a list of some of the signs that may indicate that a person is not getting enough oxygen. It is important to learn the symptoms of respiratory distress to know how to respond appropriately. Always consult your physician for a diagnosis .

Breathing rate: An increase in the number of breaths per minute may indicate that a person is having trouble breathing or not getting enough oxygen.

Color changes: A bluish color seen around the mouth, on the inside of the lips, or on the fingernails may occur when a person is not getting as much oxygen as needed. The color of the skin may also appear pale or gray.

Grunting: A grunting sound can be heard each time the person exhales. This grunting is the body's way of trying to keep air in the lungs so they will stay open.

Nose flaring: The openings of the nose spreading open while breathing may indicate that a person is having to work harder to breathe.

Retractions: The chest appears to sink in just below the neck and/or under the breastbone with each breath - one way of trying to bring more air into the lungs.

Sweating: There may be increased sweat on the head, but the skin does not feel warm to the touch. More often, the skin may feel cool or clammy. This may happen when the breathing rate is very fast.

Wheezing: A tight, whistling or musical sound heard with each breath may indicate that the air passages may be smaller, making it more difficult to breathe.

There are many types of lung problems that require clinical care by a physician or other healthcare professional. Listed below are some of the conditions.

Chronic Obstructive Pulmonary Disease (COPD)

  Chronic Bronchitis
  Pulmonary Emphysema
  Acute Bronchitis
  Cystic Fibrosis
  Interstitial Lung Disease/Pulmonary Fibrosis
  Occupational Lung Diseases
  Primary Pulmonary Hypertension
  Pulmonary Embolism
  Pulmonary Sarcoidosis

There are many types of lung problems that require clinical care by a physician or other healthcare professional. Listed below are some of the conditions.

What is the common cold?

The common cold is one of the most prevalent illnesses, leading to more doctor visits and absences from school and work than any other illness every year. It is Caused by a virus that inflames the membranes in the lining of the nose and throat, colds can be the result of more than 200 different viruses. However, among all of the cold viruses, the rhinoviruses and the coronaviruses cause the majority of colds.

When is the "cold" season?

People are most likely to have colds during fall and winter. The increased incidence of colds during the cold season may be attributed to the fact that more people are indoors and close to each other. In addition, many cold viruses thrive in low humidity, making the nasal passages drier and more vulnerable to infection.

The Cold Viruses: The rhinoviruses and the coronaviruses are the most common causes of a cold. According to the National Institute of Allergy and Infectious Diseases (NIAID), the rhinoviruses cause about one-third of all colds (30 to 35 percent), while the most common causes of adult colds are the coronaviruses. However, the cause of 30 to 50 percent of adult colds remains unidentified.

Rhinoviruses: There are more than 110 different rhinoviruses that cause most colds in early fall, spring, and summer. Named after the Greek word "rhin" for "nose," rhinoviruses thrive in the human nasal mucosa.

Coronaviruses: More than 30 different strains of the coronavirus exist, with three or four types affecting humans. The virus is most active in the winter and early spring.

What are the symptoms of the common cold?

The following are the most common symptoms of the common cold. However, each individual may experience symptoms differently. Symptoms may include:

  stuffy, runny nose
  scratchy, tickly throat
  watering eyes
  low-grade fever
  sore throat
  mild hacking cough
  achy muscles and bones
  mild fatigue
  watery discharge from nose that thickens and turns yellow or green

Colds usually start two to three days after the virus enters the body and symptoms last from several days to several weeks.

The symptoms of the common cold may resemble other medical conditions

How is the common cold spread?

The common cold is highly contagious. It is often spread through airborne droplets that are coughed or sneezed into the air by the contagious person and then inhaled by another person. Colds can also be spread by hand-to-hand or hand-to-infected-surface contact, after which a person touches his/her face.

How is a cold different from the flu?

A cold and the flu (influenza) are two different illnesses. A cold is relatively harmless and usually clears up by itself after a period of time, although sometimes it may lead to a secondary infection, such as an ear infection. However, the flu can lead to complications, such as pneumonia and even death. What may seem like a cold, could, in fact, be the flu. Be aware of these differences:

Cold Symptoms

  Low or no fever
  Sometimes a headache
  Stuffy, runny nose
  Mild, hacking cough
  Slight aches and pains
  Mild fatigue
  Sore throat
  Normal energy level

Flu Symptoms

  High fever
  Always a headache
  Clear nose
  Sometimes sneezing
  Cough, often becoming severe
  Often severe aches and pains
  Several weeks of fatigue
  Sometimes a sore throat
  Extreme exhaustion

Who is at greater risk for catching the common cold?

Children suffer more colds each year than adults, due to their immature immune systems and to the close physical contact with other children at school or daycare. In fact, the average child will have between 6 to 10 colds a year, while the average adult will get 2 to 4 colds a year. However, the average number of colds for children and adults will vary.

Prevention for the common cold:

The best way to avoid catching the common cold is to wash your hands frequently and avoid close contact with people who have colds. When around people with colds, do not touch your nose or eyes, because your hands may be contaminated with the virus.
People with colds should cough and sneeze in facial tissue and dispose of the tissue promptly, and then wash his/her hands immediately. In addition, cleaning surfaces with disinfectants that kill viruses can halt the spread of the common cold. Research has shown that rhinoviruses may survive up to three hours outside of the nasal mucosa.

How is the common cold diagnosed?

Most common colds are diagnosed based on reported symptoms. However, cold symptoms may be similar to certain bacterial infections, allergies, and other medical conditions. Always consult your physician for a diagnosis.

Vitamin C and the common cold

Many people believe taking large amounts of vitamin C will either prevent the common cold or reduce its symptoms. However, to date, studies have not indicated that high amounts of vitamin C affect the onset and symptoms of the common cold. In addition, taking large quantities of vitamin C over a long period of time may, in fact, be harmful, causing diarrhea and distorting urine and blood test results.

Treatment for the common cold:

Currently, there is no medication available to cure or shorten the duration of the common cold. However, the following are some treatments that may help to relieve some symptoms of the cold:

  over-the-counter cold medications, such as decongestants and cough medicine
  over-the-counter antihistamines (medication that helps dry up nasal secretions and suppress coughing)
  increased fluid intake
  pain relievers for headache or fever
  warm, salt water gargling for sore throat
  petroleum jelly for raw, chapped skin around the nose and lips
  warm steam for congestion

Note: Because colds are caused by viruses, treatment with antibiotics is ineffective. Antibiotics are only effective when given to treat bacterial infections.

Aspirin and the risk of Reye syndrome in children

Do not give aspirin to a child who has fever without first contacting the child's physician. Aspirin, when given as treatment for viral illnesses in children, has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Therefore, pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses (such as colds, the flu, and chickenpox) in children.

Complications from colds:

Colds can lead to secondary infections, including bacterial middle ear and sinus infections that may require treatment with antibiotics. When a cold is accompanied by high fever, sinus pain, significantly swollen glands, or a mucus-producing cough, a complication may be present that requires additional treatment.

Cold weather and colds:

Contrary to popular belief, cold weather or getting chilled does not cause a cold, according to the National Institute of Allergy and Infectious Diseases (NIAID). However, more colds do occur during the cold season (early fall to late winter), which is probably due to a variety of factors, including:

  schools are in session, increasing the risk for exposure to the virus
  people stay more indoors and are in closer proximity to each other
  low humidity, causing dry nasal passages which are more susceptible to cold viruses


Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious infection or inflammation in which the air sacs fill with pus and other liquid.

  Lobar pneumonia affects one or more sections (lobes) of the lungs.
  Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.

What are the different types of pneumonia?

The main types of pneumonia are:

  1. Bacterial pneumonia is caused by various bacteria. The Streptococcus pneumoniae is the most common bacterium that causes bacterial pneumonia.
It usually occurs when the body is weakened in some way, such as illness, malnutrition, old age, or impaired immunity, and the bacteria are able to work their way into the lungs. Bacterial pneumonia can affect all ages, but those at greater risk include the following:
persons who abuse alcohol
persons who are debilitated
post-operative patients
persons with respiratory diseases or viral infections
persons who have weakened immune systems

The symptoms of bacterial pneumonia include:
shaking, chills
chattering teeth
severe chest pain
high temperature
heavy perspiring
rapid pulse
rapid breathing
bluish color to lips and nailbeds
confused mental state or delirium
cough that produces rust-colored or greenish mucus

  2. Viral pneumonia is caused by various viruses, and is the cause of half of all cases of pneumonia.
Early symptoms of viral pneumonia are the same as those of bacterial pneumonia, which may be followed by increasing breathlessness and a worsening of the cough.
Viral pneumonias may make a person susceptible to bacterial pneumonia.
  3. Mycoplasma pneumonia has somewhat different symptoms and physical signs. It is caused by mycoplasmas, the smallest free-living agents of disease in humankind, which have the characteristics of both bacteria and viruses, but which are not classified as either. They generally cause a mild, widespread pneumonia that affects all age groups.
Symptoms include a severe cough that may produce some mucus.
  4. Other less common pneumonias may be caused by the inhaling of food, liquid, gases or dust, or by fungi.

How is pneumonia diagnosed?

Diagnosis is usually made based on the season and the extent of the illness. Based on these factors, your physician may diagnose simply on a thorough history and physical examination, but may include the following tests to confirm the diagnosis:

chest x ray: a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film..

blood tests: to analyze the amount of carbon dioxide and oxygen in the blood. sputum culture - a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.

pulse oximetry: an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

chest CT scan: a test that takes images of the structure in the chest

bronchoscopy: a procedure used to look inside the airways of the lungs

pleural fluid culture: a culture of fluid sample taken from the pleural space (space between the lungs and chest wall) to identify the bacteria that cause pneumonia

Treatment for pneumonia:

Specific treatment will be determined by your physician based on:

  your age, overall health, and medical history
  extent of the disease
  your tolerance for specific medications, procedures, or therapies
  expectations for the course of the disease
  your opinion or preference

Treatment may include antibiotics for bacterial pneumonia. Antibiotics may also speed recovery from mycoplasma pneumonia and some special cases. There is no clearly effective treatment for viral pneumonia, which usually heals on its own.
Other treatment may include appropriate diet, oxygen therapy, pain medication, and medication for cough.


What is influenza (flu)?

Influenza (or flu) is a highly contagious viral respiratory tract infection. Influenza is characterized by the abrupt onset of fever, muscle aches, sore throat, and a nonproductive cough.
Influenza can make people of any age ill. Although most people are ill with influenza for only a few days, some have a much more serious illness and may need to be hospitalized. Influenza can also lead to pneumonia and death.
Influenza viruses are divided into three types, designated as A, B, and C.

  Influenza types A and B are responsible for epidemics of respiratory illness that occur almost every winter and are often associated with increased rates for hospitalization and death. Efforts to control the impact of influenza are focused on types A and B.
  Influenza type C usually causes either a very mild respiratory illness or no symptoms at all. It does not cause epidemics and does not have the severe public health impact that influenza types A and B do.

Influenza viruses continually mutate or change, which enables the virus to evade the immune system of its host. This makes people susceptible to influenza infection throughout their lives.

What causes influenza?

The influenza virus is generally passed from person to person by airborne transmission (i.e., sneezing or coughing). But, the virus can also live for a short time on objects, such as doorknobs, pens, pencils, keyboards, telephone receivers, and eating or drinking utensils. Therefore, it may also be spread by touching something that has been handled by someone infected with the virus and then touching your own mouth, nose, or eyes.

What are the symptoms of the flu?

The following are the most common symptoms of the flu. However, each individual may experience symptoms differently. Influenza is called a respiratory disease, but the whole body seems to suffer when a person is infected. People usually become acutely ill with several, or all, of the following symptoms:

  High fever
  Runny or stuffy nose
  Sneezing at times
  Cough, often becoming severe
  Severe aches and pains
  Fatigue for several weeks
  Sometimes a sore throat
  Extreme exhaustion

Fever and body aches usually last for three to five days, but cough and fatigue may last for two weeks or more. Although nausea, vomiting, and diarrhea may accompany the flu, these gastrointestinal symptoms are rarely prominent. "Stomach flu" is an incorrect term sometimes used to describe gastrointestinal illnesses caused by other microorganisms.
The symptoms of the flu may resemble other medical conditions.

What is the treatment for influenza?

Specific treatment for influenza will be determined by your doctor based on:

  Your age, overall health, and medical history
  Extent and type of influenza, and severity of symptoms
  Your tolerance for specific medications, procedures, or therapies
  Expectations for the course of the disease
  Your opinion or preference

The goal of treatment for influenza is to help prevent or decrease the severity of symptoms. Treatment may include:

  Medications to relieve aches and fever (Aspirin should not be given to children with fever without first consulting a doctor). The drug of choice for children is acetaminophen (Tylenol).
  Medications for congestion and nasal discharge
  Bed rest and increased intake of fluids
  Antiviral medications--when started within the first two days of treatment, they can reduce the duration of the disease but cannot cure it. Four medications have been approved and include amantadine, rimantadine, zanamivir, and oseltamivir. Some side effects may result from taking these medications, such as nervousness, lightheadedness, or nausea. Individuals with asthma or chronic obstructive pulmonary disease are cautioned about using zanamivir. Viral resistance to these drugs may vary. Some drugs may be ineffective if current viral strains have developed resistance. All of these medications must be prescribed by a doctor.

How can the flu be prevented?

A nasal-spray flu vaccine, called FluMist, is currently approved to prevent flu due to influenza A and B viruses in healthy children and adolescents (ages two to 17), and healthy adults (ages 18 to 49). As with other live virus vaccines, FluMist should not be given for any reason to pregnant women and people with immune suppression, including those with immune deficiency diseases, such as AIDS or cancer, and people who are being treated with medications that cause immunosuppression. FluMist also should not be given to the following groups of people:

  Children less than two years of age
  Any person with asthma
  Children less than five years of age with recurrent wheezing

Following these precautions may also be helpful:

  When possible, avoid or limit contact with infected persons.
  Frequent handwashing may reduce, but not eliminate, the risk of infection.
  A person who is coughing or sneezing should cover his or her nose and mouth with a handkerchief to limit spread of the virus.

Vaccine effectiveness also varies from one person to another, depending on factors such as age and overall health.

What are the side effects of the flu vaccine?

The most serious side effect that can occur after influenza vaccination is an allergic reaction in people who have a severe allergy to eggs. For this reason, people who have an allergy to eggs should not receive the influenza vaccine.

Who should immunize against the flu?

The flu causes complications that may develop into a more serious disease or become dangerous to some groups, such as elderly people and those with chronic medical conditions. For these reasons, the CDC recommends that the following groups immunize themselves each year. Always consult your doctor for more information regarding who should receive the flu vaccine:

  1. Persons 50 years old or older (Vaccine effectiveness may be lower for elderly persons, but it can significantly reduce their chances of serious illness or death from influenza.)
  2. Children and adolescents six months to 19 years of age
  3. Residents of nursing homes and any other chronic care facilities that house persons of any age who have chronic medical conditions
  4. Adults and children who have chronic disorders of the pulmonary or cardiovascular systems, including children with asthma
  5. Adults and children who have chronic disorders of the pulmonary or cardiovascular systems, including children with asthma
Chronic metabolic diseases (i.e., diabetes)
Renal dysfunction
Hemoglobinopathies (such as sickle cell disease)
  6. Children and teenagers (aged 6 months to 19 years) receiving long-term aspirin therapy
  7. Women who will be pregnant during flu season
  8. Health care providers
  9. Employees of nursing homes and chronic care facilities who have contact with patients or residents
  10. Providers of home care to persons at high risk
  11. Household members (including children) of persons in high-risk groups
  12. Persons of any age who wish to decrease their chances of influenza infection, excluding persons who are allergic to eggs

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a term that refers to a large group of lung diseases which can interfere with normal breathing. The two most common conditions of COPD are chronic bronchitis and emphysema.

The causes of COPD are not fully understood. It is generally agreed that the most important cause of chronic bronchitis and emphysema is cigarette smoking. Causes such as air pollution and occupational exposures may play a role, especially when combined with cigarette smoking. Heredity also plays a contributing role in some patients' emphysema, and is especially important in a rare form - due to alpha 1 anti-trypsin deficiency.

Patients with chronic bronchitis usually have a cough and sputum production for many years before they develop shortness of breath.

Patients with emphysema usually have shortness of breath and develop a cough and sputum during a respiratory infection, or in the later stages of the illness.


What is acute bronchitis?

Bronchitis is an inflammation of the breathing tubes (airways) that are called bronchi, which causes increased production of mucus and other changes. Although there are several different types of bronchitis, the two most common are acute and chronic.
Acute bronchitis is the inflammation of mucous membranes of the bronchial tubes.

What causes acute bronchitis?

Acute bronchitis is usually caused by infectious agents such as bacteria or viruses. It may also be caused by physical or chemical agents--dusts, allergens, strong fumes--and those from chemical cleaning compounds, or tobacco smoke. Acute asthmatic bronchitis may happen as the result of an asthma attack, or it may be the cause of an asthma attack.
Acute bronchitis is usually a mild, and self-limiting condition, with complete healing and return to function.
Acute bronchitis may follow the common cold or other viral infections in the upper respiratory tract. It may also occur in people with chronic sinusitis, allergies, or those with enlarged tonsils and adenoids. It can be serious in people with pulmonary or cardiac diseases. Pneumonia is a complication that can follow bronchitis.

What are the symptoms acute bronchitis?

The following are the most common symptoms for acute bronchitis. However, each individual may experience symptoms differently. Symptoms may include:

  Runny nose
  Slight fever
  Back and muscle pain
  Sore throat
  Early--dry, nonproductive cough
  Later--abundant mucus-filled cough
  Shortness of breath

The following are the most common symptoms for acute bronchitis. However, each individual may experience symptoms differently. Symptoms may include:

How is acute bronchitis diagnosed?

Acute bronchitis is usually diagnosed by completing a medical history and physical examination. Many tests may be ordered to rule out other diseases, such as pneumonia or asthma. The following tests may be ordered to help confirm a diagnosis:

  Chest X-rays--diagnostic tests which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  Arterial blood gas--to analyze the amount of carbon dioxide and oxygen in the blood.
  Pulse oximetry--an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
  Cultures of nasal discharge and sputum--a test used to find and identify the microorganism causing an infection.
  Lung (pulmonary function) tests--diagnostic tests that help to measure the ability of the lungs to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines that a person must breathe into.

Treatment for acute bronchitis

Specific treatment for acute bronchitis will be determined by your doctor based on:

  Your age, overall health, and medical history
  Extent of the disease
  Your tolerance for specific medications, procedures, or therapies
  Expectations for the course of the disease
  Your opinion or preference

In most cases, antibiotic treatment is not necessary to treat acute bronchitis, since most of the infections are caused by viruses. If the condition has progressed to pneumonia, then antibiotics may be appropriate. Most of the treatment is designed to address the symptoms, and may include:

  Analgesics, such as acetaminophen for fever and discomfort
  Cough medicine
  Increased fluid intake
  Increase in humidity
  Smoking cessation

Antihistamines should be avoided in most cases because they dry up the secretions and can make the cough worse.

What is chronic bronchitis?

Chronic bronchitis is a long-term inflammation of the bronchi, which results in increased production of mucus, as well as other changes. To be classified as chronic bronchitis:

  cough and expectoration must occur most days for at least three months per year, for two years in a row.
  other causes of symptoms, such as tuberculosis or other lung diseases, must be excluded.

What are the symptoms of chronic bronchitis?

The following are the most common symptoms for chronic bronchitis. However, each individual may experience symptoms differently. Symptoms may include:

  expectoration (spitting out) of mucus

Chronic bronchitis may cause:

  frequent and severe respiratory infections
  narrowing and plugging of the breathing tubes (bronchi)
  difficult breathing

Other symptoms may include:

  lips and skin may appear blue
  abnormal lung signs
  swelling of the feet
  heart failure

The symptoms of chronic bronchitis may resemble other lung conditions or medical problems. Consult your physician for a diagnosis.

What are the causes of chronic bronchitis?

In acute bronchitis, bacteria or viruses may be the cause, but in chronic bronchitis there is no specific organism recognized as the cause of the disease.
Cigarette smoking is cited as the most common contributor to chronic bronchitis, followed by:

  bacterial or viral infections
  environmental pollution (chemical fumes, dust, and other substances)

Chronic bronchitis is often associated with other pulmonary diseases such as:

  pulmonary emphysema
  pulmonary fibrosis
  upper respiratory infections

Other symptoms may include:

  lips and skin may appear blue
  abnormal lung signs
  swelling of the feet
  heart failure

How is chronic bronchitis diagnosed?

In addition to a complete medical history and physical examination, your physician may request the following:

  A. pulmonary function tests - diagnostic tests that help to measure the lungs' ability to exchange oxygen and carbon dioxide appropriately. The tests are usually performed with special machines that the person must breathe into, and may include the following:

  1. spirometry - a spirometer is a device used by your physician that assesses lung function. Spirometry, the evaluation of lung function with a spirometer, is one of the simplest, most common pulmonary function tests and may be necessary for any/all of the following reasons:
to determine how well the lungs receive, hold, and utilize air
to monitor a lung disease
to monitor the effectiveness of treatment
to determine the severity of a lung disease
to determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow)
  2. peak flow monitoring (PFM) - a device used to measure the fastest speed in which a person can blow air out of the lungs. During an asthma or other respiratory flare up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled.

  B. arterial blood gas (ABG) - a blood test that is used to evaluate the lungs' ability to provide blood with oxygen and remove carbon dioxide, and to measure the pH (acidity) of the blood.
  C. pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.
  D. x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  E. computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for chronic bronchitis:

Specific treatment for chronic bronchitis will be determined by your physician based on:

  your age, overall health, and medical history
  extent of the disease
  your tolerance for specific medications, procedures, or therapies
  expectations for the course of the disease
  your opinion or preference

Treatment may include:

  oral medications
  bronchodilators for inhaled medications
  oxygen supplementation from portable containers
  lung reduction surgery to remove damaged area of lung
  lung transplantation


What is tuberculosis?

Tuberculosis (TB) is a chronic bacterial infection that usually infects the lungs, although other organs are sometimes involved. TB is primarily an airborne disease.
There is a difference between being infected with the TB bacterium and having active tuberculosis disease.
There are three important ways to describe the stages of TB. They are as follows:

  1. Exposure:This occurs when a person has been in contact, or exposed to, another person who is thought to have or does have TB. The exposed person will have a negative skin test, and normal chest x-ray, and no signs or symptoms of the disease.
  2. Latent TB infection:This occurs when a person has the TB bacteria in his/her body, but does not have symptoms of the disease. This person would have a positive skin test, but a normal chest x-ray.
  3. TB disease:This describes the person that has signs and symptoms of an active infection. The person would have a positive skin test and a positive chest x-ray.

The predominant TB bacterium is Mycobacterium tuberculosis (M. tuberculosis). Several people infected with M. tuberculosis never develop active TB. However, in people with weakened immune systems, especially those with HIV (human immunodeficiency virus), TB organisms can overcome the body's defenses, multiply, and cause an active disease.

Who is at risk for developing TB?

TB affects all ages, races, income levels, and both genders. Those at higher risk include the following:

  people who live or work with others who have TB
  medically underserved populations
  homeless people
  people in group settings, such as nursing homes
  people who abuse alcohol
  people who use intravenous drugs
  people with impaired immune systems
  the elderly
  healthcare workers who come in contact with high-risk populations

What are the symptoms of TB?

The following are the most common symptoms for TB. However, each individual may experience symptoms differently.

  cough that will not go away
  loss of appetite
  loss of weight
  coughing blood
  night perspiring

The symptoms of TB may resemble other lung conditions or medical problems. Consult a physician for a diagnosis.

What causes TB?

The TB bacterium is spread through the air when an infected person coughs, sneezes, speaks, sings, or laughs; however, repeated exposure to the germs is usually necessary before a person will become infected. It is not likely to be transmitted through personal items, such as clothing, bedding, a drinking glass, eating utensils, a handshake, a toilet, or other items that a person with TB has touched. Adequate ventilation is the most important measure to prevent the transmission of TB.

How is TB diagnosed?

TB is diagnosed with a TB skin test. In this test, a small amount of testing material is injected into the top layer of the skin. If a certain size bump develops within two or three days, the test may be positive for tuberculosis infection. Additional tests to determine if a person has TB disease include x-rays and sputum tests.
TB skin tests are suggested for those:

  in high-risk categories.
  who live or work in close contact with people who are at high-risk.
  who have never had a TB skin test.

Recommendations for skin testing in children, from the American Academy of Pediatrics are as follows:
Immediate testing:

  If the child is thought to have been exposed in the last 5 years.
  If the child has an x-ray that looks like TB.
  If the child has any symptoms of TB.
  A child who is coming from countries where TB is prevalent.

Yearly skin testing:

  Children with HIV.

Testing every 2 to 3 years:

  Children who are exposed to high-risk people.

Consider testing in children from ages 4 to 6 and 11 to 16 if:

  A child's parent has come from a high-risk country.
  A child has traveled to high-risk areas.
  Children who live in densely populated areas.

Treatment for tuberculosis:

Specific treatment will be determined by your physician based on:

  your age, overall health, and medical history
  extent of the disease
  expectations for the course of the disease
  your opinion or preference

Treatment may include:

  short-term hospitalization
  medications - isoniazid, rifampin, pyrazinamide, ethambutol, or streptomycin, may be prescribed for a period of time up to six months or more for the medication to be effective. Patients usually begin to improve within a few weeks of the start of treatment. After two weeks of treatment with the correct medications, the patient is not usually contagious, provided that treatment is carried through to the end, as prescribed by a physician.


Asthma is a chronic disease of the airways that makes breathing difficult. With asthma, there is inflammation of the air passages that results in a temporary narrowing of the airways that carry oxygen to the lungs. This results in asthma symptoms, including coughing, wheezing, shortness of breath, and chest tightness. Some people refer to asthma as "bronchial asthma."

Adult-Onset Asthma

Asthma may occur at any age, although it's more common in younger individuals (under age 40). People who have a family history of asthma have an increased risk of developing the disease. Allergies and asthma often occur together. Smoking with asthma, a dangerous combination, is still seen commonly.

Asthma in Children

Asthma is increasingly prevalent among children An estimated 6.5 million children under age 18 (8.9%) are now diagnosed with the disease. The rate of childhood asthma has more than doubled since 1980, according to the CDC. Asthma symptoms can vary from episode to episode in the same child. Signs and symptoms of asthma to look for include:

  Frequent coughing spells, which may occur during play, at nighttime, or while laughing. It's important to know that coughing with asthma may be the only symptom present.
  Less energy during play
  Rapid breathing
  Complaint of chest tightness or chest "hurting"
  Whistling sound when breathing in or out. This whistling sound is called wheezing.
  Seesaw motions in the chest from labored breathing. These motions are called retractions.
  Shortness of breath, loss of breath
  Tightened neck and chest muscles
  Feelings of weakness or tiredness

Asthma Causes and Triggers

People with asthma have very sensitive airways that react to many different things in the environment called "asthma triggers." Contact with these triggers cause asthma symptoms to start or worsen. The following are common triggers for asthma:

  Infections such as sinusitis, colds, and flu
  Allergens such as pollens, mold spores, pet dander, and dust mites
  Irritants such as strong odors from perfumes or cleaning solutions, and air pollution
  Tobacco smoke
  Exercise, called exercise-induced asthma
  Weather; changes in temperature and/or humidity, cold air
  Strong emotions such as anxiety, laughter or crying, stress
  Medications, such as aspirin-sensitive asthma

Asthma Attack

An asthma attack is a sudden worsening of symptoms. With an asthma attack, your airways tighten, swell up, or fill with mucus. Common symptoms include:

  Coughing, especially at night
  Wheezing (a high-pitched whistling sound when breathing out)
  Shortness of breath or trouble breathing
  Chest tightness, pain, or pressure

Treatment of Asthma

The drugs may be administered either by inhalation, orally, or by means of injections.

  Broncodilators relieve symptoms quickly and are therefore often referred to as ‘Relievers’.
  Drugs like salbutamol or terbutaline which relieve broncospasm are called broncodilators.
  Some patients get wheezing episodes quite infrequently like only once or twice a month and have mild attacks lasting only a few days. These patients need only broncodilators.
  Anticholinergic drugs are also useful in treating acute episodes but are not used often.
  Steroids reduce the inflammation within the airways in asthma and are highly effective.

Inhaled medicines

Drugs can be given orally (tablets/syrups) or by the inhaled route. It is commonly thought that inhaled medicines are ‘Strong’ medicines and a person gets habituated and a patient becomes ‘Dependant’ on inhalers. But this is absolutely wrong. Actually, the medicine that is administered by inhalation works faster and are quite safe as they are in much lower doses and have fewer side–effects.

Your age for inhaling medicines

  It is administered in children above 12 years of age.
  A ‘Rotahaler’ is used to inhale medicines for children above six years of age.
  For children above four years, a ‘Spacer’ is used directly.
  For infants, a mask is attached to a spacer.
  A ‘Nebuliser’ is used in infants and children who are very breathless and cannot take inhaled medication.

How can you prevent asthma attacks?

You can prevent some asthma attacks by avoiding those things that cause them. These are called triggers. A trigger can be:

  Irritants in the air, such as cigarette smoke or other air pollution. Don't smoke, and try to avoid being around others when they smoke.
  Things you are allergic to, such as pet dander, dust mites, cockroaches, or pollen. When you can, avoid those things you are allergic to. It may also help to take certain kinds of allergy medicine.
  Exercise. Ask your doctor about using a quick-relief inhaler before you exercise if this is a trigger for you.
  Other things like dry, cold air; an infection; or some medicines, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Try not to exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections. And ask about what medicines you should avoid.

Complementary medicine

  Alternative treatments such as homeopathy, acupuncture, and breathing exercises have been used to treat asthma
  Use of natural antioxidants.
  Breathing exercises practiced in yoga may improve lung function.

Ayurvedic View

Bronchial asthma is known as tamaka svassa in Ayurveda. This medical science emphasises on gastro-intestinal factors apart from the respiratory afflictions to be the cause for bronchial asthma. That is why in the preliminary stage of the disease or just before its onset, the patient complains of indigestion, constipation or diarrhoea.
It is mainly a kapha syndrome, though differentiation of humoural types also exists. In other words, bronchial asthma can be from any of the three humours—vaata, pitta or kapha. Most often, the disease is kapha in nature.
Vaata type asthma, is characterised by dry cough and wheezing. Additional symptoms are thirst, dry mouth, dry skin, constipation, anxiety and craving for warm drinks. Attacks occur predominantly at vaata time—dawn and dusk.
Pitta type asthma is characterised by cough and wheezing with yellow phlegm. Other symptoms are fever, sweating, irritability and need for cool air. Attacks are at pitta time—noon and midnight.
Kapha type asthma is characterised by cough and wheezing with abundant clear or white phlegm. The lungs are often congested producing a whistling sound.
Attacks are at kapha time—morning and evening.

Guidelines & ayurvedic remedies

Bronchitis & Asthma

In Ayurveda, Bronchial Asthma – an allergic condition resulting from the reaction of the body to one or more allergens and is one of the most fatal respiratory diseases – is named `tamaka shvasa’ and its seat of manifestation is the lungs.


During an attack of Bronchial Asthma you have to literally gasp for every breath – breathing out being more difficult than breathing in, since the air cannot be properly driven out of the lungs before you have to take another breath. For chronic patients these frequent attacks, specially in the night or early morning, are often preceded by nasal congestion and sneezing.

Root Causes

Either allergy inducing factors as weather conditions, dust, food, drugs, perfumes, pollution etc. or psychological factors as deep-seated emotional insecurity, an intense need for parental love etc. or hereditary / genetic factors.
Specific Medicines

  Tulsi (Ocimum sanctum)
  Vasak (Adhatoda vasika)

During an acute attack, a hot chest and shoulder pack, repeatedly given every half an hour, will have a sedative effect upon the nerves and a relaxing influence generally, giving the quickest and most satisfactory relief.
Hot milk or hot water when sipped little by little, provides immediate relief from the attack. The inhalation of steam-laden air may be provided by using an ordinary teakettle, attaching a funnel to the spout, and inhaling from the upper wide end of the cone. This is very effective in relieving spasms. In many acute attacks, relief will be found in a simple hot hand-bath or hot foot-bath (immersing hands or feet up to the elbows or knees).
Concussion to the cervical vertebrae from the fourth to the seventh for six to eight minutes with half minute interruptions every minute is excellent to relieve attacks.
A creeping plant known as somalataa (Ephedra vulgaris) is found to be highly efficacious in relieving asthma. This grows in western Himalayas in abundance and is sent in hundreds of tonnes to western countries where ephedrine is prepared from it. The powder made from the whole plant, after drying in the shade and is given in the dosage of 100 to 250 milligrams, mixed with honey or water at the intervals of 8 to 4 hours. At the time of a full attack, wrapping a hot brick in a rough cloth and then giving dry fomentation with it to the chest is found to be useful in asthma. Smearing chandanaadi oil and then giving heat fomentation is also good. Turmeric paste used as poultice on the chest or warming the chest with it is very soothing.
Only the use of pippalee (Piper longum) powder along with pure honey, makes an attack of asthma subside.
The rhizomes of turmeric are to be baked in hot sand slightly and made into fine powder. This is to be taken 3 grams twice a day with sugar. The dose can be increased up to 10 grams in due course.
During an acute attack of asthma, drink some hot water with the juice of one clove of garlic.
Take the juice of the whole plant of Solanum surattense (chote kateri)—7 to 14 ml as such, or with Trikatu (equal parts of dried ginger, long pepper and black pepper)—one gm twice a day. You can even take Terminalia bellirica powder (baheda)—3 to 6 grams with 4 to 6 grams honey twice a day.
Mustard oil (sarason) is a good remedy. Take a spoonful with jaggery, twice a day.
If you wish to use a compound formulation, then here is a medicine for you. Prepare a decoction by boiling equal parts of root of Adhatoda vasica (adoosaa), rhizome of turmeric, stem of Tinospora cordifolia (giloa), and the fruit of Solanum surattense (chote kateri). Take this decoction internally, 14 to 28 ml. with one gram of powdered black pepper twice a day.
Smoke leaf of Datura stramonium (dhatura). This gives instant relief but needs medical supervision.
Supplement with omega-3 fatty acids, may help decrease inflammation.


  A limited quantity of carbohydrates, fats and proteins.
  A liberal amount of alkali-forming foods – fresh fruits, green vegetables, sprouted seeds and grains.
  Avoid foods which tend to produce phlegm – rice, sugar, lentils and curd.
  Avoid difficult-to-digest foods – strong tea, coffee, alcoholic beverages, condiments, pickles, sauces and all refined and processed foods.


  Avoid excess humidity
  Avoid exposure to dust, fumes & pollen grains
  Check your allergens


  Half Wheel (Ardha Chakrasana)
  Bow (Dhanura Asana)

Homeopathy For Asthama

Arsenicum album: A person needing this remedy can feel exhausted, yet be very restless and anxious. Breathing problems tend to be worse while lying down, better when sitting up, and may begin, or be the most intense, between midnight and two a.m. Dry wheezing may progress to a cough that brings up frothy whitish fluid. The person can be thirsty, taking frequent tiny sips. General chilliness is usually seen, with burning pains in the chest and heat in the head. Warmth often brings improvement.

Carbo vegetabilis:This remedy may be indicated when a person feels weak or faint with a hollow sensation in the chest. Coughing jags can lead to gagging. The person may be very cold (especially hands and feet), yet feel a need for moving air, wanting to sit beside a fan or open window. Gas and digestive upset are also likely, and sitting up and burping offers some relief. Feeling worse in the evening, and worse from talking, eating, or lying down are other indications for this remedy.

Chamomilla: Asthma with a dry, hard, irritating cough that starts after being exposed to moving air, or after becoming overexcited and angry, may be helped with this remedy. The cough is often worse around nine p.m., and may continue into the night. The person seems hypersensitive and may be extremely irritable and agitated. (Children may even shriek and hit, though they often calm down if someone carries them.)

Ipecacuanha: Coughing spasms that lead to retching or vomiting strongly indicate this remedy. Wheezing can come on suddenly with a feeling of suffocation and heaviness in the chest. Mucus collects in breathing tubes, but the person has difficulty coughing much out. The person may sweat a lot and feel clammy or nauseous, be worse from motion, and sometimes worse from warmth.

Natrum sulphuricum: This remedy is sometimes indicated when asthma attacks are brought on by exposure to mold and dampness. The person may hold the chest while coughing, because it feels so weak. Wheezing and breathing difficulties are aggravated by exertion, and episodes tend to be worse in the very early morning.

Nux vomica: Indications for this remedy include a tense, constricted feeling in the chest during asthma attacks, with pressure in the stomach. Problems are often worse in the morning. Overindulgence in stimulants, alcohol, sweets, or strong spicy food can bring on or aggravate an episode. Both physical effort and mental exertion can make things worse, and warmth and sleep often bring relief. A person needing this remedy is typically very irritable and impatient, with a general feeling of chilliness.

Pulsatilla: Wheezing that starts when a person gets too warm (especially in a stuffy room), or after eating rich food, can indicate this remedy. Coughing brings up yellow-colored mucus, with gagging and choking. Tightness in the chest tends to be worse in the evening and at night, and is relieved by cool fresh air. A person who needs this remedy is likely to be changeable and emotional, wanting a lot of attention and comforting. (Pulsatilla is often useful in children’s illnesses.)

Spongia tosta:A hard or “barking” cough during an asthma attack is a strong indication for this remedy. Breathing can be labored, with a sawing sound, and not much mucus is produced. The person may feel best when sitting up and tilting the head back, or when leaning forward. Warm drinks may be helpful. The problems often start while the person is asleep (typically before midnight). Spongia is often used in croup, as well.

Homeopathy Dosage Directions

Select the remedy that most closely matches the symptoms. In conditions where self-treatment is appropriate, unless otherwise directed by a physician, a lower potency (6X, 6C, 12X, 12C, 30X, or 30C) should be used. In addition, instructions for use are usually printed on the label.


Treatment of bronchial asthma in an impending attack

  Not to panic, for anxiety will accentuate the attack.
  Rest and relaxation: Sit down in a chair for 10 minutes as resting helps lungs relax. Breathe slowly taking small puffs of air through pursed lips.
  One should take rest in a warm, well–ventilated room.
  Bedclothes should be warm.
  Patient should be supported by pillows in a semi–recumbent or upright position.
  Fasting with vegetable soup and hot honey water is helpful.
  Take an enema, as emptying of bowels will relieve pressure on the lungs.
  Plenty of warm liquids relax the air passages by fomenting the wind pipe (which is in front of the food pipe). Liquids also thin the mucus and replace the water lost during forced breathing.
  Gentle spinal massage followed by hot fomentation to back and neutral chest pack help relax bronchial muscles. Hot fomentation softens the mucus and chest pack and relieves congestion in the lungs.
  Try exhaling forcefully through a drinking straw inserted into a large bottle of water. The resistance of the water will force the expansion of bronchial tubes by creating positive pressure in the lungs.
  Facial steam will clear upper respiratory secretions.
  Hot foot bath relieves congestion by diverting blood flow to the limbs.

Long Term Treatment of Acute Bronchitis/Chronic Bronchitis/Bronchial Asthma.

  Treat fever by means of sponge baths frequently, chest packs at night and friction baths.
  The patient should refrain from smoking.
  Chest packs must be used every night.
  Practice of Jalaneti and Sutraneti as and when required keeps upper respiratory passages clear. Pranayama and asanas to prevent lung congestion should be practiced under the guidance of an expert teacher.
  Neutral half baths with Epsom salt which divert blood to the periphery, relieving lung congestion, could be employed frequently with advantage.
  Asthma bath once a week/15 days is useful is relieving congestion and increase in oxygen consumption.
  Neutral underwater massage, neutral jet massage and whirlpool bath provide relaxation by action on the muscles at the spinal region.
  A fat–free diet needs to be adopted.
  Pranayama and Kriyas help build resistance of the lung and upper respiratory tract, besides clearing them.

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