Category: Respiratory System

Once in the interstitium, particles may be engulfed by macrophages that live there. the particles may then be degraded intracellulary. On the other hand, these interstitial macrophages may therefore effectively relocate to a close by lymphatic channel, or alongside uningested particles, be conveyed in the flow of interstitial fluid towards the lymphatic framework, bronchial tree, or to perivenous or subpleural locales, where they may get caught. Uningested particles in the interstitium may cross the endothelium of alveolar capillaries, entering the blood[,,,]. Be that as it may, entry into the lymphatic framework is more probable.

Another Nonspecific mechanisms of respiratory framework is local detoxification, in addition to serving as physicochemical barrier protecting underlying cells, respiratory tract fluid contain different proteins and mucopolysaccharides that are involved in nonspecific bacteriocidal and detoxification activity[,,]. Some are delivered locally; the sources of others are definitely not known. The main ones found in tracheobronchial fluids are lysozyme, and transferin, which are We live in an ocean of infectious agents, and we have developed a few mechanisms for ensuring ourselves against those that are possibly pathogenic[5].Human body has a two line guard framework against pathogens. The first line of protection (or outside safeguard framework) incorporates physical and chemical barriers that are consistently prepared and arranged to guard the body from disease, These incorporate skin, tears, mucus, cilia, stomach corrosive, pee stream, ‘well disposed’ microorganisms and white blood cells called neutrophils. If the pathogens can move beyond the first line of protection, for instance, through a cut in your skin, and an infection creates,the seconed line of guard becomes active. Through a grouping of steps called the immune response, the immune framework assaults these pathogens[7].

The respiratory framework also have a function of protection by defense mechanisms of this system,the defense of the respiratory tract against breathed in particles and gases includes the coordination of numerous complex physiological, biochemical and immunological procedures that collaborate straightforwardly with the properties of breathed in materials[8].The different guard mechanisms are integrated to provide local degradation and detoxication just as mechanical end of both exogenous substances and the results of pathological processes from the airways.Befor any defense framework works, breathed in material should initially contact an airway or aviation route surface. Evacuation inside conducting airways may fill in as a barrier, diminishing entrance to the alveoli. The factors controlling expulsion of material from the airstream vary for particles and gases.There are four primary physical mechanisms by which particles might be removed from breathed in air : impaction, sedimentation, Brownian diffusion, and interception.the relative contribution of each relies on various qualities of the particles themselves, for instance; size, shape, density, as well as regarding breathing pattern and anatomical attributes of the respiratory tract.

The defense mechanisms might be helpfully divided into two general categories, The first comprises of nonspecific, nonselective mechanisms that handle a wide variety of materials.The other one consists of specific, immunologic responses elicted by highly selective stimulation.First of all, Nonspecific mechanisms of safeguard of the respiratory framework contains clearance, local detoxification, and reflex responses.1-Clearance is the physical expulsion of material that stores on aviation route surfaces. The mechanisms included and the time for clearance rely on the area of the respiratory tract where the material is expelled from the breathed in air.Clearance from the conducting aviation routes happens by means of mucociliary system. Except the front nares and the back nasopharynx, the nasal passages and all aviation routes of the tracheobronchial tree through the terminal bronchioles are fixed or lined with a ciliated epithelium overlaid by a liquid layer, generally called mucus. There is some discussion with regards to the physical coherence of this mucous cover. It has been portrayed as either moderately persistent9[…] or existing as discrete beads or plaques[…] in any event in the upper tracheobronchial tree.The fluid coating of conducting aviation routes is gotten from different sources[…]. In the nasal passages and bronchi is secreted from specific epithelial cells, known as goblet cells, and from submucosal glands whose conduits empty at the lumenal surface.

In human, the quantities of these secretory component decline distally until they vanish at the bronchiolar level; here, the liquid layer is presumably emitted by cells known as Clara cells[..]. The overall extent of goblet cells, glands, and Clara cells vary among mammalian species.

We have also clearance through macrophages or via macrophages in the nonciliated respiratory region of the lung, the first-line resistance against microbes and nonviable insoluble particles is the alveolar macrophage, which works by isolating, shipping, and detoxifying deposited material. These enormous cells rest openly inside the fluid covering of the alveolar epithelium.Macrophages proceed onward the alveolar epithelium by means of ameboid motion. They are phagocytes and contain a variety of proteolytic lysosomal enzymes that permit them to digest a wide assortment of organic materials.They likewise eliminate microorganisms through peroxide-producing oxidative mechanisms[..]. Contact with deposited particles may happen by some coincidence, or be because of coordinated movement coming about because of the arrival of chemotactic factors following, for instance, immunologic response[..]. Albeit most stored particles are ingested, which forestalls their entrance through alveolar epithelium and all associated with antibacterial guard. In expansion, mucus glycoproteins play a role in the buffering capacity of bronchial secretions. Some components of alveolar fluids are associated with opsonization of deposited particles. Opsonins are molecules, for instance, lipid and proteins, that upgrade the adherence of particles to macrophages, increasing the efficiency of phagocytosis[,,]. Opsonins may likewise lyse bacteria, or they may be specific for certain moieties. Alveolar fluid likewise contains components of the complement framework, which is involved in antimicrobial and inflammatory responses of the lung, interferon, and transferin[,,,]. These latter may actually be synthesized by the macrophages[,,]. Moreover, the last Nonspecific defense mechanisms of respiratory framework is Reflex responses, breathed in materials may elicit reflex responses because of mechanical or chemical stimulation of different receptors, for example, those in the epithelium of large bronchi (irritant receptors) and in the pulmonary parenchyma (J receptors)[,,,]. Some responses prevent or diminish further entry of breathed in material, these include bronchoconstriction, laryngeal constriction, apnea(transient suppression of breathing), hyperpnea(rapid breathing), or dyspnea(labored breathing). Sneezing and coughing actually expel irritants. Sneezing aids clearance by rapid expulsion of air in the upper respiratory tract; coughing moves air from the large bronchi.

The seconed kind of defense mechanisms of respiratory framework is specific defense mechanisms, breathed in antigens may activate immunogenic defenses, which are often expressed in the area where the antigen contacts respiratory tract tissue. There are two types of immune effector mechanisms: antibody(immunoglobulin)-mediated and cellular-mediated; the degree of stimulation of each relies on properties of the particular antigen bringing out the response[,,]. Both serve to secure the respiratory tract against pathogens, and both rely on specific cells for their expression. To elicit an immune response, an antigen must contact and be ‘recognized’ by immunocompetent lymphoid tissue. Antigens that penetrate the aviation route fluid barrier may enter lymphatic vessels and contact organized structures, for example, nodes which are aggregated around conducting aviation route branching points. There also appear to be specialized sites along the bronchial tree where antigens may be transported, via pinocytosis, across the epithelium to submucosal lymphoid tissue; these include

Arterial blood gas test (ABG) is one of the most common standard diagnostic tools that is used to measure important physiological components, such as arterial blood oxygen tension, arterial carbon dioxide tension, and the blood’s pH level. Therefore, arterial blood gases give us easy accessibility to understand how well a patient’s acid-base balance functions, how well gas is being exchanged, and the performance status of ventilation. Furthermore, it gives physicians clues about the integrity of the respiratory system and metabolic system, since these two systems play a vital role in keeping the fragile acid-base balance. Arterial blood gas tests are ordered in cases of shortness of breath, confusion, shock, chronic vomiting, uncontrolled diabetes, carbon monoxide poisoning, heart failure, kidney failure, and respiratory failure. Arterial blood gases are equally important in all the cases stated, but it is of particular importance in the diagnosis of breathing problems since it allows specialists and nurses to pinpoint precisely the root of the breathing problem, whether it is the lungs that is responsible or a sign of another condition.

It’s worth mentioning that there is a stark difference between an ordinary blood gas analysis and arterial blood gas analysis. A blood sample for blood gas analysis can be obtained from pretty much anywhere within the circulatory system: arteries, veins, or capillary system. On the other hand, in arterial blood gas analysis, it is crucial to take a blood sample specifically from an artery. The sample is drawn either through an arterial puncture or it can be drawn through an indwelling arterial catheter. This blood sample is most commonly obtained from the radial artery of the wrist, and if not this, the blood sample can be obtained from the medial side of the arm right above where the elbow crease horizontally crosses, from the brachial artery. And if these two arteries are not preferred, a more uncommon way specialists take arterial blood samples is from the femoral artery in the thigh. In the case that blood sample is taken from the upper limb, the patient must be seated with arm extended, and the wrist must be resting on a mini cushion at an angle of 20-30°. Specialist must look for the pulse at the preferred site before proceeding on. To be extra cautious, a modified Allen’s test may be performed to ensure that there is normal and collateral blood flow in that patient’s hand. The modified Allen’s test is a very quick easy test whereby the radial and ulnar arteries are located and occluded, with the patient’s hand clenched tightly into a fist for about thirty seconds. Then afterwards, the clenched fist is released. And then shortly afterwards, the pressure over the ulnar artery is released, whilst the radial artery still being occluded; the color of the hand must return back to normal within approximately five to fifteen seconds. If the color does not return back to normal within the specified five to fifteen seconds, this is a negative modified Allen’s test, meaning that the hand does not have a dual blood supply (either inadequate or nonexistent ulnar artery), thus arterial puncture is not advised at this particular site in the radial artery, therefore the blood sample must be obtained from somewhere else. It must be noted that arterial blood gas samples must be not be obtained from sites used for dialysis, or areas of infection and inflammation. Before proceeding, the specialist must also take into consideration the patient’s medical record, whether the patients has allergies, has circulation or clotting problems, or is on anticoagulant therapy. After taking note of contraindications, the healthcare worker must clean the needle site and inject a local anesthetic, next the needle is inserted into the radial artery at an angle of 30-45°, and the blood fills the syringe by itself until desired amount. Next a cotton ball with applied pressure is put on the punctured site once the needle is removed. After the sample is taken, it must be immediately put on an automated blood gas analyzer, otherwise there is a big possibility of having erroneous results. Blood gas analyzers measure the following physiological components: pH, PaO2, PaCO2, HCO3, and SaO2. In addition to this, arterial blood gas analysis also measures the relative excess or deficit of base in the blood. PaO2 is the partial pressure of oxygen, it provides information about the how well the oxygenation status of a patient is working. PaCO2 is the partial pressure of carbon dioxide, this value gives doctors or nurses a clue about how well the ventilation status of the patient is working-it tells us whether the patient’s ventilation status is fully normal or if the patient may be suffering from acute or chronic respiratory failure. Even though there are noninvasive techniques to assess the oxygenation status (via pulse oximetry) and the ventilation status (via end-tidal carbon dioxide monitoring), arterial blood gas analysis is the standard way of assessment.

Three main systems work hand in hand to take care of the acid-base equilibrium, these include: the respiratory system, the metabolic system, and also the buffer system. If one among these systems is disturbed, then the others will work in conjunction to restore the balance, or compensate for the change when restore is not possible. These systems are commonly used to identify acid-base disorders, gas exchange problems, and a patient’s response to oxygen therapy. The delicate acid-base balanced must be maintained between 7.35-7.45, otherwise it will lead to medical conditions known as acidosis and alkalosis. Acidosis is a condition where the body fluids are excessively acidic, meaning that the pH is below 7.35. While on the other hand, alkalosis is a condition in which the body fluids are excessively basic, thus the pH is above 7.45. Patients with pH imbalance present with a variety of symptoms, such as: headaches, confusion, seizures, nausea, tiredness, tingling sensations and so on. With this wide range of symptoms, how are specialists supposed to pinpoint the root cause of these symptoms using the arterial blood gas test? Well this is why analysis and interpretation of arterial blood gas results are so important, because it leads to a deeper understanding of the severity of abnormalities, whether it is acute or chronic, whether it is a primary disorder of the metabolic or respiratory system. There are several methods when it comes to analyzing an arterial blood gas result. First, it’s worth noting that arterial blood gas test results definitely vary depending on the patient’s age, altitude, gender, history, and health conditions. The Romanski method is the most simplistic and accurate techniques utilized in the analysis of arterial blood gas test. It first determines if an acid-base disorder is present, then identifies the primary cause, and then points out if it is compensated or not. The first important factor is to determine if the patient has alkalosis (pH>7.45) or acidosis (pH

Blood pH HCO3- PCO2 Condition Common Etiologies

• < 7.4 Low Low Metabolic acidosis Renal failure, shock, diabetic ketoacidosis
• > 7.4 High High Metabolic alkalosis Chronic vomiting, low blood K+
• < 7.4 High High Respiratory acidosis Lung diseases: pneumonia or COPD
• > 7.4 Low Low Respiratory alkalosis tachypnea, pain, or anxiety

It should be emphasized that the presence of a normal PaO2 value does not rule out respiratory failure, even in the presence of oxygen therapy. It is the PaCO2 value that reflects the pulmonary ventilation status, thus it’s a more sensitive marker of respiratory failure that PaO2.

As mentioned before, ABG tests are frequently ordered in cases of shortness of breath, kidney failure, shock, heart failure, and so on, but its use in respiratory failure is quite significant and popular. So what is respiratory failure? Respiratory failure is a syndrome, not a disease, in which the respiratory system fails to carry out either one or both of its conditions: oxygenation and/or carbon dioxide evacuation. Respiratory failure originates from abnormalities in the components of the respiratory system: airways, alveoli, CNS, PNS, respiratory muscles, and thoracic cage. It’s classified into two main types: hypoxemic (type 1) or hypercapnic (type 2). Type 1 respiratory failure is characterized by having an arterial oxygen tension less than 60 mmHg accompanied by either normal or low arterial carbon dioxide tension. Type 1 respiratory failure is the most common type of respiratory failure that is frequently linked with any type of acute respiratory disease that involves fluid filling the alveoli or collapse of alveolar units, such as pneumonia, pulmonary edema, pneumoconiosis, pulmonary embolism and pulmonary hemorrhage. To sum it up, this type of RF is typically caused by ventilation-perfusion mismatch or shunts. Symptoms for acute respiratory failure can range anywhere from rapid breathing and confusion to arrhythmias and heaving sweating. Meanwhile, type 2 respiratory failure is characterized by having an arterial carbon dioxide tension higher than 50 mmHg. The symptoms for type 2 respiratory failure include fatigue, anxiety, wheezing, and shortness of breath, to name a few. Common etiologies for type 2 respiratory failure includes any disease that causes inadequate alveolar ventilation such as: COPD, cystic fibrosis, drug/alcohol disuse, injuries to the spinal cord, and myasthenia gravis. Respiratory failure can be even further classified into acute or chronic. Acute respiratory failure, as its name suggests develops over a short period of time (minutes to hours), in contrast, chronic respiratory failure develops over a longer period of time (days). The time period for the development of chronic respiratory failure allows for the body’s compensation mechanism (in renal) to come into play and increase HCO3 levels in the body; this is the exact reason why chronic respiratory failure isn’t as readily detectable as that of the acute one, the pH is only slightly imbalanced. Respiratory failure is accompanied by a variety of clinical manifestations that are nonspecific, this only reiterates the importance of arterial blood gas analysis. Once chest radiography, echocardiography, and pulmonary function tests are conducted and respiratory failure is of great suspect, ABG test must be conducted to confirm the diagnosis. The ABG test assists in the distinction between type 1 and type 2, acute and chronic, and the specific treatment required for the specific type of respiratory failure. Arterial blood gas analysis in type 1 RF shows a drastic decrease in PaO2 (50mmHg), a decrease or a normal PaO2 (

The job of the respiratory system is to keep the oxygen demand and supply at its optimal balance, it does this by three basic functions, which include: transfer of oxygen across lung parenchyma, transport of oxygen to the tissues, and elimination of carbon dioxide from the body. Respiratory failure arises when any of these units malfunction. As stated before, respiratory failure is accompanied by a wide variety of symptoms and signs, some of which may be nonspecific, this is why the use of arterial blood gas tests are so crucial. Arterial blood gas tests help in assessing the three fundamental physiological components, which include: arterial blood oxygen tension, arterial blood carbon dioxide tension, and the body’s pH level. Even though the mere use of arterial blood gas test alone is not sufficient in diagnosing a patient, it is definitely a key component that assists healthcare workers in accurately determining the fundamental reason for a patient’s constellation of signs and symptoms. Not only this, arterial blood gas test analysis can act as a guide for healthcare workers when in comes to choosing specific therapeutic interventions, and it also allows doctors in knowing how well a patient responds to those therapeutic interventions.

A 56-year-old male was diagnosed with Chronic Obstructive Pulmonary Disease, also known as COPD. He has a past medical history of heart failure with an ejection fraction of 35% following a myocardial infarction. He was a smoker for 41 years, has hypertension, and is on 2 liters of home oxygen. The medications that this patient takes are Lisniopril, Metoprolol, Spironolactone, Furosemide, Salmeterol/Fluticasone dry powder puff inhaler, Tiotropium, Albuterol/ipratropium metered dose inhaler, and Levalbuterol. The patient’s health care provider is considering adding Theophylline to the list of medications. Through out this paper, information on the major structures and roles of the respiratory system including the structure that controls respirations, the pathophysiology of COPD and how the current medications and Theophylline works to help treat COPD, and lastly the teaching needs of Theophylline if he is found to have been prescribed this medication.

Respiratory System

Throughout this section information will be discussed about the major structures and roles of the respiratory system as well as the structures that controls respirations. The respiratory system is divided into two parts; the upper and lower respiratory tract. The upper respiratory tract, includes the nose, mouth, and the beginning of the trachea, while the lower respiratory tract includes the trachea, bronchi, bronchioli, and the lungs (Bloomfield Science Museum Jerusalem, 2013). The trachea attaches the throat to the bronchi and then divides into two bronchi, which lead to both the left and right lung. Within the lungs, the bronchi are split up into smaller bronchi (Bloomfield Science Museum Jerusalem, 2013). Bronchioli are smaller tubes that the bronchi branch off of and eventually lead to the pulmonary alveolus. The pulmonary alveoli are minute air sacs that are outlined by a single-layer of blood capillaries (Bloomfield Science Museum Jerusalem, 2013).

The anatomy that is responsible in having the ability to breathe is the pons and medulla (Cherniack and Siebens, 2019). There are three main combinations of neurons that are involved: a group of inspiratory neurons in the dosomedial medulla, another group is made up of inspiratory and expiratory neurons in the ventrolateral medulla, and the last group in the rostral pons consists mostly of neurons that discharge during inspiration and expiration (Cherniac and Siebens, 2019).

Chronic Obstructive Pulmonary Disease (COPD) and Treatment

Chronic Obstructive Pulmonary Disease (COPD) is an advanced inflammatory disease of the lungs (Kim, 2016). COPD is characterized by the limited amount of airflow through the respiratory system. This disease is non-reversible and can get progressively worse overtime. Two pathologic processes that result from this chronic inflammation are the narrowing of the small airways and the emphysematous destruction of the lung parenchyma (Kim, 2016). The airway can become constricted and swollen, as the inflammation continues and then leads to excessive amounts of mucus production and poorly functioning cilia which makes airway clearance difficult (Leader, 2018).

A list of medications was prescribed to this patient to treat his COPD. Spironolactone is a diuretic, which helps treat fluid retention that occur in patients who have hypertension or heart failure (Medi Resource Incorporated, 2019). Spironolactone aids in excreting excessive amounts of water and salt in the body but can also reduce a patient’s serum potassium level (Medi Resource Incorporated, 2019). Salmeterol/Fluticasone is a combination of bronchodilators and inhaled steroids. Fluticasone is a corticosteroid that reduces airway swelling and Salmeterol is a long-acting bronchodilator. These work by opening and relaxing the airways that lead to the lungs, and will aid in making it easier to breathe for this patient (COPD News Today, 2019). Titropium is also a bronchodilator, which helps the air passage relax and aids in the opening to the lungs also making it easier to breathe (Medline Plus, 2019). Albuterol/Ipratropium is a combination of two bronchodilators; this breathing treatment is used when there is an acute spasm of the airways (Obgru, 2019). Albuterol and ipratropium work differently but they both cause the muscles in the airways to relax. Albuterol stimulates receptors on smooth muscle cells that outline the airway to aid in the relaxation of the muscles (Obgru, 2019). Ipratropium blocks the effect of nerves that communicate with muscle cells known as acetylcholine, which causes the muscles of the airway to relax and dilate (Ogbru, 2019). Levalbuterol, is a short-acting bronchodilator, also known as the rescue bronchodilator, this treats and prevent bronchospasms, improve wheezing, coughing, and minimize chest tightness (COPD News Today, 2019).

Teaching Needs

If this patient is prescribed Theophylline, there are teaching needs for this patient since it is a new medication that will be added to his medication list. Theophylline is a bronchodilator, this is used to treat wheezing and acute episodes of shortness of breath (COPD News Today, 2019). Theophylline has two different types of action; one action is the causes the muscles relax by smoothing it and the other action suppress the response to stimuli (COPD News Today, 2019). Side effects of Theophylline, stomach pain, diarrhea, upset stomach, headache, sweating, and insomnia (COPD News Today, 2019). Theophylline is taken orally and is dosed by serum theophylline level. It is key to report if the patient drinks alcohol as theophylline blood levels can be affected by alcohol consumption. Additionally, it can be very easy to overdose with this medication and multiple office visits may be necessary to monitor this theophylline level.

Conclusion

The information provided on the respiratory system and COPD has enhanced my knowledge and because I work on a pediatric pulmonary floor; I now have a better understanding on how the respiratory system works. I can apply this to my clinical practice because most of our pediatric patients have scheduled breathing treatments. I now have more knowledge on how breathing treatments work for patients who have bronchospasms, wheezing, or shortness of breath. The information throughout this case study that I have learned will be extremely beneficial to me.

References

1. Medi Resource Incorporated (2019). Aldactone. Retrieved from https://chealth.canoe.com/drug/getdrug/aldactone
2. Cherniack, N. S., & Siebens, A. A. (2019). Human respiratory system. Retrieved from https://www.britannica.com/science/human-respiratory-system/Control-of-breathing
3. Fluticasone-Salmeterol (Advair Diskus) for COPD. (2019). Retrieved from https://copdnewstoday.com/fluticasone-salmeterol-for-copd/
4. Kim, E. (1970) Pathophysiology of COPD. Retrieved from https://link.springer.com/chapter/10.1007/978-3-662-47178-4_5
5. Leader, D. (2018). How Does COPD Affect the Function of Your Lungs? Retrieved from https://www.verywellhealth.com/copd-pathophysiology-914745
6. Levalbuterol (Xopenex HFA) for COPD (2019). Retrieved from https://copdnewstoday.com/levalbuterol-for-copd/
7. Ogbru, O. (2019). Albuterol/ipratropium inhaler (Combivent) Side Effects & Dosage. Retrieved fromhttps://www.medicinenet.com/albuterol_and_ipratropium_inhaler/article.htm#what_is_albuterol_and_ipratropium_inhaler_and_how_does_it_work_mechanism_of_action
8. Bloomfield Science Museum Jerusalem (2013). The respiratory system- Structure and function. Retrieved from https://www.mada.org.il/en/about/engineer/challenge/respiratory-system
9. Theophylline for COPD. (2019). Retrieved from https://copdnewstoday.com/theophylline-for-copd/
10. Tiotropium Oral Inhalation: MedlinePlus Drug Information. (2019). Retrieved from https://medlineplus.gov/druginfo/meds/a604018.html

The major functions of the respiratory system are to allow the movement and exchange of circulating air in the atmosphere to and from the lungs and to monitor and control blood acid-base balance in the body. The system is made up of multiple structures carrying out processes of ventilation, inspiration and expiration, to ensure the major functions are performed.

As the respiratory system goes through the cycle of ventilation, a partial pressure of oxygen is created. This gradient determines the oxygen transfer from atmospheric air to the mitochondria. In the atmosphere there are specific pressures of various gases, the percentage of each gas along with the atmospheric pressure determines the partial pressure that drives oxygen from high to low pressure. Oxygen diffuses through alveolar membranes in the lungs and into the blood. Oxygen dissociates from hemoglobin and diffuses into cells of muscles. (al., (2015). Oxygen is consumed at mitochondria sites in the final step of electron transport chain. (Coyle E. F., 1995) Found evidence that more mitochondria can play a role in allowing a vo2 max value to increase, however only in a very minor way, there are greater factors which affect a V02max.

Hill et al and Herbst described VO2 max as a term for the “maximal oxygen uptake” for any given individual, it is the highest rate at which oxygen can be delivered around the body during severe exercise. (Hill, 1923). In their studies they state that a healthy human being has an upper limit to oxygen uptake, that humans have individual differences in vo2 max, that a high vo2 max is needed to be a successful middle to long distance runner recognized the importance of a high V̇O2max for elite performers (Hill A. V., 1923) and that there are limiting factors for vo2 max in a healthy human. The major limiting factor of a vo2 max is the ability of the cardiorespiratory system transportation of oxygen to the muscles. (Bassett Jr, 2000)

“This is shown by three major lines of evidence: 1) when oxygen delivery is altered (by blood doping, hypoxia, or beta-blockade), V̇O2max changes accordingly; 2) the increase in V̇O2max with training results primarily from an increase in maximal cardiac output (not an increase in the a- O2 difference); and 3) when a small muscle mass is over perfused during exercise, it has an extremely high capacity for consuming oxygen” (Bassett Jr, 2000) (BASSETT JR, Maximal oxygen uptake:“classical” versus “contemporary” viewpoints. Medicine & Science in Sports & Exercise, ., 1997.)

Although oxygen transportation is seen as the primary limiting factor in healthy exercising humans, metabolic adaptations in skeletal muscle are crucial for “improving submaximal endurance performance” (BASSETT JR, 1997.) In relation to maximal whole body exercise however literature studies prove that these are the four possible limiting factors for vo2 max in healthy humans.

1. the pulmonary diffusing capacity,
2. maximal cardiac output,
3. oxygen carrying capacity of the blood, and
4. skeletal muscle characteristics.” (BASSETT JR, 1997.)

Literature states that elite athletes generally have a higher O2 desaturation in the arteries when performing maximal full body exercise compared to regular healthy humans (Dempsey, 1984).

Fit individuals prove to have a much higher cardiac output in comparison to an untrained individual “40 vs 25 L·min−1” (Bassett Jr, 2000). Trained bodies display lower heart rate for performing the same submaximal work rate as an untrained body (Christensen, 1931). This backs up that maximal cardiac output is the major limiting factor and highlights individual differences of heathy human beings v02 max during maximal performance (Hill, 1923)

Oxygen transport to working muscles is controlled by the hemoglobin (Hb) content of the blood (Ekblom, 1976). Red blood cells are removed, stored and reinfused into the body, increasing a subjects volume of red blood cells, which is used to increase maximal aerobic [power as it increases the ability and capacity of blood to bear oxygen (APA, 1982) this level of oxygen transport impacts and limits a vo2 max. Skeletal Muscle is the final possible limitation of a v02 max, Honig et al showed evidence for “a peripheral O2 diffusion limitation in red canine muscle.” A difference in VO2 can be caused by the contractions involved in isolated muscle fibers, where mitochondria use oxygen in the final stage of the electron transport chain, creating a peripheral diffusion gradient. Differences in capillary densities can also impact a vO2 max and power output, in 1977 Andersen and Henriksson 1) stated that training can increase capillary density in a muscle. The effect training has on skeletal muscle has been proven much more than in the lung (Dempsey J. A., 1986)

V02max is not accurate predictor of the ability and capability an endurance athlete and performance, however often a high vo2 max is needed for a good endurance performance (BASSETT JR, Maximal oxygen uptake:“classical” versus “contemporary” viewpoints. Medicine & Science in Sports & Exercise, ., 1997.)acknowledged this with runners. Literature has shown that endurance can differ greatly between athletes with the same V02 max value (Coyle E. C., 1988). However Vo2 max values have proven to be useful and important to set the upper limit for endurance performance, as an athlete cannot work above Vo2 max for a prolonged time (Bassett Jr, 2000). A better predictor of endurance performance (of a runner) is their running economy, utilization of v02max along with lactate threshold (Bassett Jr, 2000). However v02 max alone is more beneficially used as a method of presenting training effects and improvements or not rather than a predictor of endurance performance rather it sets the upper limit in an endurance event (APA BASSETT & HOWLEY, May 1997). Literature states (Bassett Jr, 2000) that the plateau in V̇O2 shouldn’t be the “sole criterion for achievement of V̇O2max.“ It is recommended that secondary criteria to be used to verify a maximal effort such as “respiratory exchange ratio” and “blood lactic acid level” which can be tested in a laboratory (Bassett Jr, 2000). BASSETT JR, D.R. and HOWLEY state that these variables do “correlate with endurance performance, have been used to prescribe exercise training loads and are useful to monitor adaptation to training.” (BASSETT JR, Maximal oxygen uptake:“classical” versus “contemporary” viewpoints. Medicine & Science in Sports & Exercise, ., 1997.) Yamagata et al discovered that success in distance running may be closely related to the point at which lactate starts to accumulate in the plasma of a subject running at a certain velocity. Blood lactate measures are measured from either the fingertip or the earlobe.(Yamagata T. &., 2018)

A multi stage incremental test can be performed to collect lactate or respiratory data. An exercise such where the athlete becomes exhausted, such as cycling on an ergometer or running on a treadmill for a prolonged duration can be performed to collect such data, when the subject surpasses a certain intensity the lactate begins to accumulate exponentially.(Åstrand, 1963) (. COSTILL, 1970) Vo2 max and endurance performance has proved to be closely interlinked with the build up of blood lactate so this information can be used see the extent of physiological adaptations that were made during a period of training (Andersen, 1977.) (Bransford, 1977) The laboratory respiratory data along with blood lactate data can also be used wisely to create a specific training plan and make recommendations further training (Jones, 2006)

Lower respiratory infections include pneumonia (infection of the lung alveoli), as well as infections affecting the airways such as acute bronchitis and bronchiolitis, influenza and whooping cough. They are a leading cause of illness and death in children and adults across the world (European Lung Foundation).

History of disease

Lower respiratory tract infections are a leading cause of morbidity and death worldwide. A relatively small percentage of these infections come to the attention of the surgical pathologist because most are diagnosed in the microbiology laboratory. The biopsied pulmonary infection typically has eluded standard microbiologic techniques, has not responded to empirical therapy, or requires morphologic analysis for clarification of a critical aspect of the differential diagnosis (Practical Pulmonary Pathology: A Diagnostic Approach (Third Edition), 2018) In these situations, the diagnostic pathologist is indispensable, if not for providing an immediate report intraoperatively, then for dramatically improving diagnosis turnaround time with the use of newer rapid tissue-processing systems (Practical Pulmonary Pathology: A Diagnostic Approach Third Edition, 2018).

Anatomy and physiology

Etiology: Causative agents of lower respiratory infections are viral or bacterial. Viruses cause most cases of bronchitis and bronchiolitis. In community-acquired pneumonias, the most common bacterial agent is Streptococcus pneumoniae. Atypical pneumonias are cause by such agents as Mycoplasma pneumoniae, Chlamydia, Legionella, Coxiella burnetti and viruses (Medical Microbiology. 4th edition) Nosocomial pneumonias and pneumonias in immunosuppressed patients have protean etiology with gram-negative organisms and staphylococci as predominant organisms (Medical Microbiology. 4th edition)

Pathogenesis: Organisms enter the distal airway by inhalation, aspiration or by hematogenous seeding. The pathogen multiplies in or on the epithelium, causing inflammation, increased mucus secretion, and impaired mucociliary function; other lung functions may also be affected. In severe bronchiolitis, inflammation and necrosis of the epithelium may block small airways leading to airway obstruction (Medical Microbiology. 4th edition)

Clinical Manifestations: Symptoms include cough, fever, chest pain, tachypnea and sputum production. Patients with pneumonia may also exhibit non-respiratory symptoms such as confusion, headache, myalgia, abdominal pain, nausea, vomiting and diarrhea (Medical Microbiology. 4th edition)

Objective and subjective data during assessments

Subjective data

Cough-productive/nonproductive, hoarse, or barking; Sputum characteristics-clear, purulent, bloody (hemoptysis), rust colored, or pink and frothy; Dyspnea (shortness of breath) with or without activity, wheezing, or stridor; Chest pain-on inspiration, expiration, or with coughing and location of pain. Ask about associated symptoms such as cold symptoms, fever, night sweats, and fatigue. For positive responses, ask when symptoms started (duration), location, severity, setting, time of day, alleviating factors (what helps), and aggravating factors (what makes it worse). In addition, ask about smoking history, environmental exposure, past medical and family history, and current medications (Bickley, 2012; Mansen & Gabiola, 2015).

Objective data

Visual inspection begins with observation of facial expression, skin color, moisture, and temperature. Skin should be warm and dry, and skin color should be uniform and consistent with ethnicity. Facial expression should be relaxed, without signs of distress or apprehension. Any indication that breathing is a conscious effort may be a sign that something is wrong. Observe nail beds, lips, mouth, ears, and conjunctiva for oxygen saturation. A bluish color indicates cyanosis and hypoxia. Clubbing of the fingers may indicate chronic hypoxemia. Observe the neck for contraction of the sternomastoid muscles; any use of neck muscles to breathe signals difficult breathing (Bickley, 2012; Mansen & Gabiola, 2015).

Signs and symptoms

LRTIs can sometimes become more severe, leading to pneumonia, bronchitis, or other more serious infections. Signs and symptoms include;

• Fever
• Severe cough
• Rapid breathing or difficulty breathing
• Wheezing
• Skin turning a blue color due to lack of oxygen
• Chest pain or tightness (temple lung center)

Diagnosis

There are several tests your doctor may perform if LRTI is suspected:

Pulse Oximetry: this test uses a small sensor that attaches to the finger or ear. It uses light to estimate how much oxygen is present in the blood.

Chest X-ray: creates an image of the lungs. Doctors can visually inspect this image for signs of pneumonia.

Blood Test: a sample of blood is taken and inspected in a laboratory for the presence of viruses, bacteria, or other organisms.

Laboratory Tests: a sample of sputum or mucus is taken and inspected in a laboratory for the presence of bacterial organisms (Temple lung center)

Medical management

Since most LRTIs are viral, medications are generally not used in treatment. However, certain over-the-counter medicines may provide some relief from symptoms:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin can relieve pain and fever
• Acetaminophen can also provide relief from pain and fever
• Using a bronchodilator inhaler can help wheezing and shortness of breath

If an LRTI is bacterial, antibiotics may be prescribed, depending on how serious the infection is and your overall health. These treat the bacterial cause of the infection (Temple lung center 2018)

Socio-economic factors

Numerous studies indicate that a major health problem in children are illnesses of the respiratory system. Currently, increased attention is being paid to family social conditions and environmental factors in the pathogenesis of these illnesses. Acute respiratory infections are a leading cause of mortality among children under five years of age. In low and middle-income countries, 6.9 million children died in 2011 and about one in five of these deaths was caused by an acute lower respiratory infection (ALRI) (Arch Public Health. 2016; 74: 19.). ALRI is characterized by cough accompanied by short, rapid breathing that is chest-related, and is commonly linked to death through co-morbidities with other childhood illnesses. Ninety-seven percent of ALRI cases occur in the developing world with seventy percent of those cases occurring in south Asia and sub-Saharan Africa alone (Arch Public Health. 2016; 74: 19.)

The respiratory system is divided into two tracts. The upper respiratory tract consists of the paranasal sinuses, the nasal cavity, the pharynx, and the epiglottis. The paranasal sinuses are lined with mucous membranes that warm, humidify, and filter the air. The epiglottis seals off the airway during swallowing. The lower respiratory tract consists of the larynx, the trachea, bronchi, bronchioles, lungs, and alveoli. Mucous membranes line the trachea, bronchi, and bronchioles and form the mucociliary escalator. The mucociliary escalator prevents inhaled debris from entering the lungs. Gas exchange occurs in the alveoli, the air sacs in the lungs.

The sinus membranes can become inflamed from allergens or pathogens. This is called sinusitis and can cause sinus congestion if mucus is unable to drain into the nose. Accumulation of mucus in the sinuses can allow bacteria to multiply, causing a sinus infection.

Bronchitis is inflammation of the bronchi or bronchioles, tracheitis is inflammation of the trachea, and laryngitis is inflammation of the larynx. Laryngitis may also cause temporary loss of voice as the vocal cords become swollen. Epiglottitis is a serious condition in which the epiglottis is inflamed. This can block the airway. Pneumonia is usually caused by inflammation of the alveoli.

Respiratory infections commonly cause sneezing, cough, and runny nose which aid in the transmission of these infections through respiratory droplets. Since air is constantly being breathed into the body, inhaling these respiratory droplets can happen very easily. It is for this reason that most microbes gain access to the body through the respiratory route.

Bacterial infections may also occur as a secondary complication of viral infections. Colds commonly cause mucus to accumulate in the respiratory tract, allowing bacterial to proliferate.

Streptococcus pyogenes can cause streptococcal pharyngitis, commonly referred to as strep throat. Many people are carriers of S. pyogenes, as humans are a natural reservoir. Transmission usually occurs through respiratory droplets. Symptoms of strep throat include inflammation of the throat, exudate in the tonsils, swollen lymph nodes in the neck, and low-grade fever.

Streptococcus pneumoniae can cause pneumococcal pneumonia. Humans are the only know reservoir of pneumococcal bacteria. Children and the elderly are at the greatest risk of this disease. S. pneumoniae first colonizes the nasopharynx which can then migrate to the lungs. Symptoms of pneumonia cause by S. pneumoniae include high fever, chills, shortness of breath, cough with sputum, and chest pain when inhaling. Pneumonia can be cause by a wide array of infectious agents. Pneumonia resembling S. pneumoniae is used to classify the category of typical pneumonia. Typical pneumonia is caused by bacteria, while atypical pneumonia is caused by viruses. Haemophilus influenzae can also cause pneumonia.

Mycobacterium tuberculosis can cause tuberculosis, also known as consumption. Mycobacterium bovis was historically another common cause until pasteurization made milk products safer to consume. Most infections of M. tuberculosis are latent and do not cause symptoms. Latent tuberculosis cases also do not usually progress to an active case. When an active case of tuberculosis does occur, symptoms include a cough that sometimes contains blood, fever, fatigue, weight loss, and night sweats. Tuberculosis is the fourth leading cause of death form an infectious disease.

Bordetella pertussis can cause Pertussis, also known as the whooping cough. Pertussis is preventable through vaccine. As a result, unvaccinated infants are at the highest risk of contracting this infection. Infants also have the most severe symptoms. Pertussis has three stages. The first stage is the catarrhal phase and lasts for 1-2 weeks. The patient has mild symptoms with runny nose, watery eyes, and a cough. The second stage is the paroxysmal stage which brings severe coughing fits that last for 2-6 weeks. The convalescent stage is the final stage, lasting about 4 weeks. Coughing fits become less frequent.

Corynebacterium diphtheriae causes diphtheria. Diphtheria in the United States is rare, as children are routinely vaccinated for it. Young children in developing countries are most likely to be affected. Diphtheria causes sore throat and low-grade fever, as well as a swollen neck. C. diphtheriae produces a dangerous toxin that kills tissue in the airway, forming a pseudomembrane on the tonsils and throat a few days after the first symptoms appear. If left untreated, the pseudomembrane will continue to grow until airflow is constricted, suffocating the patient.

The normal microbiota of the respiratory system closely resembles the normal microbiota of the mouth. Normal flora of the upper respiratory tract include staphylococci, alpha-hemolytic streptococci, nonhemolytic streptococci, Streptococcus pneumoniae, spirochetes, enterococci, diphtheroids, and members of Moraxella, Neisseria, and Haemophilus. Veillonella, Streptococcus, Pseudomonas, and Prevotella are normal microbiota of the lungs.

Cystic Fibrosis is a hereditary disease. Asymptomatic carriers contain one copy of the mutated cystic fibrosis transmembrane regulator (CFTR) gene. Those with cystic fibrosis inherited two copies of the faulty gene. Not all mutations of the CFTR gene cause cystic fibrosis. Mutations that cause a defective chloride channel result in cystic fibrosis. Intracellular chloride ions build up, causing abnormally thick mucus to accumulate in the mucous membranes. In addition, sweat contains increased levels of sodium chloride. As the mucus is thick, it settles in the lungs and allows bacteria to proliferate and form biofilm. Because of this, lung infections are common and difficult to treat in these patients. Pseudomonas aeruginosa is an infamous microorganism that infects cystic fibrosis patients. Other bacteria that predominately affect cystic fibosis patients include Burkholderia cepacia and Stenotrophomonas. Infections cause inflammation and can lead to lung failure.

Sputum gram stain reports include quantitation of epithelial cells, white blood cells, and any bacteria or fungus seen. Quantitation is reported as rare, few, moderate, or many, though this may vary depending on the laboratory. Bacteria is listed with their gram stain result, and gram positive cocci are described as being in pairs, clusters, or chains. Normal flora is noted, and any potential pathogens are identified in the sputum culture. Identification can be done through the VITEK 2 or MALDI-TOF. Sputum cultures are plated on blood, chocolate, and MacConkey agar. Oxidase and indole are performed on gram negative organisms. An acceptable sputum specimen should contain greater than or equal to 10 white blood cells with mucus and less than 25 epithelial cells per low-power field. Specimens that do not meet this criteria may be contaminated by oropharyngeal flora.

This essay will be explaining the causes, symptoms, diagnosis and treatment of three conditions which effect the respiratory system, these are asthma, cystic fibrosis and tuberculosis. It will also be discussing how lung carcinoma and emphysema relate lifestyle to conditions and how they affect the respiratory system.

Asthma is a respiratory disorder that is associated with erratic contraction (abnormal tightening) of the bronchial smooth muscle, also known as a bronchospasm. Asthma causes shortness of breath, coughing, wheezing and a tightness in the chest. There are 2 different types of asthma, these are extrinsic and intrinsic. Extrinsic typically occurs in children who are more susceptible to obstructive problems due to the structure of their airways. Intrinsic is more common in adults and can be brought on by stress or exercise. There are many causes of having asthma naturally, these can be due to genetics; such as having a family history of the illness, having had bronchiolitis as a child, having an allergy related illness such as eczema or hay fever or being born prematurely; before 37 weeks. Asthma can also be brought on in life due to lifestyle factors such as smoking or environmental factors including pollen, dust particles or pollution.

For asthma to be diagnosed a person must see their GP who will then carry out a series of tests to see whether that person is a sufferer of the illness. The main tests are FeNO; you breathe into a machine and it measures the levels of nitric oxide in a person’s breath, this is a sign of inflammation in the lungs. Spirometry; this measure how fast you breathe out and how much air you hold in your lungs and finally the peak flow test, this measures how fast you can breathe out and can be done several times over a few weeks to judge whether there are any changes. Depending on what asthma you have or what treatments are available. There is no current cure for asthma, there are treatments which can control the symptoms. These include: inhalers, there are 2 types these are relievers and preventers. Relievers relieve symptoms as they occur and normally work within minutes and preventers are to be used daily to reduce inflammation and sensitivity of the airways. Both pumps cause the airways to widen which helps breathing become easier. There are also tablets, surgery and complementary therapies.

Cystic fibrosis is an inherited condition in which a person has an excessive amount of mucus on the lungs. The lungs and digestive system become clogged up with this thick, sticky mucus. This mucus also clogs the pancreas which stops any enzymes reaching the gut and helping with digestion, this makes it difficult for nutrients to be absorbed into the body and malnutrition quite a plausible side effect, therefore people who suffer with CF generally struggle to gain weight. Other symptoms of this disease are coughing, frequent chest infections, breathing problems, diarrhoea and constipation. Cystic fibrosis is usually picked up at birth with a new-born screening heel prick test, if CF gets picked up on this test then further tests are required. These include a sweat test to measure the salt in the sweat, people with cystic fibrosis tend to have abnormally high levels of salt within their sweat. Another test would be a genetic test; a sample of blood or saliva is taken and tested to see if the results are positive to having CF. This test can also see if a person is a carrier of the disease. As cystic fibrosis doesn’t yet have a cure, a person will unfortunately have it for the rest of their lives. There are some treatments available and these include preventative medication such as dornase alfa, hypertonic saline and mannitol dry powder; these are to help make the mucus within the body thinner and easier to cough up. Bronchodilators are asthma like pumps which help widen the airways and help make it easier to be able to breathe. Steroid medications are also available in the form of a nasal spray which help treat nasal polyps, which block the airways, and make it easier to breathe. People with CF can also be on the organ donation list and have either a heart or lung transplant.

Tuberculosis, or otherwise known as TB is a bacterial infection which is spread by coughs and sneezes. There are two types of TB, latent and active. Tuberculosis is highly contagious whilst active and people whose immune systems are compromised are at a higher risk of contracting the illness, e.g.; smokers, diabetics, those who are malnourished and those with HIV. It is more likely to spread within people who live within a proximity to each other. Symptoms of active TB include a cough, fever, night sweats and weight loss; these can be delayed in seeking treatment due to these symptoms only being mild and getting ignored. Latent TB doesn’t cause any symptoms; however, TB can sometimes develop outside the lungs, within the lymph nodes, bones, joints, digestive system, bladder, reproductive system, brain and nervous system. Symptoms can include; swollen glands, abdominal pain, confusion and headaches. Diagnoses can be difficult, and several tests may be needed to diagnose the illness, these include a chest x-ray or a sample of phlegm to be taken and checked for the presence of TB. To test for TB that has developed outside the lungs there are different tests such as; a CT scan, MRI scan, ultrasound, biopsy or even a lumbar puncture. Tuberculosis can helped be prevented with the help of the BCG vaccine, this is 70-80% effective in preventing severe forms of TB (Vaccination against TB, 2016). Tuberculosis is a curable disease, with the use of antibiotics which must be taken for 6 months.

Other diseases can affect the respiratory system, some are natural, and others are due to lifestyle choices. An example of a disease which is due to lifestyle, yet also beyond a person’s control is lung carcinoma, also known as; lung cancer. Lung carcinoma is a malignant tumour on the lungs which in most cases is deadly. Signs and symptoms of the disease are a new cough that doesn’t go away, coughing up blood, shortness of breath, chest pain and general feeling unwell. It is not yet known exactly how this is caused yet lifestyle factors play an important role in contracting the disease, things such as; smoking, diet, obesity, lack of physical exercise and exposure to UV rays, this however is more commonly seen in skin cancer patients. Smoking is one of the leading causes in lung carcinoma and life insurance companies have concluded that for every cigarette smoked it reduces a person’s life by 10.7 minutes (AQA Biology 2008). It is treated with chemotherapy and can be diagnosed through biopsy’s and x-rays. If a person was to quit smoking it reduces the chances of lung cancer drastically, even if a person had been smoking for a considerable amount of years.

The respiratory framework also have a function of protection by defense mechanisms of this system,the defense of the respiratory tract against breathed in particles and gases includes the coordination of numerous complex physiological, biochemical and immunological procedures that collaborate straightforwardly with the properties of breathed in materials.The different guard mechanisms are integrated to provide local degradation and detoxication just as mechanical end of both exogenous substances and the results of pathological processes from the airways.Befor any defense framework works, breathed in material should initially contact an airway or aviation route surface. Evacuation inside conducting airways may fill in as a barrier, diminishing entrance to the alveoli. The factors controlling expulsion of material from the airstream vary for particles and gases.There are four primary physical mechanisms by which particles might be removed from breathed in air : impaction, sedimentation, Brownian diffusion, and interception.the relative contribution of each relies on various qualities of the particles themselves, for instance; size, shape, density, as well as regarding breathing pattern and anatomical attributes of the respiratory tract.

The defense mechanisms might be divided into two general categories, The first comprises of nonspecific, nonselective mechanisms that handle a wide variety of materials.The other one consists of specific, immunologic responses elicited by highly selective stimulation.First of all, Nonspecific mechanisms of safeguard of the respiratory framework contains clearance, local detoxification, and reflex responses.1-Clearance is the physical expulsion of material that stores on aviation route surfaces. The mechanisms included and the time for clearance rely on the area of the respiratory tract where the material is expelled from the breathed in air.Clearance from the conducting aviation routes happens by means of mucociliary system. Except the front nares and the back nasopharynx, the nasal passages and all aviation routes of the tracheobronchial tree through the terminal bronchioles are fixed or lined with a ciliated epithelium overlaid by a liquid layer, generally called mucus.

The fluid lining of conducting aviation routes is gotten from different sources. In the nasal passages and bronchi is secreted from specific epithelial cells, known as goblet cells, and from submucosal glands whose conduits empty at the lumenal surface. In human, the quantities of these secretory component decline distally until they vanish at the bronchiolar level; here, the liquid layer is presumably emitted by cells known as Clara cells. The overall extent of goblet cells, glands, and Clara cells vary among mammalian species.

Various inhaled agents impair respiratory defenses, leading to increased systemic absorption of inhaled materials or increasing the susceptibility to acute and chronic respiratory diseases. For instance, derangement of mucociliary system may be involved in development of chronic bronchitis. And may be a factor in the pathogenesis of bronchial cancer.

We have also clearance through macrophages or via macrophages in the nonciliated respiratory region of the lung, the first-line resistance against microbes and nonviable insoluble particles is the alveolar macrophage, which works by isolating, shipping, and detoxifying deposited material. These enormous cells rest openly inside the fluid covering of the alveolar epithelium. They are phagocytes and contain a variety of proteolytic lysosomal enzymes that permit them to digest a wide assortment of organic materials. Contact with deposited particles may happen by some coincidence, or be because of coordinated movement coming about because of the arrival of chemotactic factors following, for instance, immunologic response. the proficiency of phagocytosis relies upon explicit properties of the particles, for instance, size, shape, and structure. Damage to macrophages may have a role in the pathogenesis of chronic lung disease involving proteolysis (e.g, emphysema) and fibrogenesis (e.g, silicosis), as well as in an increased risk of viral and bacterial infections.

Another Nonspecific mechanisms of respiratory framework is local detoxification, in addition to serving as physicochemical barrier protecting underlying cells, respiratory tract fluid contain different proteins and mucopolysaccharides that are involved in nonspecific bacteriocidal and detoxification activity. The main ones found in tracheobronchial fluids are lysozyme, and transferin, all of which are involved in antibacterial defense. In expansion, mucus glycoproteins play a role in the buffering capacity of bronchial secretions. Some components of alveolar fluids are associated with opsonization of deposited particles. Opsonins are molecules, for instance, lipid and proteins, that upgrade the adherence of particles to macrophages, increasing the efficiency of phagocytosis. Opsonins may likewise lyse bacteria, or they may be specific for certain moieties. Alveolar fluid likewise contains components of the complement framework, which is involved in antimicrobial and inflammatory responses of the lung, interferon, and transferin. These latter may actually be synthesized by the macrophages. Moreover, the last Nonspecific defense mechanisms of respiratory framework is Reflex responses, breathed in materials may elicit reflex responses because of mechanical or chemical stimulation of different receptors, for example, those in the epithelium of large bronchi (irritant receptors) and in the pulmonary parenchyma (J receptors). Some responses prevent or diminish further entry of breathed in material, these include bronchoconstriction, laryngeal constriction, apnea(transient suppression of breathing), hyperpnea (rapid breathing), or dyspnea (labored breathing). Sneezing and coughing actually expel irritants. Sneezing aids clearance by rapid expulsion of air in the upper respiratory tract; coughing moves air from the large bronchi.

The seconed kind of defense mechanisms of respiratory framework is specific defense mechanisms, breathed in antigens may activate immunogenic defenses, which are often expressed in the area where the antigen contacts respiratory tract tissue. There are two types of immune effector mechanisms: antibody (immunoglobulin)-mediated and cellular-mediated; the degree of stimulation of each relies on properties of the particular antigen bringing out the response. Both serve to secure the respiratory tract against pathogens, and both rely on specific cells for their expression. To elicit an immune response, an antigen must contact and be ‘recognized’ by immunocompetent lymphoid tissue. Antigens that penetrate the aviation route fluid barrier may enter lymphatic vessels and contact organized structures, for example, nodes which are aggregated around conducting aviation route branching points. There also appear to be specialized sites along the bronchial tree where antigens may be transported, via pinocytosis, across the epithelium to submucosal lymphoid tissue; these include areas in proximal airways where specialized epithelial cells spread what is named “ bronchial-related lymphoid tissue” and less welldefined totals of lymphoid tissue, known as ‘lymphoepithelial organs’, in the mucosa of bronchioles. Furthermore, free immunocompetent lymphocytes are present diffusely in the alveolar area.

There are local and useful contrasts between the class of immunoglobulins found in the respiratory tract. Immunoglobulin A ;(IgA), is the primary immunoglobulin in the upper respiratory tract; it additionally occurs to some extent in lower airways.It is essential job is to prevent the entry of microbial antigens into cells by lessening attachment of bacteria to airway surfaces. It also agglutinates microscopic organisms, kills certain bacterial poisons, and has a role in resistance to viral infections. IgA predominates in the lower respiratory framework, particularly in alveoli, however is present all through the whole framework. It is function is to promote, via opsonization, the phagocytosis of bacteria by alveolar macrophages. It may also be involved in neutralization of bacterial toxins, agglutination of bacteria, and activation of complement.

Different immunoglobulins are found in respiratory tract secretions in lesser amount. IgA is involved in the interaction of breathed in allergens with mast cells, which are found in the mucosa of conducting aviation routes, resulting in the release of mediators of allergic response in the lungs(immediate hypersensitivity), IgA may be engaged with bacterial agglutination, bacterial lysis via opsonization and complement fixation.

Cellular immunity is effected by Tcells, thymus-derived lymphocyte. These are arise from stem cells in bone marrow, but differentiate under the influence of the thymus gland. They constantly flow through the blood and lymphatic system. Interaction with the appropriate antigen results in proliferation into sensitized cells that mediate the immune response.

Sensitized T-cells produce and secrete a diverse group of biologically active molecules called lymphokines, whose major effect is the attraction, localization, and activation of macrophages and other effector cells. Activated macrophages have upgraded phagocytosis and enzymatic activity against both the sensitizing antigen and unrelated intracellular pathogens.

Some sensitized T-cells, which may or may not be these same cells that produce lymphokines, directly kill cells carrying membrane-antigens against which they are sensitized[,,]. Other Tcells participate in the regulation of antibody production by B-cells, and may provide residual immunity to certain antigens, for instance, those involved in producing chronic intracellular infections of the lung.

Conclusion

To sum up, the human body is an incredibly complex and amazing structures one of these amazing structures is the respiratory system, The respiratory system is constantly filtering through the external environment as human breathe air. The airways of this tract must keep up the capacity to clear breathed in pathogens, allergens, and debris to maintain homeostaisis and prevent inflammation.

Respiratory epithelium is ciliated pseudostratified columnar epithelium found lining most of the respiratory framework; it isn’t present in the larynx or pharynx. The epithelium classifies as pseudostratified ;though it’s a snigle layer of cells along the basement membrane, the alignment of the nuclei is not in the same plane and appears as multiple layers.The role of this unique type of epithelium is to function as a barrier to pathogens and foreign particles; moreover,it also operates by preventing infection and tissue injury via the use of the mucociliary elevator.

With each breathe, the respiratory tract is exposed to numerous noxious materials present in ambient air, these include pathogenic organisms, as well as toxic or radioactive gases and particles. The large surface area of the alveolar region and the proximity of the pulmonary circulation to the external environment make the lung a vulnerable portal of entry for these materials, fortunately, the respiratory tract has an array of intricate and interlocking specific and nonspecific defense mechanisms to detoxify and physically remove inhaled material via cellular and acellular processes.

Introduction

Organs and structures in the respiratory system are very important for life because they make it possible for gases that are needed for cellular processes to move between cells. Carbon dioxide, a waste result of metabolism, is pushed out of the body by this complex system. Oxygen from the air we breathe is efficiently absorbed into the bloodstream. The respiratory system is made up of the nose, throat, esophagus, larynx, trachea, bronchi, and lungs. Its structure is carefully planned to include as much surface area as possible for gas exchange. While we breathe, our bodies are also using a lot of different systems to control how much oxygen we take in and how much carbon dioxide we let out. These systems work together to keep our bodies running smoothly. These essays aim to explore the anatomy and physiology of the respiratory system, delving into its critical functions, the mechanisms that underpin respiratory gas exchange, and the impact of environmental and health factors on respiratory efficiency. The respiratory system is an important part of keeping homeostasis and overall health. Knowing how it works can help you understand how essential respiratory health is to your overall health.

100 Words Essay about the Respiratory System

The respiratory system is a vital group of organs and cells that work together to make breathing possible. It includes taking in oxygen and letting go of carbon dioxide. The lungs, airways (like the trachea and bronchi), and breathing muscles (like the diaphragm) all work together to make up this system. It is very complicated, but this system makes sure that oxygen gets into the bloodstream to feed the cells and gets rid of carbon dioxide, which is a waste product of metabolism. The respiratory system’s effectiveness is essential for life, which shows how important it is to keep your lungs healthy by doing things like staying away from pollution and working out occasionally.

250 Words Essay about the Respiratory System

The respiratory system, a fundamental pillar of human biology, orchestrates the critical task of gas exchange, ensuring that oxygen is supplied to and carbon dioxide is removed from the body’s cells. This complex system comprises various structures, including the nose, pharynx, larynx, trachea, bronchi, and the lungs, each playing a pivotal role in the breathing process. The journey of air begins at the nasal passages, which filter, warm, and humidify it, enhancing its quality before it reaches the lungs.

Within the lungs, the bronchi branch into finer tubes called bronchioles, culminating in tiny air sacs known as alveoli. It is here, in these microscopic structures, that the actual exchange of gases occurs. The alveoli’s thin walls, closely apposed to capillaries, facilitate the diffusion of oxygen into the blood and carbon dioxide out of it, a process vital for cellular respiration and energy production.

Breathing, the physical act of air movement in and out of the respiratory system, is driven by the diaphragm and intercostal muscles, which modulate the thoracic cavity’s pressure dynamics. This system is not only anatomically complex but also physiologically sophisticated, regulated by the brain’s respiratory centers, which adjust breathing rates based on the body’s metabolic demands and external factors like altitude and exercise.

The respiratory system’s efficiency can be compromised by factors such as pollution, smoking, and respiratory diseases like asthma and COPD, underscoring the importance of environmental quality and healthy lifestyle choices in maintaining respiratory health. Understanding this system’s functionality and vulnerabilities is crucial for fostering well-being and preventing respiratory ailments.

400 Words Essay about the Respiratory System

As a complex and necessary part of the body, the respiratory system is very important for keeping life going by allowing the exchange of gases needed for cellular metabolism. The pharynx, larynx, trachea, bronchi, and lungs are just a few of the organs and structures that make up this complicated system. Each one is carefully made to make breathing easier. The main job of the respiratory system is to get oxygen into the bloodstream and get rid of carbon dioxide, which is produced when cells breathe.

The first stop on air’s trip is the nose, where it is filtered, warmed, and humidified so it can safely reach the lungs. After going through the pharynx and larynx, the air goes down the airway and into the bronchi. The bronchi then split into smaller and smaller bronchioles inside the lungs. The network ends with the alveoli, which are small air pockets surrounded by a network of vessels. The alveoli are very important for gas exchange because their thin walls let oxygen into the blood and carbon dioxide out of the bloodstream so that it can be breathed out.

Breathing, the mechanical process of moving air into and out of the lungs, is driven by the diaphragm and intercostal muscles. Inhalation occurs when these muscles contract, expanding the chest cavity and reducing pressure within the lungs, drawing air in. Exhalation is typically passive, occurring when these muscles relax, allowing the chest cavity to decrease in volume and air to be expelled.

The respiratory system is under the constant regulation of the brain’s respiratory centers, which monitor the levels of oxygen and carbon dioxide in the blood. These centers adjust the rate and depth of breathing to meet the body’s demands, such as during exercise or in response to changes in altitude.

However, the respiratory system’s efficiency can be compromised by various factors, including environmental pollutants, allergens, and pathogens. Conditions such as asthma, chronic obstructive pulmonary disease (COPD), and lung infections can significantly impair gas exchange, leading to decreased oxygenation of the blood and systemic health issues. Moreover, lifestyle choices, particularly smoking, have a profound impact on respiratory health.

In conclusion, the respiratory system is a marvel of biological engineering, essential for life. Its health is critical not only for the function of every cell in the body but also for overall well-being. Understanding its complexity and the factors that can compromise its function is crucial for promoting respiratory health and, by extension, the health of the entire organism.

500 Words Essay about the Respiratory System

The respiratory system, a cornerstone of human physiology, is ingeniously designed to perform the critical function of gas exchange, supplying oxygen to the body while removing carbon dioxide, a waste product of cellular metabolism. This complex system encompasses a network of organs and passages, including the nasal cavity, pharynx, larynx, trachea, bronchi, and lungs, each intricately structured to optimize the efficiency of breathing and gas exchange.

Breathing begins with the inhalation of air through the nasal cavity, where it is filtered, warmed, and humidified, safeguarding the deeper structures of the respiratory system from irritants and pathogens. This preconditioned air then traverses the pharynx and larynx, entering the trachea, a vital conduit to the lungs. The trachea bifurcates into two primary bronchi, each leading to a lung where they further divide into smaller bronchioles, culminating in the alveoli, the system’s functional units. Surrounded by a dense capillary network, the alveoli facilitate the delicate exchange of oxygen and carbon dioxide through their thin, permeable membranes.

The mechanical aspect of breathing is orchestrated by the diaphragm and intercostal muscles, which modulate the volume of the thoracic cavity. Inhalation is an active process, initiated by the contraction of these muscles, expanding the chest cavity and creating a negative pressure that draws air into the lungs. Exhalation typically follows as a passive process, with the relaxation of these muscles allowing the chest cavity to contract, expelling air from the lungs.

The regulation of breathing is a sophisticated physiological process overseen by the brain’s respiratory centers, which continuously monitor the body’s oxygen and carbon dioxide levels through chemoreceptors. This feedback mechanism ensures that the respiratory rate and depth are precisely adjusted to the body’s metabolic demands, such as during physical exertion or in response to environmental changes.

The respiratory system’s health and efficiency can be compromised by various factors, including environmental pollutants, tobacco smoke, respiratory pathogens, and chronic conditions like asthma and chronic obstructive pulmonary disease (COPD). These factors can impair the system’s ability to facilitate gas exchange, leading to reduced oxygenation of the blood and subsequent health complications.

The impact of lifestyle choices on respiratory health cannot be overstated. Smoking, in particular, is detrimental, as it introduces harmful toxins that damage the respiratory tract, leading to decreased lung function and an increased risk of respiratory diseases. Conversely, regular physical activity can enhance lung capacity and efficiency, underscoring the importance of healthy habits in maintaining optimal respiratory function.

The respiratory system’s significance extends beyond its primary function of gas exchange; it also plays a role in regulating blood pH, vocalization, and even the body’s immune defense against airborne pathogens. Its intricate design and multifaceted functions highlight the marvel of biological engineering, essential for sustaining life.

In essence, the respiratory system is a testament to the complexity and adaptability of the human body. Its optimal functioning is crucial not only for individual health but also for the overall well-being of populations, especially in the face of global challenges such as air pollution and respiratory epidemics.

The ongoing spread of tuberculosis is worldwide and still seen present day. Efforts are directed at examining the respiratory system functions of physiology patterns before pathogenic Mycobacterium tuberculosis infection occurs. The respiratory system is responsible for oxygen exchange and ensuring the body excretes carbon dioxide while taking in oxygen. Tuberculosis can affect the normal homeostasis pattern and cause signs and symptoms of respiratory illness. Understanding of the host immune response, with an emphasis of the roles of fights against engendering protective immunity, can help differentiate a normal respiratory system from an infected respiratory system. Tuberculosis addresses the ability of the bacteria to survive within the respiratory system and develop resistance to multiple antibiotic measures. Resistance to antibiotics requires more diagnostic testing and testing to confirm the presence of the contagious disease tuberculosis. Increased attention of this disease and the integration of studies have allowed for a greater understanding of tuberculosis and the steps necessary to control this infection. Continued research is being done to elaborate on this issue and to develop prevention mechanisms.

Keywords: Tuberculosis, respiratory system, antibiotic resistance

Tuberculosis

Introduction

Tuberculosis is a disease that has occurred in many countries for a very long time. Although it is not as common today, tuberculosis is still present although it may not be visible. Depending on latent or active tuberculosis, both mainly affect the respiratory system, more specifically the lungs. The normal physiology of the respiratory system is affected and can result in the human body compensating and visualizing signs and symptoms that may require future testing to confirm the disease. Research is being conducted to eliminate this disease and preventive measures are being conducted to prevent the spread of tuberculosis. In order to understand how to reach preventive measures and research, the respiratory system healthy anatomy must be understood.

Affected System

The human respiratory system consists of the organs responsible for taking in oxygen and expelling carbon dioxide. The primary organs include the lungs, which carry out this exchange of gases and is the main organ affected with tuberculosis. The lungs are located below the rib cage and above the diaphragm (Marinho, 2019). Another important organ in the respiratory system is the trachea, which conducts inhaled air into the lungs through the bronchi. The bronchi are divided into tiny branches known as bronchioles before becoming clusters of microscopic air sacs, and alveoli (Marinho, 2019). In the alveoli, oxygen from the air gets absorbed into the blood. Carbon dioxide, the end waste product, travels from the blood to the alveoli, where it can be exhaled (Marinho, 2019). The lungs are covered with a thin tissue layer called known as the pleura. This layer of fluid acts as a lubricant allowing the lungs to slide smoothly as they expand and contract with each breath (Marinho, 2019). The major function of the lungs is to perform gas exchange, which requires blood from pulmonary circulation. This blood supply contains deoxygenated blood and travels to the lungs where erythrocytes, pick up oxygen to be transported to tissues throughout the body( May 2019). The pulmonary artery carries deoxygenated arterial blood to the alveoli. Normal respiratory breathing occurs by the dilation and constriction of the airway through the parasympathetic and sympathetic nervous systems (May 2019). The parasympathetic system causes bronchoconstriction, while the sympathetic nervous system stimulates bronchodilation (May 2019). During this process, red blood cells collect oxygen from the lungs and carry it to the parts of the body where it is needed (May 2019). During the process, the red blood cells collect the carbon dioxide and transport it back to the lungs, where it leaves the body when a person exhales. A healthy functioning respiratory system is vital to survival which requires the conduction of effective homeostasis.

Homeostasis

During a normal homeostasis pattern, when a human breathes, air enters through the mouth and nose, travels down the throat, into the trachea and lungs, through the right and left main bronchi, into the smaller bronchi airways and into the alveoli (May, 2019). Each alveolus is covered by capillaries. These capillaries are the site for an exchange of oxygen and carbon dioxide (May, 2019). The heart sends deoxygenated blood to the lungs. As the blood passes through the tiny, thin-walled capillaries it receives oxygen from the alveoli, next, returns carbon dioxide through the thin walls to the alveoli. The oxygen-rich blood from the lungs is sent back to the heart, where it is pumped through the entire body (May 2019). The carbon dioxide is breathed out of the lungs and alveoli through the mouth and nose. The pressure differs allowing for oxygen and carbon dioxide to diffuse in and out of the blood (May, 2019). Gas exchange in the respiratory system helps the body maintain acid balance if the pH of the blood becomes too acidic, the breathing rate increases. This reduces the amount of carbon dioxide in the blood, so the pH increases toward normal. Blood that is too alkaline will slow the breathing rate to increase the amount of carbon dioxide and lower the pH. Normal breathing patterns can be disrupted by certain conditions, such as tuberculosis.

Disease Process

Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis that spreads from person to person through microscopic droplets released into the air (Schezle, 2019). This can occur by a person with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings (Schezle, 2019). This is a potentially serious infectious disease that mainly affects the lungs first. Tuberculosis is commonly presented as a disease of the lungs; however, the infection can spread via blood from the lungs to all organs in the body. Besides the lungs, tuberculosis can be in the pleura, bones, urinary tract, sexual organs, intestines and skin (Rathawati, 2019). Latent tuberculosis is tuberculosis infection, but the bacteria in the body remain in an inactive dormant state and cause no symptoms(Schezle, 2019). It can turn into active tuberculosis; this condition has visible sickness and can spread to others. It can occur in the first few weeks after infection with Mycobacterium tuberculosis bacteria, or it might occur years later once the immune system becomes weak (Schezle, 2019). A nodule forms in the lung, usually in the outer portion of the upper lobes. The body’s defenses stop the infection from expanding and the bacteria is trapped inside the nodule and is inactive until the immune system becomes weak (Schezle, 2019). As tuberculosis progresses, it can cause damage to the surrounding lung tissue and progress into the blood vessels, future spreading to any part of the body (Rathawati, 2019). A person with active tuberculosis may show signs and symptoms of this disease.

Signs and Symptoms

Abnormalities in the body may be seen as a result of the body trying to compensate and remain the normal homeostasis level. This can lead to abnormal actions by the body as it compensates for the improper work of the lungs. Coughing lasts three or more weeks, due to the ability of the lungs trying to regulate oxygen and carbon dioxide levels (Marinho, 2019). Coughing is important for expelling mucus and clearing the airways. Coughing up blood and mucus from deep inside the lungs, this mucus usually traps bacteria, and viruses, before progressing further into the body, during tuberculosis the mucus is infected and needs a way out (Marinho, 2019). Chest pain, pain with breathing or coughing, unintentional weight loss, fatigue, fever as the body fights infection, night sweats, chills, and loss of appetite can all be signs and symptoms present with tuberculosis due to the body out of normal homeostasis pattern, trying to compensate (Schezle, 2019). The pain is felt due to bacteria damaging the lungs, making them unable to bring enough oxygen to the blood (Schezle, 2019). When the body doesn’t get enough oxygen, it cannot function properly. As the infection progresses, people feel tired and generally unwell, and weight loss may be due to loss of appetite (Schezle, 2019). These signs and symptoms represent the respiratory system is not working to maintain homeostasis.

Failure of homeostasis

Within the respiratory system, there are numerous interaction points for airborne Mycobacterium tuberculosis droplets to attach too and disrupt the normal homeostasis function. Lungs are directly exposed to the air and enable gas exchange. The lungs are constantly invaded by microbes from both outside and inside as a prototypic host-adapted airborne pathogen, Mycobacterium tuberculosis traverses the lung and has several spots that it must overcome to cause infection (Marinho, 2019). Once inhaled, the infectious droplets settle throughout the airways. The initial defense is the bacilli trapped in the upper parts of the airways by mucus produced catching these foreign substances, and the cilia on the surface remove these foreign pathogens (Marinho, 2019). Bacteria in droplets bypass the system and reach the alveoli are quickly surrounded and engulfed by alveolar macrophages. These macrophages, the next line of host defense, are part of the innate immune system and provide an opportunity for the body to destroy the invading mycobacteria and prevent infection (May 2019). Macrophages are cells that fight many pathogens without previous exposure to the pathogen (May 2019). The subsequent phagocytosis by macrophages initiates a cascade of events that results in either successful control of the infection, followed by latent tuberculosis, or progression to active disease. The outcome is essentially determined by the quality of the host defenses and the balance that occurs between host defenses and the invading mycobacteria.

For systems with intact cell-mediated immunity, the next defensive step is the formation of granulomas around the Mycobacterium tuberculosis organisms. These nodular-type lesions form from an accumulation of activated T lymphocytes and macrophages, which creates a micro-environment that limits replication and the spread of the mycobacteria(May 2019). Mycobacterium tuberculosis organisms change to enhance survival (Marinho, 2019). This condition restricts further growth and establishes the dormant stage. An adequate immune system generally undergoes fibrosis and calcification, successfully controlling the infection so that the bacilli are contained and remain dormant (May 2019). Less effective immune systems progress to active tuberculosis. In patients infected with Mycobacterium tuberculosis, droplets can be coughed up from the bronchus and spread the infection.

Diagnosis

There are two main types of tests that are used to detect tuberculosis bacteria in the body, the tuberculosis skin test (TST) and tuberculosis blood tests. A positive tuberculosis skin test or tuberculosis blood test only tells that a person has been infected with bacteria (Schezle, 2019 ). It does not tell whether the person has latent or has progressed to active. Additional tests such as a chest x-ray and a sample of sputum, are needed to confirm the tuberculosis disease (Rathawati, 2019). Healthcare workers need to ask about the patient’s history of exposure, infection, or disease. It is also an important factor to consider demographic factors, country of origin, age, ethnic or racial group, and occupation, which may increase the patient’s risk for exposure to tuberculosis or to drug-resistant (Wilson, 2018). Those with diabetes, cancer, on steroids, HIV/AIDS, and older adults are at risk for developing tuberculosis and conditions need to be closely monitored (Wilson, 2018). A physical exam can provide valuable information about the patient’s overall condition and other factors that may affect how TB is treated. The Mantoux tuberculin skin test (TST) or the TB blood test can be used to test for Mycobacterium tuberculosis infection (Schezle, 2019). This is done is by injecting a small amount of fluid of tuberculin into the skin of the lower part of the forearm (Schezle, 2019). The test is read within 48 to 72 hours after, observing for a reaction on the arm that may appear as a firm red bump or nodule in the area of the test (Schezle, 2019). The tuberculosis blood test measures the patient’s immune system reaction to Mycobacterium tuberculosis. Future testing such as a posterior-anterior chest radiograph is used to detect chest abnormalities and may be ordered after the initial test to confirm and look for lesions that may appear anywhere in the lungs (Rathawati, 2019). Any abnormalities may suggest tuberculosis. A chest radiograph may be used to rule out the possibility of tuberculosis in a person who has had a positive reaction to a TST or TB blood test and no symptoms of disease (Rathawati, 2019). The presence of acid-fast-bacilli (AFB) on a sputum smear or other specimen often indicates tuberculosis. Acid-fast microscopy is easy and quick, but it does not confirm a diagnosis of TB because Mycobacterium tuberculosis is not acid-fast (Schezle, 2019). Therefore, a culture is needed on all initial samples to confirm the diagnosis. A positive culture for Mycobacterium tuberculosis confirms the diagnosis of tuberculosis (Schezle, 2019). For all patients, the initial Mycobacterium tuberculosis isolate should be tested for drug resistance. It is an important factor to identify drug resistance to ensure effective treatment.

Treatment

Those with active tuberculosis need treatment as soon as possible. This might involve medication, preventing the spread by covering the mouth with a tissue when a cough or sneeze occurs and disposing of the tissue into a plastic bag, then throwing it away. With the proper treatment, tuberculosis is almost always curable. Doctors prescribe antibiotics to kill the bacteria, and treatment options for latent and active tuberculosis all include different antibiotics that a doctor will prescribe depending on contraindications and risk factors (Wilson, 2018 ). Treatment of tuberculosis via antibiotics takes longer than most bacterial infections, however, the use of antibiotics destroys the bacteria and prevents for Tuberculosis from spreading through the body and continuing the normal respiratory system. Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (Wilson, 2018). This vaccine is not commonly used in the United States, but it is often given to infants and children in countries where Tuberculosis is common (Wilson, 2018 ). BCG does not always prevent tuberculosis, people who were previously vaccinated with BCG may receive a TB skin test to test for infection (Wilson, 2018). A positive reaction to a tuberculosis skin test may be due to the BCG vaccine itself or due to infection with bacteria (Wilson, 2018). Other prevention measures include proper cough etiquette, infection control for those in healthcare settings and education for those at risk. More prevention methods and treatments are currently being placed in healthcare facilities.

Research

The Tuberculosis Epidemiologic Studies Consortium II (TBESC-II) is a partnership of the Division of Tuberculosis Elimination (DTBE) control programs. These programs focus on strategies and tools to increase the diagnosis and treatment of latent tuberculosis infection (LTBI) in high-risk populations (Wilson, 2018). Current research of these programs includes tuberculosis elimination in the United States is and the knowledge of M. tuberculosis infection and finding preventive services for persons with Latent Tuberculosis (Wilson, 2018). These programs include Population-based calculation of tuberculosis prevalence overall and high-risk areas of changes over time and identifying where patients are lost to care in the process from diagnosis to treatment completion (Wilson, 2018). The main goal of the tuberculosis Prevention Cascade is to develop local estimates of tuberculosis prevalence in high-risk populations, and the proportions of those who are identified to complete treatment (Wilson, 2018). Identification of these gaps is the first step to intervening to close the gaps. To assist, TBESC-II is developing a case management system for tuberculosis programs. The Management System contains modules for patient registration, testing, treatment, follow-up, and contact investigations (Wilson, 2018). Other research being done on tuberculosis includes finding new antibiotics to quickly stop the infection. UConn chemist Alfredo Angeles-Boza and colleagues from the Indian Institute of Science, are in the process of current research to try a new drug to kill Mycobacterium tuberculosis in a faster, more effective way (Schezle, 2019). People infected with tuberculosis on antibiotics must take multiple over many months due to the bacteria being susceptible to the drugs when they break out of the macrophage in which they were born and search out a new one to invade (Schezle, 2019). These chemists take antibiotics produced by fish, and experiment with peptides binding to copper atoms. They enable the copper to shift its electrical charge, with the ability to become aggressive, ripping electrons away from some molecules and adding them to oxygen-containing molecules (Schezle, 2019). The oxygen-containing molecules become free radicals, that attack anything they encounter, including Mycobacteria (Schezle, 2019). The antibiotic peptide developed kills Mycobacteria living in macrophages in the lab, but they haven’t been able to cure tuberculosis in mice yet. These peptide drugs have various problems the chemist is currently working through. The research is continuing to progress to get this drug to fight tuberculosis and relieve those suffering through months of changing antibiotics.

Conclusion

Both latent and active tuberculosis affects the respiratory system, although latent may remain dormant in the lobes until the immune system is weak and active tuberculosis shows. Forms of tuberculosis can be treated with antibiotics, multiple may have to be used due to the body developing drug resistance to those antibiotics over long periods of time. Signs and symptoms may be present in active, while latent tuberculosis patients may have no symptoms. A skin test can be done, and results provided within a three-day time frame. Future testing may be required, such as culture and x-ray. Due to current research being conducted, a new treatment may arise and those suffering from tuberculosis may get treatment in a proper care setting. Tuberculosis affects the respiratory system, which is a vital system of the body needed to maintain normal homeostasis properties and keep the human healthy