Coughing and Shortness of Breath


A.    Problem Background

Coughing and shortness of breath are clinical signs based on disorders of the respiratory tract. Both are not diseases, but are manifestations based on diseases that attack the respiratory tract. Diseases that can cause coughing and shortness of breath are very much ranging from infections, allergies, inflammation and even malignancy. So poly once the patient who arrives to the doctor because of these two complaints. Therefore it is very important for us to know the pathophysiology and clinical review based on both.

In this report the first author on the literature review will discuss the basics of the respiratory system. Then continued using the pathophysiology of coughing and shortness of breath. Next in the discussion the author will do an analysis on the scenario. May the writing &making of this report receive pleasure based on the God of the Lord of the Universe.

History: women aged 20 years, previously cleaned shelves full of dust; The oldest brother of a chronic lung disease using an X-ray image of honeycomb appereance, without wheezing

Main complaint: cough does not decrease since three days, since today phlegm & shortness of breath.

Management: 2 drugs using out-of-sync functions.

1. What diseases do patients suffer from?

two.      What is the mechanism of coughing and shortness of breath?

three.      What is the mechanism of the symptoms contained in the scenario?

4. How is this problem organized?

Students can reveal the basic sciences of respiration including anatomy, physiology, &histology.

two.      Students are able to explain the symptoms &sign of respiratory system disease.

Students can reveal the mechanism of cell/organ abnormalities in the disease of the respiratory system.

It can help students know & achieve the goal of learning block respiration system.

Anatomy, Physiology, and Histology of the Respiratory System

In general, the respiratory airways are as follows: from the anterior nares to the nasal cavitas, choanae, nasopharynx, larynx, trachea, bronchus primarius, bronchus secundus, bronchus tertius, bronchiolus, bronchiolus, bronchiolus terminalis, bronchiolus respiratorius, ductus alveolaris, atrium alveolaris, sacculus alveolaris, then ended in alveolus loka air exchange (Budiyanto, et al, 2005).

Tractus respiratorius is divided into two parts: (1) conduction zone, based on nostrils to terminal bronciolus, (2) respiratory zones, ranging from respiratory bronciolus to alveolus. The conduction zone serves as a warming, moisturizer, and respiratory air filter. Respiratory zone for gas exchange (Guyton, 1997).

Respiration consists of two procedures, namely a new view & expiration. When the costa wangsit is attracted to the cranial using the axis on the articulatio costovertebrale, the diaphragm contracts down to the caudal, so that the thorax cavity expands, and the air enters due to the pressure on the thorax cavity that expands to be lower according to the outside air pressure. While expiratory is the opposite based on wangsit (Ganong, 1999).

Respiration involves regular muscles and auxiliary muscles. Regular muscles work in normal breathing, while auxiliary muscles or auxiliar work when breathing is tight. Regular muscle inspiration: m. Intercostalis externus, m. Levator costae, m. The posterior serratus is superior, and m. Intercartilagineus. Otot auxiliar ilham : m. Scaleni, m. Sternocleidomastoideus, m. Pectoralis mayor et minor, m. Latissimus dorsi, m. Serrarus anterior. Regular muscle expiration: m. Intercostalis internus, m. Subcostalis, m. Tranversus thorachis, m. Serratus is posteriorly inferior. Auxiliar muscle of expiration: m. Obliquus externus et internus abdominis, m. Tranversus abdominis, m. Rectus abdominis (Syaifulloh, et al, 2008).

Histologically, the airway is composed of epithelium, goblet cells, kelanjar, cartilage, smooth muscle, and elastin. Epithelium from fossa nasalis to bronchus is a stratified peacock, while afterwards is the spis of ciliated cabbage. Many goblet cells are still present in the nasal fossa to large bronchus, while thereafter a little to non-existent. Cartilage in horseshoe-shaped trachea, in bronchioles is not found and there are many elastins (Carlos Junqueira, et al., 1998).

Signs and Symptoms of Respiratory Disorders

Dyspnea or shortness of breath is a feeling of difficulty breathing characterized by shortness of breath & use of breathing muscles. Dyspnea can be found in cardiovascular disease, pulmonary embolism, interstitial or alveolar lung disease, chest wall disorders, obstructive pulmonary disease (emphysema, bronchitis, asthma), anxiety (Price and Wilson, 2006).

Lung parenchym is insensitive to pain, and most lung diseases do not cause pain. Pleura parietalis is sensitive, & inflammatory diseases in the pleura parietalis cause chest pain.

Coughing is a common sign of respiratory illness. This is caused by (1) stimulation of the cough reflex of the foreign body that enters into the larink, (two) the accumulation of secretions in the lower respiratory tract. Chronic bronchitis, asthma, tuberculosis, and pneumonia are diseases with striking signs of cough (Chandrasoma, 2006).

Examination of sputum / sputum is very useful for evaluating lung disease. The preparation of the smear gr and the sputum breed are useful for assessing the presence of infection. Cytology examination for malignant cells. In addition, according to the hue, volume, consistency, &origin of the sputum can be identified the type of disease.

Hemoptys is coughing up blood or sputum using a small amount of blood. Recurrent hemoptycils is generally still present in acute or chronic bronchitis, pneumonia, bronchogenic carcinoma, tuberculosis, bronchiectasis, and pulmonary embolism.

Tabuh finger is a normal shape change falanx distal &kuku hand &toe, characterized by loss of nail angle, smooth hollow taste at the base of the nail, and fingertips as akbar. These signs are found in tuberculosis, lung abscesses, lung cancer, cardiovascular disease, chronic liver disease, or the digestive tract. Cyanosis is the change in skin color to bluish due to the increasing amount of Hb reduced to capillaries (Price &Wilson, 2006).

Wet ronki in the form of intermittent, nonmusical, and short breath sounds, which is a hint of increased secretion in the large airway. It is found in pneumonia, fibrosis, heart failure, bronchitis, bronchiectasis. Wheezing in the form of constant sounds, musicals, high notes, long duration. Wheezing can occur when the air genre quickly passes through a flat/narrowed airway. Found in asthma, chronic bronchitis, CPOD, heart disease. Stridor is a wheezing sound when the view is new &thorough. It sounds louder on the neck than on the chest wall. This indicates partial obstruction in the larink or trachea. Pleural rub is the sound of inflammatory pleura. Sounds similar to rough wet ronki and poly (Reviono, et al, 2008).

Mechanism & management of cough


Coughing can be triggered reflexively or intentionally. As a self-defense reflex, coughing is determined by the sarad afferent &efferent pathway. Coughing begins using inspiration followed by glottis closure, relaxation of the diaphragm, and muscle contractions against the closing glottis. The result will be a positive pressure in the intratoracs that causes narrowing of the trachea. Once the glottis opens, a large pressure difference between the airways and the outer air along with the narrowing of the trachea will form the flow of air through the trachea. This explosive force will “sweep” the secretions and foreign bodies contained in the airway. (Ikawati, 2008)

1. Irritants: Irritants that enter through inhalation will stimulate cough receptors. Cough receptors are present in the larynx to the bronchi. While in the bronchioles and the distal part of it has not been found again.

2. Inflammation: In inflammatory cough receptors will be easier to activate the irritant, making it easier to cough.

4. Compression. (Ikawati, 2008)

– Management

For acute coughs & subacute that are common can generally heal using itself without pharmacological therapy. In addition, for prevention can use avoiding cough triggers. For pharmacological therapy we can use

1. Antitussive: Works by suppressing cough receptors.

2. Expectorant: Intended to stimulate coughing so as to facilitate the production of sputum.

three. Mucolytic: Works to lower the viscosity of the mucous, as a result of which facilitates expectoration. (Ikawati, 2008)

Etiology & Pathophysiology of Shortness of Breath

Things that can cause shortness of breath include:

two. Increased breathing work.

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