ANATOMY AND PHYSIOLOGYANATOMY AND PHYSIOLOGYupper and lower respiratoryupper and lower respiratory

tracts. Prepared bytracts. Prepared by-:-:Dr / amany lotfyDr / amany lotfy

Describe the structures and Describe the structures and functions of the upper and lower functions of the upper and lower respiratory tractsrespiratory tracts..

22 . .Describe ventilation, perfusion, Describe ventilation, perfusion, diffusion, shunting, and the diffusion, shunting, and the relationship of pulmonary relationship of pulmonary circulation to these processescirculation to these processes..

33 . .Discriminate between normal Discriminate between normal and abnormal breath soundsand abnormal breath sounds..

44 . .Use assessment parameters Use assessment parameters appropriate for determining theappropriate for determining the

characteristics and severity of characteristics and severity of the major symptoms of the major symptoms of respiratory dysfunctionrespiratory dysfunction..

55 . .Identify the nursing Identify the nursing implications of the various implications of the various procedures used forprocedures used for

diagnostic evaluation of diagnostic evaluation of respiratory functionrespiratory function..

NORMAL ANATOMY AND NORMAL ANATOMY AND PHYSIOLOGYPHYSIOLOGY

--The respiratory system consists of The respiratory system consists of the nose, nasal cavities, pharynx, the nose, nasal cavities, pharynx, larynx, trachea, bronchial tree, lungs, larynx, trachea, bronchial tree, lungs, and respiratory musclesand respiratory muscles..

- -The parts outside the chest cavity The parts outside the chest cavity are collectively called the upper are collectively called the upper respiratory tract, and those within the respiratory tract, and those within the chest cavity make up the lower chest cavity make up the lower respiratory tractrespiratory tract

--

Anatomic and Physiologic Anatomic and Physiologic OverviewOverview

ANATOMY OF THE UPPERANATOMY OF THE UPPER

RESPIRATORY TRACTRESPIRATORY TRACT

Upper airway structuresUpper airway structures consist of the nose, sinuses consist of the nose, sinuses and nasal passagesand nasal passages,,

pharynx, tonsils and adenoids, pharynx, tonsils and adenoids, larynx, and trachealarynx, and trachea..

ANATOMY OF THE LOWERANATOMY OF THE LOWERRESPIRATORY TRACTRESPIRATORY TRACT

LUNGSLUNGSThe lower respiratory tract consists The lower respiratory tract consists of the lungs, which containof the lungs, which containthe bronchial and alveolar structures the bronchial and alveolar structures needed for gas exchangeneeded for gas exchange..The lungs are the site of gas The lungs are the site of gas exchange between the air and the exchange between the air and the blood; the rest of the system moves blood; the rest of the system moves air into and out of the lungsair into and out of the lungs

FUNCTION OF THE FUNCTION OF THE RESPIRATORY SYSTEMRESPIRATORY SYSTEM

Oxygen TransportOxygen Transport

Oxygen is supplied to, and carbon Oxygen is supplied to, and carbon dioxide is removed from, cellsdioxide is removed from, cells

by way of the circulating blood. by way of the circulating blood. Cells are in close contact withCells are in close contact with

capillaries, whose thin walls permit capillaries, whose thin walls permit easy passage or exchange ofeasy passage or exchange of

oxygen and carbon dioxideoxygen and carbon dioxide..

RespirationRespirationAfter these tissue capillary exchanges, After these tissue capillary exchanges, blood enters the systemic veins (where blood enters the systemic veins (where it is called venous blood) and travels to it is called venous blood) and travels to the pulmonarythe pulmonary

circulationcirculation . .The oxygen concentration in blood The oxygen concentration in blood withinwithinthe capillaries of the lungs is lower the capillaries of the lungs is lower than in the lungs’ air sacs (alveoli)than in the lungs’ air sacs (alveoli)..

Because of this concentration gradient, Because of this concentration gradient, oxygen diffuses from the alveoli to the oxygen diffuses from the alveoli to the bloodblood..

Mechanism Mechanism of of BreathingBreathing

11--VentilationVentilation is the term for the is the term for the movement of air into and out of movement of air into and out of the alveoli. Air moves from high-the alveoli. Air moves from high-pressure to low-pressure areas pressure to low-pressure areas (pressure gradients), some of (pressure gradients), some of which are created by the which are created by the respiratory muscles, which in turn respiratory muscles, which in turn are controlled by the nervous are controlled by the nervous

systemsystem . .

VentilationVentilation

During inspiration, air flows During inspiration, air flows from the environment into the from the environment into the trachea, bronchi, bronchioles, trachea, bronchi, bronchioles, and alveoli. During expiration, and alveoli. During expiration, alveolar gas travels the same alveolar gas travels the same route in reverseroute in reverse..

InhalationInhalation--Inhalation, also called inspiration, Inhalation, also called inspiration,

occurs when motor impulses from occurs when motor impulses from the medulla cause contraction of the the medulla cause contraction of the respiratory musclesrespiratory muscles..

ExhalationExhalation--Normal exhalation is a passive Normal exhalation is a passive

process that begins when motor process that begins when motor impulses from the medulla decrease impulses from the medulla decrease and the diaphragm and external and the diaphragm and external intercostals muscles relaxintercostals muscles relax..

Transport of Gases in the BloodTransport of Gases in the Blood

--Oxygen is carried in the blood by Oxygen is carried in the blood by iron in the hemoglobin (Hgb) of red iron in the hemoglobin (Hgb) of red blood cells (RBCs). The iron-blood cells (RBCs). The iron-oxygen bond is formed in the oxygen bond is formed in the lungs, where the partial pressure of lungs, where the partial pressure of oxygen (PO2) is high. In tissues oxygen (PO2) is high. In tissues where the PO2 is low, hemoglobin where the PO2 is low, hemoglobin releases much of its oxygenreleases much of its oxygen..

Causes of Increased Airway Causes of Increased Airway ResistanceResistance

Common phenomena that may Common phenomena that may alter bronchial diameter, whichalter bronchial diameter, whichaffects airway resistance, affects airway resistance, includeinclude::

• •11 - -Contraction of bronchial Contraction of bronchial smooth muscle—as in asthmasmooth muscle—as in asthma

• •22--Thickening of bronchial mucosaThickening of bronchial mucosa—as in chronic bronchitis—as in chronic bronchitis••

Causes of Increased Airway Causes of Increased Airway ResistanceResistance

33 - -Obstruction of the airway—byObstruction of the airway—by mucus, a tumor, or a foreignmucus, a tumor, or a foreign

bodybody

• •44 - -Loss of lung elasticity—asLoss of lung elasticity—as in in emphysemaemphysema, which is characterized, which is characterized

by connective tissue encircling the by connective tissue encircling the airways, thereby keeping them open airways, thereby keeping them open during both inspiration and expirationduring both inspiration and expiration

Partial Pressure AbbreviationsPartial Pressure Abbreviations

P P = pressure= pressurePO2 = partial pressure of oxygenPO2 = partial pressure of oxygenPCO2 = partial pressure of carbon PCO2 = partial pressure of carbon dioxidedioxidePAO2 = partial pressure of alveolar PAO2 = partial pressure of alveolar oxygenoxygenPACO2 = partial pressure of PACO2 = partial pressure of alveolar carbon dioxidealveolar carbon dioxidePaO2 = partial pressure of arterial PaO2 = partial pressure of arterial oxygenoxygen

Partial Pressure AbbreviationsPartial Pressure Abbreviations

PaCO2 = partial pressure of arterial PaCO2 = partial pressure of arterial carbon dioxidecarbon dioxidePv–O2 = partial pressure of venous Pv–O2 = partial pressure of venous oxygenoxygenPv–CO2 = partial pressure of venous Pv–CO2 = partial pressure of venous carbon dioxidecarbon dioxideP50 = partial pressure of oxygen when P50 = partial pressure of oxygen when the hemoglobin is 50%the hemoglobin is 50%saturatedsaturated

Assessment :HEALTH HISTORYAssessment :HEALTH HISTORYThe health history focuses on the The health history focuses on the physical and functional problemsphysical and functional problems

of the patient and the effect of these of the patient and the effect of these problems on his or her life. : problems on his or her life. : dyspnea (shortness of breath), pain, dyspnea (shortness of breath), pain, accumulation of mucus, wheezing, accumulation of mucus, wheezing, hemoptysis (blood spit up from the hemoptysis (blood spit up from the respiratory tract), edema of the respiratory tract), edema of the ankles and feet, cough, and general ankles and feet, cough, and general fatigue and weaknessfatigue and weakness..

Signs and SymptomsSigns and SymptomsThe major signs and symptoms of The major signs and symptoms of respiratory diseaserespiratory disease are are dyspneadyspnea,,

cough,cough, sputum productionsputum production, , chest chest painpain, , wheezingwheezing, , clubbing of theclubbing of the

fingersfingers, , hemoptysishemoptysis, and , and cyanosiscyanosis . .

These clinical manifestationsThese clinical manifestations

are related to the duration and are related to the duration and severity of the diseaseseverity of the disease..

Clinical Significance for SPUTUM Clinical Significance for SPUTUM PRODUCTIONPRODUCTION

A profuse amount of purulent A profuse amount of purulent sputumsputum

))thickthick and and yellowyellow, , greengreen, or , or rust-coloredrust-colored ( (or a change in color ofor a change in color ofthe sputum probably the sputum probably indicates a bacterial indicates a bacterial infectioninfection. Thin, mucoid. Thin, mucoidsputum frequently results from viral sputum frequently results from viral bronchitis. bronchitis. A gradual increase of sputumA gradual increase of sputum over time may over time may indicate the presence of indicate the presence of chronic bronchitis or bronchiectasischronic bronchitis or bronchiectasis..

CHEST PAINCHEST PAINChest painChest pain or discomfortor discomfort may be may be associated with associated with pulmonary or pulmonary or cardiac cardiac disease or disease or pulmonary pulmonary conditionsconditions may be may be sharpsharp, , stabbingstabbing, and , and intermittentintermittent, or it , or it may be may be dulldull, , achingaching, and , and persistentpersistent..

CLUBBING OF THE FINGERSis a sign of lung disease found in patients with chronic hypoxic conditions, chronic lung infections, and malignancies. This finding may be manifested initially assponginess of the nail bed and loss of the nail bed angle

HEMOPTYSISHEMOPTYSIS • •Pulmonary infectionPulmonary infection

• •Carcinoma of the lungCarcinoma of the lung

• •Abnormalities of the heart or Abnormalities of the heart or blood vesselsblood vessels

• •Pulmonary artery or vein Pulmonary artery or vein abnormalitiesabnormalities

• •Pulmonary emboli and infarctionPulmonary emboli and infarction

CYANOSISCYANOSIS

Cyanosis, a bluish coloring of the Cyanosis, a bluish coloring of the skin, is a very late skin, is a very late indicator ofindicator of

hypoxiahypoxia. The presence or absence . The presence or absence of cyanosis of cyanosis is determined by theis determined by the

amount of unoxygenated amount of unoxygenated hemoglobin in the bloodhemoglobin in the blood..

UPPERUPPERRESPIRATORY STRUCTURESRESPIRATORY STRUCTURES

PHYSICAL ASSESSMENTPHYSICAL ASSESSMENT

For a routine examination of For a routine examination of the the upper airwayupper airway

PHYSICAL ASSESSMENT OF PHYSICAL ASSESSMENT OF THE THE LOWER RESPIRATORY LOWER RESPIRATORY STRUCTURES AND BREATHINGSTRUCTURES AND BREATHING

Thoracic PalpationThoracic Palpation11--The nurse palpates the thorax forThe nurse palpates the thorax for

tendernesstenderness, , masses, lesions, masses, lesions, respiratory excursion, and vocal respiratory excursion, and vocal fermatasfermatas. . If the patient has reportedIf the patient has reported

an area of pain or if lesions are an area of pain or if lesions are apparentapparent,2- ,2- the nurse performs directthe nurse performs direct

palpation with the fingertipspalpation with the fingertips ( (for skin for skin lesions and subcutaneous masseslesions and subcutaneous masses) or ) or with the ball of the hand (for deeper with the ball of the hand (for deeper masses ormasses or

33--generalized flank or rib discomfortgeneralized flank or rib discomfort.).)

Abnormal (Adventitious) Breath Abnormal (Adventitious) Breath SoundsSounds

CracklesCrackles Soft, high-pitched, Soft, high-pitched, discontinuous popping sounds that discontinuous popping sounds that occur during inspirationoccur during inspiration

22--Sonorous wheezes (rhonchiSonorous wheezes (rhonchi)) Deep, Deep, low-pitched rumbling sounds heardlow-pitched rumbling sounds heard

primarily during expiration; caused by primarily during expiration; caused by air moving through narrowed air moving through narrowed tracheobronchial passagestracheobronchial passages

Diagnostic EvaluationDiagnostic Evaluation

PULMONARY FUNCTION TESTSPULMONARY FUNCTION TESTS

ARTERIAL BLOOD GAS STUDIESARTERIAL BLOOD GAS STUDIES

PULSE OXIMETRYPULSE OXIMETRY

Pulse oximetry is a noninvasive Pulse oximetry is a noninvasive method of continuously monitoringmethod of continuously monitoring

the oxygen saturation of the oxygen saturation of hemoglobin (SpO2 or SaO2)hemoglobin (SpO2 or SaO2)..

CULTURESCULTURES

Throat culturesThroat cultures may be performed to may be performed to identify organisms responsibleidentify organisms responsible

for for pharyngitis.pharyngitis. Throat culture may also Throat culture may also assist in identifying organisms responsible assist in identifying organisms responsible for infection of the lower respiratory tractfor infection of the lower respiratory tract..

SPUTUM STUDIESSPUTUM STUDIES

Sputum is obtained for analysis to identify Sputum is obtained for analysis to identify pathogenic organisms and to determine pathogenic organisms and to determine whether whether malignant cells are presentmalignant cells are present..

ThoracoscopyThoracoscopy

ThoracoscopyThoracoscopy is a diagnostic is a diagnostic procedure in which the pleural procedure in which the pleural cavity is examined with an cavity is examined with an endoscope )Fig. 21-16). Small endoscope )Fig. 21-16). Small incisions are made into the incisions are made into the pleural cavity in an intercostal pleural cavity in an intercostal space; the location of the incisionspace; the location of the incision

Upper airway infectionUpper airway infection

Dr / Amany lotfyDr / Amany lotfy

Upper Airway InfectionsUpper Airway Infections

Upper airway infectionsUpper airway infections are are common conditions that affect common conditions that affect most people on occasion. most people on occasion. Some infections are acute, with Some infections are acute, with symptoms that last several symptoms that last several daysdays;;

VIRAL RHINITIS (COMMON VIRAL RHINITIS (COMMON COLD) (“the flu”)COLD) (“the flu”)..

The term “common cold” often is used The term “common cold” often is used when when referring toreferring to an an

upper respiratory tract infection upper respiratory tract infection that is self-limited and that is self-limited and caused bycaused by

a virusa virus (viral rhinitis).(viral rhinitis). Nasal Nasal congestion, rhinorrhea, sneezingcongestion, rhinorrhea, sneezing,,

sore throat, and general malaise sore throat, and general malaise characterize itcharacterize it..

Clinical ManifestationsClinical Manifestations

Signs and symptoms of viral Signs and symptoms of viral rhinitisrhinitis are are nasal congestionnasal congestion, , runny noserunny nose, , sneezingsneezing, , nasal nasal dischargedischarge, , nasal itchinessnasal itchiness,, tearingtearing watery eyeswatery eyes,,

““scratchy” or sore throatscratchy” or sore throat, , general general malaisemalaise, , low-grade feverlow-grade fever, , chillschills,,

Medical ManagementMedical Management

Management consists of symptomatic Management consists of symptomatic therapytherapy.. Some measures includeSome measures include

11--providing adequate fluid intakeproviding adequate fluid intake 22--encouraging restencouraging rest , ,

33--preventing chilling, preventing chilling, 4-4-increasing intake increasing intake of vitamin C, of vitamin C, 5- 5- using xpectorants. using xpectorants. 66--Warm salt-water gargles soothe the sore Warm salt-water gargles soothe the sore throat throat 7-7- nonsteroidal anti-inflammatory nonsteroidal anti-inflammatory agents (NSAIDs) such as aspirin or agents (NSAIDs) such as aspirin or ibuprofen relieve the aches, pains, and ibuprofen relieve the aches, pains, and

fever in adultsfever in adults . .88--Antihistamines to relieve sneezing, Antihistamines to relieve sneezing,

rhinorrhea,and nasal congestionrhinorrhea,and nasal congestion..

Preventing and Managing Upper Preventing and Managing Upper Respiratory InfectionsRespiratory Infections

Identify strategies to prevent infectionIdentify strategies to prevent infection and, if and, if infected, to prevent spread of infection to othersinfected, to prevent spread of infection to others ✓ ✓

✓✓PerformPerform hand hygiene often hand hygiene oftenUseUse disposable tissues disposable tissuesAvoidAvoid crowds during the flu season crowds during the flu seasonAvoidAvoid individuals with colds or respiratory individuals with colds or respiratory infectionsinfectionsObtainObtain influenza vaccination, if recommended influenza vaccination, if recommended (especially if elderly or diagnosed with a chronic (especially if elderly or diagnosed with a chronic illnessillness))

• •Practice good health habitsPractice good health habits ✓ ✓ ✓ ✓

Preventing and Managing Upper Preventing and Managing Upper Respiratory InfectionsRespiratory Infections

Eat Eat a nutritious dieta nutritious dietGetGet plenty of rest and sleep plenty of rest and sleepAvoidAvoid or reduce stress when possible or reduce stress when possibleExerciseExercise appropriately appropriatelyAvoidAvoid smoking or second-hand smoke and smoking or second-hand smoke and excessive intake of alcoholexcessive intake of alcoholIncreaseIncrease humidity in house, especially humidity in house, especially during winterduring winterPractice Practice adequate oral hygieneadequate oral hygiene

• •Avoid Avoid allergens, if allergies are associated allergens, if allergies are associated with upper respiratory infectionswith upper respiratory infections

Prevention and ManagementPrevention and Management • •Identify strategies to control the Identify strategies to control the

environmentenvironment ✓ ✓ ✓ ✓Adequately humidifyAdequately humidify (avoid over humidifying) living quarters(avoid over humidifying) living quartersPlace a dehumidifierPlace a dehumidifier in the basement, if in the basement, if appropriateappropriateProvide centralProvide central ventilation fans, air ventilation fans, air conditioning with microstatic air filtersconditioning with microstatic air filtersReduce irritantsReduce irritants (dust, chemical, (dust, chemical, tobacco smoke) when possibletobacco smoke) when possibleLimit exposureLimit exposure to animals and house to animals and house pets, particularly in the bedroompets, particularly in the bedroom

ManagementManagement • •Describe strategies to relieve symptoms of Describe strategies to relieve symptoms of

upper respiratory infectionupper respiratory infection ✓ ✓ ✓ ✓Gargle with salt waterGargle with salt waterIncrease fluid intakeIncrease fluid intake, particularly of hot , particularly of hot liquidsliquidsProvide warmProvide warm, moist air by shower or , moist air by shower or humidifier to relieve swollen mucous humidifier to relieve swollen mucous membranesmembranesAvoid irritantsAvoid irritants (dust, chemicals, (dust, chemicals, tobacco smoke) when possibletobacco smoke) when possible

• •Recognize signs and symptomsRecognize signs and symptoms of of infectioninfection and state when to contact a and state when to contact a

health care providerhealth care provider ✓ ✓ ✓ ✓

ManagementManagementUpper respiratory tract signs &symptomsUpper respiratory tract signs &symptoms

Extreme red throatExtreme red throat or white patches on or white patches on the back of the throatthe back of the throatDiscolored drainageDiscolored drainage or foul-smelling or foul-smelling nasal dischargenasal dischargeProlonged fever of 100.5°F (38°C) >2 daysProlonged fever of 100.5°F (38°C) >2 daysShortness of breathShortness of breath, wheezing, wheezingSwollen lymph nodesSwollen lymph nodesSevere painSevere pain or tenderness around the or tenderness around the eyes or persistent pain in sinus areaseyes or persistent pain in sinus areasSevere headacheSevere headache

THE PATIENT WITH UPPERTHE PATIENT WITH UPPERAIRWAY INFECTIONAIRWAY INFECTION

NURSING PROCESSNURSING PROCESS::

AssessmentAssessment A health history may A health history may reveal signs and symptoms of reveal signs and symptoms of headache, soreheadache, sorethroat, pain around the eyes and on throat, pain around the eyes and on either side of the nose, difficultyeither side of the nose, difficultyin swallowing, cough, hoarseness, in swallowing, cough, hoarseness, fever, stuffiness, and generalizedfever, stuffiness, and generalizeddiscomfort and fatiguediscomfort and fatigue..

Based on the assessment data, the Based on the assessment data, the patient’s major nursing diagnosespatient’s major nursing diagnoses

•:•:11 - -Ineffective airway clearanceIneffective airway clearance related to excessive mucus related to excessive mucus production secondary to production secondary to retained secretions and retained secretions and inflammationinflammation

22 •- •-Acute painAcute pain related to upper related to upper airway irritation secondary toairway irritation secondary to

an infectionan infection

33--Impaired verbal communicationImpaired verbal communication related to physiologic changes and related to physiologic changes and upper airway irritation secondary to upper airway irritation secondary to infectioninfection

or swellingor swelling

44--Deficient fluid volumeDeficient fluid volume related to related to increased fluid loss secondary to increased fluid loss secondary to diaphoresis associated with a feverdiaphoresis associated with a fever

••55 - -Deficient knowledgeDeficient knowledge regarding regarding prevention of upper respiratoryprevention of upper respiratory

infections, treatment regimen, surgical infections, treatment regimen, surgical procedureprocedure

Nursing InterventionsNursing InterventionsMAINTAINING A PATENT AIRWAYMAINTAINING A PATENT AIRWAYPROMOTING COMFORTPROMOTING COMFORTENCOURAGING FLUID INTAKEENCOURAGING FLUID INTAKEPROMOTING HOME AND COMMUNITY-PROMOTING HOME AND COMMUNITY-BASED CAREBASED CARETeaching Patients Self-CareTeaching Patients Self-Care

MONITORING AND MANAGINGMONITORING AND MANAGINGPOTENTIAL COMPLICATIONSPOTENTIAL COMPLICATIONSWhile While major complications of upper major complications of upper respiratory infections arerespiratory infections arerare, the nurse must be aware of them and rare, the nurse must be aware of them and assess the patient for themassess the patient for them..

EvaluationEvaluationEXPECTED PATIENT OUTCOMESEXPECTED PATIENT OUTCOMES

Expected patient outcomes may includeExpected patient outcomes may include::11 . .MaintainsMaintains a patent airway by managing a patent airway by managing

secretionssecretionsa. a. Reports Reports decreased congestiondecreased congestionb. b. AssumesAssumes best position to facilitate best position to facilitate drainage of secretionsdrainage of secretions

22 . .ReportsReports feeling more comfortable feeling more comfortablea. Uses comfort measures: analgesics, hot a. Uses comfort measures: analgesics, hot packs, gargles, restpacks, gargles, restb. b. DemonstratesDemonstrates adequate oral hygiene adequate oral hygiene

33 . .DemonstratesDemonstrates ability to communicate ability to communicate needs, wants, level of comfortneeds, wants, level of comfort

44--MaintainsMaintains adequate fluid intake adequate fluid intake55 . .Identifies strategies to prevent upper airway Identifies strategies to prevent upper airway

infections and allergic reactionsinfections and allergic reactionsa. a. DemonstratesDemonstrates hand hygiene technique hand hygiene techniqueb. Ib. Identifiesdentifies the value of the influenza vaccine the value of the influenza vaccine

66 . .Demonstrates Demonstrates an adequate level of an adequate level of knowledge and performsknowledge and performsself-care adequatelyself-care adequately

77 . .Becomes freeBecomes free ofof signs and symptoms of signs and symptoms of infectioninfectiona. a. ExhibitsExhibits normal vital signs (temperature, normal vital signs (temperature, pulse, respiratorypulse, respiratoryraterate((

b. b. Absence Absence of purulent drainageof purulent drainagec. c. Free ofFree of pain in ears, sinuses, and throat pain in ears, sinuses, and throat

Management of Patients Management of Patients with with Chest and Lower RespiratoryChest and Lower Respiratory

DisordersDisordersAcute BronchitisAcute Bronchitis: It is an : It is an acute inflammation of the acute inflammation of the mucous membrane of the mucous membrane of the bronchi often following infections bronchi often following infections of the upper respiratory tractof the upper respiratory tract

Acute BronchitisAcute BronchitisCausesCauses::

11--Viral infection bacterial infection Viral infection bacterial infection )streptococcus pneumonia)streptococcus pneumonia,,

22--Homophiles influenzaHomophiles influenza)) 33--Physical Physical & & chemical irritants chemical irritants

)dust, gases smoke))dust, gases smoke) 44--Air pollutionAir pollution

Clinical manifestationsClinical manifestations:: * *Dry, irritating cough, scanty sputumDry, irritating cough, scanty sputum

Sternal sorenessSternal soreness FeverFever

HeadacheHeadache General malaiseGeneral malaise

As the infection progresses the patient As the infection progresses the patient may have profuse sputummay have profuse sputum

[ [It is an inflammatory process of the lung It is an inflammatory process of the lung that is. Commonly caused by infections that is. Commonly caused by infections agentagent