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The 7 Most Common Types of Respiratory Disease

Cystic fibrosis, lung cancer, tuberculosis.

The most common respiratory diseases are asthma, chronic obstructive pulmonary disease, cystic fibrosis, lung cancer, tuberculosis, bronchitis, and pneumonia.

Some respiratory diseases are acute, like an infection that will get better with treatment, while others are or become chronic and need to be managed.

This article will look at the seven most common respiratory diseases, their symptoms, diagnosis, and what causes them.

Verywell / Joules Garcia

Asthma affects 25 million people in the United States. People with a family history of asthma, respiratory allergies , or severe childhood respiratory illness are at a higher risk of developing asthma.

Asthma is a chronic inflammatory disease that causes breathing problems when the airways become narrowed by inflammation or blocked by mucus. The condition’s severity varies from person to person, but most people take daily preventive medication to control their symptoms and prevent flare-ups.

Asthma can have several symptoms, including:

• Tightness in the chest
• Shortness of breath

Diagnosing asthma begins with taking a health history. If your healthcare provider suspects asthma, you may undergo a breathing test called spirometry. This test measures how much air you exhale and how fast you exhale.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe two primary types of obstructive lung disease that used to be classified separately: emphysema and chronic bronchitis.

• Emphysema develops when the tiny air sacs in the lungs ( alveoli ) become damaged and less elastic. As these air sacs become damaged and die off, your lungs have fewer working parts to move oxygen from the air you breathe into your blood. This can lead to a lack of oxygen in the blood (hypoxia) and a buildup of toxic waste products. Smoking is a leading contributor to emphysema, but exposure to other pollutants and chemicals can also cause it. Age and obesity are also risk factors for emphysema.
• Chronic bronchitis is a condition where the lining of the bronchial tubes becomes irritated and inflamed. The swelling can make it more difficult to breathe and cause an overproduction of mucus. With chronic bronchitis , the inflammation is caused by repeated exposure to irritants like cigarette smoke or pollution. Chronic bronchitis does not go away. You may have periods of relief along with periods where it gets worse (exacerbations), especially if you get a cold or another respiratory infection.

Nearly 15 million people have been diagnosed with COPD in the United States, and another 12 million are believed to have the disease but do not have an official diagnosis.

COPD is the fourth leading cause of death in the United States. About eight in 10 cases are linked to exposure to cigarette smoke.

The symptoms of COPD vary based on which type you have. Common symptoms can include:

• Frequent coughing
• A cough that produces a lot of mucus
• Shortness of breath that gets worse with activity
• A whistling or squeaking sound when you breathe
• Tightness in your chest
• Sensitivity to respiratory infections like colds or the flu
• Weight loss
• Swelling in your legs and feet
• A blue tinge to your lips or fingernails (cyanosis)

To diagnose COPD, your healthcare provider will take your health history and conduct a health exam. If COPD is suspected, they may order lung function tests, such as:

• Chest X-ray
• Computed tomography (CT) scan
• Alpha-1 test

Cystic fibrosis (CF) is a genetic condition that affects about 35,000 people in the United States. It can cause both breathing and digestive problems because the disease makes the mucus in the body very thick.

While the disease can involve several organs, it tends to cause specific problems in the lungs, such as blockages from thick mucus that trap harmful bacteria and lead to infections.

Since cystic fibrosis can affect many parts of the body, a wide range of symptoms can develop, such as:

• A cough that does not go away
• A cough that produces thick mucus or blood
• Frequent respiratory or sinus infections
• Nasal polyps
• Slow growth in childhood or poor weight gain
• Constipation
• Greasy or foul-smelling stools

A diagnosis of CF is usually made early in life because newborns in the United States are screened for the disease. If a diagnosis is not made at birth, symptoms that occur in childhood can lead to the diagnosis later on.

Newborn screening looks for high levels of the enzyme immunoreactive trypsin. Cystic fibrosis can also be diagnosed with other tests such as:

• Genetic testing
• Nasal potential difference

Lung cancer is one of the most common types of cancer, ranking third in the United States with more than 218,000 people affected. It can develop as either small cell lung cancer or non-small cell lung cancer. The latter is the more common of the two.

Cigarette smoking—both direct and secondhand—is one of the biggest risk factors for lung cancer.

Lung cancer can develop gradually and often with no symptoms. When it does appear, symptoms may include:

• Chronic cough
• Difficulty breathing
• Fatigue or weakness
• Difficulty swallowing
• A cough that produces bloody mucus
• Swelling in the face or neck

Your healthcare provider will note your symptoms and medical history, then order imaging tests, which may include:

• Positron emission tomography (PET) scan

If something suspicious is found on imaging tests, you may need further testing to confirm the diagnosis. This may include:

• Sputum cytology
• Endobronchial ultrasound (EBUS)
• Endoscopic esophageal ultrasound (EUS)
• Mediastinoscopy/mediastinotomy
• Thoracentesis

Tuberculosis is a bacterial lung disease caused by Mycobacterium tuberculosis . More than 1.8 billion people around the world have tuberculosis, but the disease is only considered active in 10 million of them.

People with strong immune systems sometimes carry an inactive form of the disease, called latent tuberculosis. In people with weaker immune systems, the bacteria attacks lung tissue. It can also spread and cause damage to other parts of the body.

Many respiratory diseases share symptoms, such as long-term cough. Certain symptoms are specific to one disease or another. For example, night sweats tend to occur in people with tuberculosis.

Other tuberculosis symptoms include:

• A cough that lasts longer than three weeks
• Poor appetite
• A cough that brings up blood or mucus
• Night sweats

Tuberculosis may be suspected if you've lived or recently traveled to a place where TB spreads. Your healthcare provider may also listen to your lungs and check to see if the lymph nodes in your neck are swollen. To confirm TB, your healthcare provider may order a skin or blood test.

If TB is confirmed, further testing may include:

• Sputum test

Bronchitis is a condition that develops when the windpipe ( bronchial tube ) gets irritated or inflamed. In response to the inflammation, the lining of the bronchial tube may make too much mucus as it tries to coat the area. The mucus can make it difficult to breathe.

Inflammation can also cause swelling of the airway. This will cause it to narrow and make it harder to breathe. In acute bronchitis, the inflammation is usually caused by an infection that will get better in a few days to several weeks .

Chronic bronchitis falls under the umbrella of COPD. Acute bronchitis is not considered COPD, but it shares symptoms with the chronic form of the disease. These symptoms include:

• A frequent cough that produces mucus
• Shortness of breath (especially with activity)
• Fever (acute bronchitis only)

Most of the time, acute bronchitis is diagnosed with a basic health exam. In some cases, a healthcare provider may want to order a chest X-ray to rule out pneumonia.

If your healthcare provider suspects a bacterial infection is causing your symptoms, they may order a sputum test.

Pneumonia is a generic diagnosis. Even though there are different types of pneumonia, the way that the condition affects the lungs is similar in each one.

With pneumonia, a virus, bacteria, or another infectious agent causes the tiny air sacs in the lungs ( alveoli ) to fill with fluid or pus. These air sacs are what help exchange oxygen and other gases between the air that is breathed in and the blood. When these sacs are filled with fluid, the body’s ability to exchange gases is reduced.

The several types of pneumonia are:

• Mycoplasma (also called “walking pneumonia”)

In some types of pneumonia, such as walking pneumonia, the symptoms can be mild and not affect daily activities. However, the symptoms of pneumonia can be severe and, in some cases, will require hospitalization.

Common symptoms of pneumonia are:

• A cough that produces phlegm
• Chest pain when you cough or breathe

Before diagnosing pneumonia, your healthcare provider will ask about your medical history, including places you may have traveled and any exposure to viruses you may have had. They will also listen to your lungs. If pneumonia is suspected, they may order tests such as:

• Blood tests

People who are hospitalized with severe symptoms may need additional testing such as:

• Arterial blood gas test
• Pleural fluid culture
• Bronchoscopy

There are several types of lung diseases that can affect your breathing and cause chronic symptoms like cough. Many of these diseases share symptoms.

If you have a cough that won’t go away or you are experiencing frequent shortness of breath, call your healthcare provider. They can do testing to confirm what type of lung disease is causing your respiratory problems and may refer you to a doctor that specifically treats lung disease ( pulmonologist ).

Office of Disease Prevention and Health Promotion. Respiratory diseases .

American Lung Association. Testing for asthma .

MedlinePlus. COPD .

MedlinePlus. Emphysema .

American Lung Association. Diagnosing COPD .

Centers for Disease Control and Prevention. Cystic fibrosis .

American Lung Association. Cystic fibrosis symptoms and diagnosis .

Centers for Disease Control and Prevention. Cancer statistics at a glance .

MedlinePlus. Lung cancer .

American Lung Association. Lung cancer diagnosis .

American Lung Association. Learn about tuberculosis .

MedlinePlus. Tuberculosis .

American Lung Association. Tuberculosis symptoms and diagnosis .

MedlinePlus. Chronic bronchitis .

MedlinePlus. Acute bronchitis .

American Lung Association. Bronchitis symptoms, diagnosis and treatment .

MedlinePlus.  Routine sputum culture .

MedlinePlus. Pneumonia .

American Lung Association. Pneumonia symptoms and diagnosis .

By Rachael Zimlich, BSN, RN Zimlich is a critical care nurse who has been writing about health care and clinical developments for over 10 years.

104 Respiratory Disorders Essay Topic Ideas & Examples

🏆 best respiratory disorders topic ideas & essay examples.

• ⭐ Simple & Easy Respiratory Disorders Essay Titles

👍 Good Essay Topics on Respiratory Disorders

💡 most interesting respiratory disorders topics to write about.

• The Respiratory Therapy Program Respiratory therapists assess the work of the medical equipment and consult patients helping them to use the equipment effectively. The RCP should be a certified specialist who is eager to self-develop.
• Acute Respiratory Insufficiency: Key Concepts It is characterized by hypocapnia and respiratory alkalosis, which leads to a shift of the oxyhemoglobin dissociation curve to the left. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Drugs Affecting the Respiratory System: Bronchodilators The focus of this report is the consideration of only the chemical properties of the drugs including metaproterenol sulfate, dyphylline, prednisolone, albuterol, salmeterol xinafoate, and theophylline.
• Acute Respiratory Distress Syndrome Consequently, this article widens the perspective on the causes and effects of the condition to enable the development of appropriate therapies to directly target the affected regions of the chest cavity.
• Diagnosing a Child With Upper Respiratory Infection I will encourage the father to make sure the child drinks plenty of water and remain hydrated with non-caffeinated fluids to soothe the throat.
• How the Respiratory System Works to Adjust Blood pH Specifically, the extent of Ph in the bloodstream is defined by the presence of carbon dioxide in the blood. Consequently, the functioning of the respiratory system determines the levels of Ph in a patient’s blood.
• Extreme Obesity as a Risk Factor of Respiratory Disability One of the most widespread risk factors that perturb the prevalence of respiratory impairment is extreme obesity. In conclusion, extreme obesity is a dangerous condition that may pose as a threat to the life of […]
• Respiratory Syncytial Virus Infection (RSV) There is a lack of relevant clinical data regarding the prevalence of RSV and the accompanying mortality rates, although RSV is one of the leading causes of death in infants.
• Pollution and Respiratory Disease in Louisiana The United States of America is an industrial powerhouse, a powerful nation that devoted much of its time to the growth and development of the petrochemical industry.
• Cold Respiratory Illness: The Case Study In other words, the patient’s illness is due to the development of a pathogen in the respiratory tract, but careful attention should be paid to the accompanying signs of illness to determine the nature of […]
• Comparison of Respiratory Disorders  
• Family Nurse Practitioner Case Study: Respiratory Additional data in the form of clinical findings is needed to confirm the diagnosis of the respiratory impairment. The drug use for the treatment of asthma varies according to the differing physiologic status of the […]
• Rationale of Antibiotic Treatment for Patients With Upper Respiratory Infections At the same time, there are multiple studies that indicate inappropriate use of antibiotics for the treatment of upper respiratory infections that may lead to antibiotic resistance in the future.
• Acute Respiratory Sickness: Preliminary Care Coordination Plan In this case, the insufficiency of the supply risks failure and significant damage to the appendages hence the importance of assessing the dynamic conditions that negatively affect the health index.
• How Outbreaks of Respiratory Disease Affect the Way Mass Events Are Held Indoors On the one hand, public health is one of the critical aspects of stopping the strong upward respiratory disease trend. Eventually, public health managers should promote their special goal by presenting to society a relatively […]
• Environmental Health: Seven-Year Respiratory Illness The fact that the illness appeared not shortly after she started to work in an old house makes us suppose that the cause of the health issue lies in the environment.
• Conscious Sedation: Preventing Respiratory Complications in Patients Sedation exists in a continuum. Producing an appropriate depth of sedation is required to avoid respiratory complications.
• International Outbreak – Respiratory Syndrome Coronavirus The first reports of cases of a new coronavirus infection appeared in the city of Wuhan in the PRC at the end of December 2019.
• Environmental Health of Patient With Respiratory Illness To assess the client’s risk, it is imperative to evaluate the quality of the air at the place of her residence and at work, as well as determine whether there are any substances in the […]
• Severe Acute Respiratory Syndrome: The Case of Singapore Severe Acute Respiratory Syndrome (SARS) is a recently emerged viral disease associated with severe symptoms of distress in the lower respiratory tract.
• The Identification of Respiratory Viruses First and foremost, it is essential to point out the criteria that will be applied to the analysis of the manual identification kits.
• Respiratory Tract Infections LRTIs are usually viral in origin, and the pathogens that cause pneumonia and bronchitis include S.pneumonia, H.influenza, M.catarrhalis, S.aureus, and Klebsiella pneumonia. The H5N1 subtype of the influenza virus can have the most serious negative […]
• Respiratory Distress Syndrome and Pulmonary Embolism According to Stein, morbidity of the population and age are the two main factors that enhance the development of pulmonary embolism. The clotting of blood around the region of pulmonary vasculature is the main cause […]
• Trauma Patients Suffering From Adult Respiratory Distress Syndrome Nurses can do this by “following the guidelines of FASTHUG and BANDAIDS as they provide opportunities in giving care to multi trauma patients with ARDS”.
• The Acute Respiratory Failure: Management and Treatment Other criteria include some level of oxygen malfunction, employment of variable intervals of ventilator support and the respiratory factor of the Sequential Organ Failure Assessment score.
• Asthma Respiratory Disorder Treatment Asthma etiology is the classification of various risk factors responsible for causing asthma in children and adults. Asthma etiology is the scientific classification of risk factors that cause Asthma in children and adult.
• Microbiology. Severe Acute Respiratory Syndrome At the onset of the disease outbreak, the immediate number of death cases amounted to 774. The most notable spread of the disease is through the air.
• Pharmacotherapy for Respiratory Disorders: Emphysema As a result, the infection reduces the amount of air reaching the bloodstream. The efficacy of interventions used by NPs to manage emphysema is affected by, among others, the behavior patterns of the patient.
• Respiratory Isolation Teaching for Tuberculosis The patients and their family members should be provided with the right information and guidelines on how to organize the appropriate isolation rooms and maintain the patient in order to prevent the spread of the […]
• Respiratory Alterations The former affects organs that include the nose, the ear, the larynx, and the pharynx while the former affects the bronchi, the trachea and the lungs.
• Chronic Respiratory Illness, Pneumonia and Indigenous Health The IHCWs partner with non-indigenous health professionals such as nurses to improve the health care and minimize the impacts of communication barriers in the performance of their duties.
• Respiratory Syncytial Virus: Treatment and Prognosis It comes about seasonally and commences in the course of the fall and stretches in to the spring. A drug that has been approved to be used in the prevention of the RSV infection is […]

⭐ Simple & Respiratory Disorders Essay Titles

• Pharmacotherapy for Respiratory Disorders The primary reason for the emergence and development of the condition is the behavior that includes regular cigarette smoking or the inhalation of the byproducts of smoking. Secondhand smoke is also deadly and directly related […]
• Non-invasive Ventilation in Non-Chronic Obstructive Pulmonary Disease Respiratory Failure The formulated hypothesis is as follows: the application of NIV in the adjunctive treatment of non-COPD patients will help to reduce the need for ETI, the length of stay at intensive care unit, and the […]
• Recent Advances in Respiratory Care For Neuromuscular Disease The aim of mechanical ventilation is to assist the weak respiratory muscles in producing the mechanical events needed for respiration, thus preventing hypoxemia and respiratory acidosis.
• Severe Acute Respiratory Syndrome in Hong Kong China’s Ministry of Health informed WHO in mid- February 2003 of the occurrence in Guangdong province of 305 cases of “atypical pneumonia” and reported that the spread of the illness was “under control”.
• Respiratory Therapist Responsibilities The role of a respiratory therapist include providing oxygen support, cardiopulmonary resuscitation, overseeing of the functioning of mechanical ventilators, medication of drugs for the lungs as well as ratting the functioning of the lungs.
• Respiratory Therapy as a Professional Field The therapists engaged in home healthcare have to move recurrently to the residences of their patients. Additionally, progress in treating sufferers of heart attacks, mishap victims, and untimely infants will boost the requirement for the […]
• Severe Acute Respiratory Syndrome: Time Series Modeling Its believed that one of the set backs in solving the serious Hong Kong problem was to ensure proper health care for those who were invested, and also solving the peoples fear of SARS which […]
• Croup. Respiratory Alterations and Management Croup is a disorder that affects children and is distinguished by a “barking” cough developed as a result of an infection of the trachea.
• Respiratory Disorders: Pharmacotherapy The treatment of this condition differs from that of the common cold because a person can only slow the progression of symptoms down or relieve them.
• Respiratory System Examination in Children The RS consists of the lungs, which maintain the continuous flow of oxygen and remove gaseous products from the human body.
• Mismanagement at Respiratory Hospital Departments A particular focus of the current research is nursing management issues in the departments of respiratory therapy. Do they find it necessary to replace managers with specialists in the sphere of respiratory disease?
• Respiratory Tract Infections Under Investigations RTIs are prevalent among the elderly due to the existence of chronic conditions and deterioration of health. Acute sinusitis and bronchitis are some of the most common cases of RTIs that contribute to the abuse […]
• Pulmonary Rehabilitation for Chronic Respiratory Disease This statement holds significant clinical relevance to exercise science since it recognizes pulmonary rehabilitation and the use of various exercise training methods as a medically proven and effective method of treating symptoms in patients with […]
• Respiratory Disorder and Nursing Treatment Plan With the patient describing such symptoms of a deep cough, the production of mucous, green sputum, and scratchy throat, it is recommended to proceed with the treatment for acute bronchitis.
• Respiratory Care of Thoracic Injuries Besides, the existence of the given problem conditions the rapid evolution of the spheres and tools that are aimed at the provision of help and assistance for those who suffered from the road traffic accident […]
• Severe Acute Respiratory Syndrome Epidemic A histological analysis of SARS will be developed to clarify the main signs and symptoms of the disease, its epidemiology and etiology, the histological changes, and the existing treatments.
• Respiratory Care Practice Advancement It provides information in numerous fields, including courses for respiratory therapists, created by experts in the field of respiratory care education, research, and management, for the purpose of increasing the students’ depth of knowledge.
• Mismanagement at Hospital Respiratory Units An example of the employment of grounded theory is the study by Mishra, Gupta, and Bhatnagar focused on the exploration of work-family enrichment.
• Deadspace Ventilation and Acute Respiratory Distress Syndrome The clinical importance of Deadspace Ventilation is the lack of physiologic benefit of the energy utilized to move the gas. Inefficient and inadequate flow of pulmonary blood results to an increase in dead space ventilation […]
• Air Pollution and Respiratory Illnesses in Nigeria The purpose of the article presented was to test the relationship of the respiratory system illness and air pollution in developing countries, especially in Africa.
• Patients with Acute Respiratory Failure The experimental character of the study can be proven by the following arguments: it involves an intervention; the impact of the intervention is the main focus of the study; the research is prospective; it tests […]
• What Is Severe Acute Respiratory Syndrome? According to McBride and Fielding, most of the protein functions of the genome products of the virus have been elucidated and are well known.
• Intubation and Mechanical Ventilation of the Asthmatic Patient in Respiratory The title of the article gives a clear idea of the research question to be investigated. The authors have detailed the processes of intubation and mechanical ventilation in patients with acute asthma.
• Uses of the Internet and Mobile Devices During the Severe Acute Respiratory Syndrome (SARS) Epidemic in 2003 in the PRC Of greater focus in the paper is the exploration of the socio-economic and political factors in as far as the spread and control of the disease is concerned and how communication was advanced in the […]
• Severe Acute Respiratory Syndrome The approximate incubation period of the disease is 2- 10 d. This proves that the hope of developing a secure and effective vaccines.
• Effects of PCBs on the Immune System, the Respiratory System, and the Liver PCBs are among the most dangerous persistent organic toxicants in the environment that have been known to adversely affect the health of humans, animals, and the environment.
• Association Between Dust Events In United Arab Emirates And Respiratory Diseases It has also discussed some of the diseases associated with dust events in UAE and their potential effects to this society.
• Association Between Respiratory Diseases and Dust Events in United Arab Emirates The scope of the study is to establish the relationship between respiratory diseases and dust events in the UAE. The aim of the study is to investigate the association between dust events in UAE and […]
• The Association Between Dust Incidents and Respiratory Diseases in Abu Dhabi In spite of the fact the main cause for the development of the chronic respiratory diseases is determined by the researchers as the climatic peculiarities and the frequent occurrence of dust and sand storms, the […]
• Action of Nandrolone on the Cardiovascular, Renal, Blood and Respiratory Systems Nandrolone is one of the most common performance enhancement drugs. Nandrolone is one of the major performance enhancing drugs that athletes use.
• Severe Acute Respiratory Syndrome Issues The main aim of these immune responses is to eradicate both host cells and virus particles involved. Particles of the virus contained in transmitted respiratory droplets are the main cause of the disease.
• Connection Between Respiratory Diseases and Environmental Variables A study on the Asian sand dust found elements of quartz, which is reported to cause inflammatory reactions in the lungs due to the presence of cytokines.
• Correct Classification of Respiratory Disorders
• Interventions for Respiratory Disorders
• The Respiratory Disorders Prevention Zone
• Diagnosis and Treatments of Respiratory Disorders
• Impact of Air Pollution on Respiratory Disorders
• Physical Assessment of Respiratory Disorders
• New Treatments for Respiratory Disorders
• The Most Common Types of Respiratory Disorders
• Symptoms That May Occur With Respiratory Disorders
• Predicting Respiratory Disorders Using Clinical Indexes
• Respiratory Disorders and Nursing Students
• Acute and Chronic Respiratory Disorders
• Factors in the Development of Respiratory Disorders
• Core Measure for Respiratory Disorders
• Novel Platforms for the Development of Universal Therapy for Respiratory Disorders
• The Danger of Respiratory Disorders
• Host-Directed Therapeutic Strategies for Respiratory Disorders
• Modeling of Respiratory Disorders for Online Monitoring
• Prevention of Respiratory Disorders in the Intensive Care Unit
• Respiratory Disorders and Its Effects on the Human Body
• Pharmacological Treatment of Respiratory Disorders
• Common Clinical Presentations of Respiratory Disorders
• Respiratory Disorders, Their Distribution, and Impact
• Relationships Between Respiratory Disorders and Air Pollution
• Respiratory System: Functions, Facts, Organs & Respiratory Disorders
• The Relationship Between Respiratory Disorders and Congestive Heart Failure
• Morphological Classification of Respiratory Disorders
• Modeling Spatial Patterns of Respiratory Disorders in Sweden
• Pathology of Respiratory System Disorders
• Social Implications for Patients With Respiratory Disorders
• Common Myths About Respiratory Disorders
• Advances in the Study of Respiratory Disorders in Lung Cell Culture
• Treatment and Psychosocial Aspects of Respiratory Disorders
• Nursing Interventions for Respiratory Disorders
• Respiratory Disorders Among Native Americans
• Respiratory Disorders Modeling in the United States
• General Strategies for Protection Against Respiratory Disorders
• Health Options for Acute Severe Respiratory Disorders
• Nutritional Applications That Help Fight Against Respiratory Disorders
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High school biology

Course: high school biology   >   unit 8.

• Meet the heart!
• Circulatory system and the heart
• The circulatory system review
• Meet the lungs!
• The lungs and pulmonary system

The respiratory system review

• The circulatory and respiratory systems

The respiratory system

Common mistakes and misconceptions.

• Physiological respiration and cellular respiration are not the same. People sometimes use the word "respiration" to refer to the process of cellular respiration, which is a cellular process in which carbohydrates are converted into energy. The two are related processes, but they are not the same.
• We do not breathe in only oxygen or breathe out only carbon dioxide. Often the terms "oxygen" and "air" are used interchangeably. It is true that the air we breathe in has more oxygen than the air we breathe out, and the air we breathe out has more carbon dioxide than the air that we breathe in. However, oxygen is just one of the gases found in the air we breathe. (In fact, the air has more nitrogen than oxygen!)
• The respiratory system does not work alone in transporting oxygen through the body. The respiratory system works directly with the circulatory system to provide oxygen to the body. Oxygen taken in from the respiratory system moves into blood vessels that then circulate oxygen-rich blood to tissues and cells.

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16.2: Structure and Function of the Respiratory System

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• Page ID 16817

• Suzanne Wakim & Mandeep Grewal
• Butte College

Seeing Your Breath

Why can you “see your breath” on a cold day? The air you exhale through your nose and mouth is warm, like the inside of your body. Exhaled air also contains a lot of water vapor because it passes over moist surfaces from the lungs to the nose or mouth. The water vapor in your breath cools suddenly when it reaches the much colder outside air. This causes the water vapor to condense into a fog of tiny droplets of liquid water. You release water vapor and other gases from your body through the process of respiration.

What is Respiration?

Respiration is the life-sustaining process in which gases are exchanged between the body and the outside atmosphere. Specifically, oxygen moves from the outside air into the body; and water vapor, carbon dioxide, and other waste gases move from inside the body into the outside air. Respiration is carried out mainly by the respiratory system. It is important to note that respiration by the respiratory system is not the same process as cellular respiration that occurs inside cells, although the two processes are closely connected. Cellular respiration is the metabolic process in which cells obtain energy, usually by “burning” glucose in the presence of oxygen. When cellular respiration is aerobic, it uses oxygen and releases carbon dioxide as a waste product. Respiration by the respiratory system supplies the oxygen needed by cells for aerobic cellular respiration and removes the carbon dioxide produced by cells during cellular respiration.

Respiration by the respiratory system actually involves two subsidiary processes. One process is ventilation or breathing. This is the physical process of conducting air to and from the lungs. The other process is gas exchange. This is the biochemical process in which oxygen diffuses out of the air and into the blood while carbon dioxide and other waste gases diffuse out of the blood and into the air. All of the organs of the respiratory system are involved in breathing, but only the lungs are involved in gas exchange.

Respiratory Organs

The organs of the respiratory system form a continuous system of passages called the respiratory tract, through which air flows into and out of the body. The respiratory tract has two major divisions: the upper respiratory tract and the lower respiratory tract. The organs in each division are shown in Figure \(\PageIndex{2}\). In addition to these organs, certain muscles of the thorax (the body cavity that fills the chest) are also involved in respiration by enabling breathing. Most important is a large muscle called the diaphragm, which lies below the lungs and separates the thorax from the abdomen. Smaller muscles between the ribs also play a role in breathing. You can learn more about breathing muscles in the concept of Breathing .

Upper Respiratory Tract

All of the organs and other structures of the upper respiratory tract are involved in the conduction or the movement of air into and out of the body. Upper respiratory tract organs provide a route for air to move between the outside atmosphere and the lungs. They also clean, humidity, and warm the incoming air. However, no gas exchange occurs in these organs.

Nasal Cavity

The nasal cavity is a large, air-filled space in the skull above and behind the nose in the middle of the face. It is a continuation of the two nostrils. As inhaled air flows through the nasal cavity, it is warmed and humidified. Hairs in the nose help trap larger foreign particles in the air before they go deeper into the respiratory tract. In addition to its respiratory functions, the nasal cavity also contains chemoreceptors that are needed for the sense of smell and that contribute importantly to the sense of taste.

The pharynx is a tube-like structure that connects the nasal cavity and the back of the mouth to other structures lower in the throat, including the larynx. The pharynx has dual functions: both air and food (or other swallowed substances) pass through it, so it is part of both the respiratory and digestive systems. Air passes from the nasal cavity through the pharynx to the larynx (as well as in the opposite direction). Food passes from the mouth through the pharynx to the esophagus.

The larynx connects the pharynx and trachea and helps to conduct air through the respiratory tract. The larynx is also called the voice box because it contains the vocal cords, which vibrate when air flows over them, thereby producing sound. You can see the vocal cords in the larynx in Figure \(\PageIndex{3}\). Certain muscles in the larynx move the vocal cords apart to allow breathing. Other muscles in the larynx move the vocal cords together to allow the production of vocal sounds. The latter muscles also control the pitch of sounds and help control their volume.

A very important function of the larynx is protecting the trachea from aspirated food. When swallowing occurs, the backward motion of the tongue forces a flap called the epiglottis to close over the entrance to the larynx. You can see the epiglottis in Figure \(\PageIndex{3}\). This prevents swallowed material from entering the larynx and moving deeper into the respiratory tract. If swallowed material does start to enter the larynx, it irritates the larynx and stimulates a strong cough reflex. This generally expels the material out of the larynx and into the throat.

Lower Respiratory Tract

The trachea and other passages of the lower respiratory tract conduct air between the upper respiratory tract and the lungs. These passages form an inverted tree-like shape (Figure \(\PageIndex{4}\)), with repeated branching as they move deeper into the lungs. All told, there are an astonishing 1,500 miles of airways conducting air through the human respiratory tract! It is only in the lungs, however, that gas exchange occurs between the air and the bloodstream.

The trachea, or windpipe, is the widest passageway in the respiratory tract. It is about 2.5 cm (1 in.) wide and 10-15 cm (4-6 in.) long. It is formed by rings of cartilage, which make it relatively strong and resilient. The trachea connects the larynx to the lungs for the passage of air through the respiratory tract. The trachea branches at the bottom to form two bronchial tubes.

Bronchi and Bronchioles

There are two main bronchial tubes, or bronchi (singular, bronchus) , called the right and left bronchi. The bronchi carry air between the trachea and lungs. Each bronchus branches into smaller, secondary bronchi; and secondary bronchi branch into still smaller tertiary bronchi. The smallest bronchi branch into very small tubules called bronchioles. The tiniest bronchioles end in alveolar ducts, which terminate in clusters of minuscule air sacs, called alveoli (singular, alveolus), in the lungs.

The lungs are the largest organs of the respiratory tract. They are suspended within the pleural cavity of the thorax. In Figure \(\PageIndex{5}\), you can see that each of the two lungs is divided into sections. These are called lobes, and they are separated from each other by connective tissues. The right lung is larger and contains three lobes. The left lung is smaller and contains only two lobes. The smaller left lung allows room for the heart, which is just left of the center of the chest.

Lung tissue consists mainly of alveoli (Figure \(\PageIndex{6}\)). These tiny air sacs are the functional units of the lungs where gas exchange takes place. The two lungs may contain as many as 700 million alveoli, providing a huge total surface area for gas exchange to take place. In fact, alveoli in the two lungs provide as much surface area as half a tennis court! Each time you breathe in, the alveoli fill with air, making the lungs expand. Oxygen in the air inside the alveoli is absorbed by the blood in the mesh-like network of tiny capillaries that surrounds each alveolus. The blood in these capillaries also releases carbon dioxide into the air inside the alveoli. Each time you breathe out, air leaves the alveoli and rushes into the outside atmosphere, carrying waste gases with it.

The lungs receive blood from two major sources. They receive deoxygenated blood from the heart. This blood absorbs oxygen in the lungs and carries it back to the heart to be pumped to cells throughout the body. The lungs also receive oxygenated blood from the heart that provides oxygen to the cells of the lungs for cellular respiration.

Protecting the Respiratory System

You may be able to survive for weeks without food and for days without water, but you can survive without oxygen for only a matter of minutes except under exceptional circumstances. Therefore, protecting the respiratory system is vital. That’s why making sure a patient has an open airway is the first step in treating many medical emergencies. Fortunately, the respiratory system is well protected by the ribcage of the skeletal system. However, the extensive surface area of the respiratory system is directly exposed to the outside world and all its potential dangers in inhaled air. Therefore, it should come as no surprise that the respiratory system has a variety of ways to protect itself from harmful substances such as dust and pathogens in the air.

The main way the respiratory system protects itself is called the mucociliary escalator. From the nose through the bronchi, the respiratory tract is covered in the epithelium that contains mucus-secreting goblet cells. The mucus traps particles and pathogens in the incoming air. The epithelium of the respiratory tract is also covered with tiny cell projections called cilia (singular, cilium), as shown in Figure \(\PageIndex{7}\). The cilia constantly move in a sweeping motion upward toward the throat, moving the mucus and trapped particles and pathogens away from the lungs and toward the outside of the body.

What happens to the material that moves up the mucociliary escalator to the throat? It is generally removed from the respiratory tract by clearing the throat or coughing. Coughing is a largely involuntary response of the respiratory system that occurs when nerves lining the airways are irritated. The response causes air to be expelled forcefully from the trachea, helping to remove mucus and any debris it contains (called phlegm) from the upper respiratory tract to the mouth. The phlegm may spit out (expectorated), or it may be swallowed and destroyed by stomach acids.

Sneezing is a similar involuntary response that occurs when nerves lining the nasal passage are irritated. It results in forceful expulsion of air from the mouth, which sprays millions of tiny droplets of mucus and other debris out of the mouth and into the air, as shown in Figure \(\PageIndex{8}\). This explains why it is so important to sneeze into a sleeve rather than the air to help prevent the transmission of respiratory pathogens.

How the Respiratory System Works with Other Organ Systems

The amount of oxygen and carbon dioxide in the blood must be maintained within a limited range for the survival of the organism. Cells cannot survive for long without oxygen, and if there is too much carbon dioxide in the blood, the blood becomes dangerously acidic (pH is too low). Conversely, if there is too little carbon dioxide in the blood, the blood becomes too basic (pH is too high). The respiratory system works hand-in-hand with the nervous and cardiovascular systems to maintain homeostasis in blood gases and pH.

It is the level of carbon dioxide rather than the level of oxygen that is most closely monitored to maintain blood gas and pH homeostasis. The level of carbon dioxide in the blood is detected by cells in the brain, which speed up or slow down the rate of breathing through the autonomic nervous system as needed to bring the carbon dioxide level within the normal range. Faster breathing lowers the carbon dioxide level (and raises the oxygen level and pH); slower breathing has the opposite effects. In this way, the levels of carbon dioxide and oxygen, as well as pH, are maintained within normal limits.

The respiratory system also works closely with the cardiovascular system to maintain homeostasis. The respiratory system exchanges gases between the blood and the outside air, but it needs the cardiovascular system to carry them to and from body cells. Oxygen is absorbed by the blood in the lungs and then transported through a vast network of blood vessels to cells throughout the body where it is needed for aerobic cellular respiration. The same system absorbs carbon dioxide from cells and carries it to the respiratory system for removal from the body.

Feature: My Human Body

Choking is the mechanical obstruction of the flow of air from the atmosphere into the lungs. It prevents breathing and may be partial or complete. Partial choking allows some though inadequate airflow into the lung—prolonged or complete choking results in asphyxia, or suffocation, which is potentially fatal.

Obstruction of the airway typically occurs in the pharynx or trachea. Young children are more prone to choking than are older people, in part because they often put small objects in their mouths and do not appreciate the risk of choking that they pose. Young children may choke on small toys or parts of toys or on household objects in addition to food. Foods that can adapt their shape to that of the pharynx, such as bananas and marshmallows, are especially dangerous and may cause choking in adults as well as children.

How can you tell if a loved one is choking? The person cannot speak or cry out or has great difficulty doing so. Breathing, if possible, is labored, producing gasping or wheezing. The person may desperately clutch at his or her throat or mouth. If breathing is not soon restored, the person’s face will start to turn blue from lack of oxygen. This will be followed by unconsciousness if oxygen deprivation continues beyond a few minutes.

If an infant is choking, turning the baby upside down and slapping on the back may dislodge the obstructing object. To help an older person who is choking, first, encourage the person to cough. Give them a few hardback slaps to help force the lodged object out of the airway. If these steps fail, perform the Heimlich maneuver on the person. You can easily find instructional videos online to learn how to do it. If the Heimlich maneuver also fails, call for emergency medical care immediately.

• What is respiration, as carried out by the respiratory system? Name the two subsidiary processes it involves.
• Describe the respiratory tract.
• Identify the organs of the upper respiratory tract, and state their functions.
• List the organs of the lower respiratory tract. Which organs are involved only in conduction?
• Where does gas exchange take place?
• How does the respiratory system protect itself from potentially harmful substances in the air?
• Explain how the rate of breathing is controlled.
• Why does the respiratory system need the cardiovascular system to help it perform its main function of gas exchange?

trachea; nasal cavity; alveoli; bronchioles; larynx; bronchi; pharynx

D. Bronchus

• Describe two ways in which the body prevents food from entering the lungs.
• True or False. The lungs receive some oxygenated blood.
• True or False. Gas exchange occurs in both the upper and lower respiratory tracts.

B. food particles

D. All of the above

• What is the relationship between respiration and cellular respiration?

Explore More

Attributions.

• Snowboarders breath on a cold day by Alain Wong via Unsplash License
• Conducting Passages by Lord Akryl , Jmarchn, public domain via Wikimedia Commons
• Larynx by Alan Hoofring , National Cancer Institute, public domain via Wikimedia Commons
• Lung Diagram by Patrick J. Lynch ; CC BY 2.5 via Wikimedia Commons
• Lung Structure by National Heart Lung and Blood Institute, public domain via Wikimedia Commons
• Alveoli by helix84 licensed CC BY 2.5 , via Wikimedia Commons
• Ciliated Epithelium by Blausen.com staff (2014). " Medical gallery of Blausen Medical 2014 ". WikiJournal of Medicine 1 (2). DOI : 10.15347/wjm/2014.010 . ISSN 2002-4436 . licensed CC BY 3.0 via Wikimedia Commons
• Sneeze by James Gathany, CDC , public domain via Wikimedia Commons
• Abdominal Thrusts by Amanda M. Woodhead, public domain via Wikimedia Commons
• Text adapted from Human Biology by CK-12 licensed CC BY-NC 3.0

Home — Essay Samples — Nursing & Health — Anatomy & Physiology — Respiratory System

Essay Examples on Respiratory System

The respiratory system is an essential part of the human body, responsible for the intake of oxygen and the release of carbon dioxide. It plays a crucial role in maintaining the body's overall health and well-being. Writing an essay about the respiratory system can help to increase awareness and understanding of its importance.

When choosing a topic for an essay on the respiratory system, it is important to consider the different types of essays that can be written. For an argumentative essay, topics could include the impact of air pollution on respiratory health or the benefits of regular exercise for lung function. In a cause-and-effect essay, topics could explore the relationship between smoking and lung disease or the effects of air quality on respiratory health. For an opinion essay, topics could focus on the importance of clean air for respiratory health or the role of government policies in promoting lung health. Finally, for an informative essay, topics could cover the anatomy and function of the respiratory system or the common respiratory disorders and their treatments.

For example, a thesis statement for an essay on the respiratory system could be "The respiratory system is a vital organ system that is essential for human survival and overall health." This statement provides a clear focus for the essay and sets the tone for the rest of the paper.

In the paragraph of an essay on the respiratory system, one could start with a thought-provoking question such as "Have you ever stopped to think about how important your breathing is to your overall health?" This can help to engage the reader and draw them into the topic. Another approach could be to provide a brief overview of the respiratory system and its functions, setting the stage for the rest of the essay.

In the paragraph of an essay on the respiratory system, one could summarize the key points discussed in the essay and reiterate the importance of maintaining respiratory health. One could also encourage readers to take proactive steps to care for their respiratory system, such as avoiding exposure to air pollutants and practicing good respiratory hygiene. This can help to leave a lasting impression on the reader and reinforce the significance of the topic.

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Case study: 60-year-old female presenting with shortness of breath.

Deepa Rawat ; Sandeep Sharma .

Affiliations

Last Update: February 20, 2023 .

• Case Presentation

The patient is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath.  Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep.

She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure, abdominal pain, abdominal distension, nausea, vomiting, and diarrhea.

She reports difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled, requiring blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower extremities that are new-onset and worsening. Subsequently, she has not ambulated from bed for several days except to use the restroom due to feeling weak, fatigued, and short of breath.

There are no known ill contacts at home. Her family history includes significant heart disease and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30 pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies.

Past medical history is significant for coronary artery disease, myocardial infarction, COPD, hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease, tobacco usage, and obesity.  Past surgical history is significant for an appendectomy, cardiac catheterization with stent placement, hysterectomy, and nephrectomy.

Her current medications include fluticasone-vilanterol 100-25 mcg inhaled daily, hydralazine 50 mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouth daily, albuterol-ipratropium inhaled every 4 hours PRN, levothyroxine 175 mcg by mouth daily, metformin 500 mg by mouth twice per day, nebivolol 5 mg by mouth daily, aspirin 81 mg by mouth daily, vitamin D3 1000 units by mouth daily, clopidogrel 75 mg by mouth daily, isosorbide mononitrate 60 mg by mouth daily, and rosuvastatin 40 mg by mouth daily.

Physical Exam

Initial physical exam reveals temperature 97.3 F, heart rate 74 bpm, respiratory rate 24, BP 104/54, HT 160 cm, WT 100 kg, BMI 39.1, and O2 saturation 90% on room air.

Constitutional:  Extremely obese, acutely ill-appearing female. Well-developed and well-nourished with BiPAP in place. Lying on a hospital stretcher under 3 blankets.

HEENT: 

• Head: Normocephalic and atraumatic
• Mouth: Moist mucous membranes 
• Macroglossia
• Eyes: Conjunctiva and EOM are normal. Pupils are equal, round, and reactive to light. No scleral icterus. Bilateral periorbital edema present.
• Neck: Neck supple. No JVD present. No masses or surgical scarring. 
• Throat: Patent and moist

Cardiovascular:  Normal rate, regular rhythm, and normal heart sound with no murmur. 2+ pitting edema bilateral lower extremities and strong pulses in all four extremities.

Pulmonary/Chest:  No respiratory status distress at this time, tachypnea present, (+) wheezing noted, bilateral rhonchi, decreased air movement bilaterally. The patient was barely able to finish a full sentence due to shortness of breath.

Abdominal:  Soft. Obese. Bowel sounds are normal. No distension and no tenderness

Skin: Skin is very dry

Neurologic: Alert, awake, able to protect her airway. Moving all extremities. No sensation losses

• Initial Evaluation

Initial evaluation to elucidate the source of dyspnea was performed and included CBC to establish if an infectious or anemic source was present, CMP to review electrolyte balance and review renal function, and arterial blood gas to determine the PO2 for hypoxia and any major acid-base derangement, creatinine kinase and troponin I to evaluate the presence of myocardial infarct or rhabdomyolysis, brain natriuretic peptide, ECG, and chest x-ray. Considering that it is winter and influenza is endemic in the community, a rapid influenza assay was obtained as well.

Largely unremarkable and non-contributory to establish a diagnosis.

Showed creatinine elevation above baseline from 1.08 base to 1.81, indicating possible acute injury. EGFR at 28 is consistent with chronic renal disease. Calcium was elevated to 10.2. However, when corrected for albumin, this corrected to 9.8 mg/dL. Mild transaminitis is present as seen in alkaline phosphatase, AST, and ALT measurements which could be due to liver congestion from volume overload.

Initial arterial blood gas with pH 7.491, PCO2 27.6, PO2 53.6, HCO3 20.6, and oxygen saturation 90% on room air, indicating respiratory alkalosis with hypoxic respiratory features.

Creatinine kinase was elevated along with serial elevated troponin I studies. In the setting of her known chronic renal failure and acute injury indicated by the above creatinine value, a differential of rhabdomyolysis is determined.

Influenza A and B: Negative

Normal sinus rhythm with non-specific ST changes in inferior leads. Decreased voltage in leads I, III, aVR, aVL, aVF.

Chest X-ray

Findings: Bibasilar airspace disease that may represent alveolar edema. Cardiomegaly noted. Prominent interstitial markings were noted. Small bilateral pleural effusions

Radiologist Impression: Radiographic changes of congestive failure with bilateral pleural effusions greater on the left compared to the right

• Differential Diagnosis
• Acute on chronic COPD exacerbation
• Acute on chronic renal failure
• Bacterial pneumonia
• Congestive heart failure
• Pericardial effusion
• Hypothyroidism
• Influenza pneumonia
• Pulmonary edema
• Pulmonary embolism
• Confirmatory Evaluation

On the second day of the admission patient’s shortness of breath was not improved, and she was more confused with difficulty arousing on conversation and examination. To further elucidate the etiology of her shortness of breath and confusion, the patient's husband provided further history. He revealed that she is poorly compliant with taking her medications. He reports that she “doesn’t see the need to take so many pills.”

Testing was performed to include TSH, free T4, BNP, repeated arterial blood gas, CT scan of the chest, and echocardiogram. TSH and free T4 evaluate hypothyroidism. BNP evaluates fluid load status and possible congestive heart failure. CT scan of the chest will look for anatomical abnormalities. An echocardiogram is used to evaluate left ventricular ejection fraction, right ventricular function, pulmonary artery pressure, valvular function, pericardial effusion, and any hypokinetic area.

• TSH: 112.717 (H)
• Free T4: 0.56 (L)
• TSH and Free T4 values indicate severe primary hypothyroidism. 

BNP can be falsely low in obese patients due to the increased surface area. Additionally, adipose tissue has BNP receptors which augment the true BNP value. Also, African American patients with more excretion may have falsely low values secondary to greater excretion of BNP. This test is not that helpful in renal failure due to the chronic nature of fluid overload. This allows for desensitization of the cardiac tissues with a subsequent decrease in BNP release.

Repeat arterial blood gas on BiPAP ventilation shows pH 7.397, PCO2 35.3, PO2 72.4, HCO3 21.2, and oxygen saturation 90% on 2 L supplemental oxygen.

CT chest without contrast was primarily obtained to evaluate the left hemithorax, especially the retrocardiac area.

Radiologist Impression: Tiny bilateral pleural effusions. Pericardial effusion. Coronary artery calcification. Some left lung base atelectasis with minimal airspace disease.

Echocardiogram

The left ventricular systolic function is normal. The left ventricular cavity is borderline dilated.

The pericardial fluid is collected primarily posteriorly, laterally but not apically. There appeared to be a subtle, early hemodynamic effect of the pericardial fluid on the right-sided chambers by way of an early diastolic collapse of the RA/RV and delayed RV expansion until late diastole. A dedicated tamponade study was not performed. 

The estimated ejection fraction appears to be in the range of 66% to 70%. The left ventricular cavity is borderline dilated.

The aortic valve is abnormal in structure and exhibits sclerosis.

The mitral valve is abnormal in structure. Mild mitral annular calcification is present. There is bilateral thickening present. Trace mitral valve regurgitation is present.

• Myxedema coma or severe hypothyroidism
• Pericardial effusion secondary to myxedema coma
• COPD exacerbation
• Acute on chronic hypoxic respiratory failure
• Acute respiratory alkalosis
• Bilateral community-acquired pneumonia
• Small bilateral pleural effusions
• Acute mild rhabdomyolysis
• Acute chronic, stage IV, renal failure
• Elevated troponin I levels, likely secondary to Renal failure 
• Diabetes mellitus type 2, non-insulin-dependent
• Extreme obesity
• Hepatic dysfunction

The patient was extremely ill and rapidly decompensating with multisystem organ failure, including respiratory failure, altered mental status, acute on chronic renal failure, and cardiac dysfunction. The primary concerns for the stability of the patient revolved around respiratory failure coupled with altered mental status. In the intensive care unit (ICU), she rapidly began to fail BiPAP therapy. Subsequently, the patient was emergently intubated in the ICU.  A systemic review of therapies and hospital course is as follows:

Considering the primary diagnosis of myxedema coma, early supplementation with thyroid hormone is essential. Healthcare providers followed the American Thyroid Association recommendations, which recommend giving combined T3 and T4 supplementation; however, T4 alone may also be used. T3 therapy is given as a bolus of 5 to 20 micrograms intravenously and continued at 2.5 to 10 micrograms every 8 hours. An intravenous loading dose of 300 to 600 micrograms of T4 is followed by a daily intravenous dose of 50 to 100 micrograms. Repeated monitoring of TSH and T4 should be performed every 1 to 2 days to evaluate the effect and to titrate the dose of medication. The goal is to improve mental function. Until coexistent adrenal insufficiency is ruled out using a random serum cortisol measurement, 50 to 100 mg every 8 hours of hydrocortisone should be administered. In this case, clinicians used hydrocortisone 100 mg IV every 8 hours. Dexamethasone 2 to 4 mg every 12 hours is an alternative therapy.

The patient’s mental status rapidly worsened despite therapy. In the setting of her hypothyroidism history, this may be myxedema coma or due to the involvement of another organ system. The thyroid supplementation medications and hydrocortisone were continued. A CT head without contrast was normal.

Respiratory

For worsening metabolic acidosis and airway protection, the patient was emergently intubated. Her airway was deemed high risk due to having a large tongue, short neck, and extreme obesity. As the patient’s heart was preload dependent secondary to pericardial effusion, a 1-liter normal saline bolus was started. Norepinephrine was started at a low dose for vasopressor support, and ketamine with low dose Propofol was used for sedation. Ketamine is a sympathomimetic medication and usually does not cause hypotension as all other sedatives do. The patient was ventilated with AC mode of ventilation, tidal volume of 6 ml/kg ideal body weight, flow 70, initial fio2 100 %, rate 26 per minute (to compensate for metabolic acidosis), PEEP of 8.

Cardiovascular

She was determined to be hemodynamically stable with a pericardial effusion. This patient’s cardiac dysfunction was diastolic in nature, as suggested by an ejection fraction of 66% to 70%. The finding of posterior pericardial effusion further supported this conclusion. The posterior nature of this effusion was not amenable to pericardiocentesis. As such, this patient was preload dependent and showed signs of hypotension. The need for crystalloid fluid resuscitation was balanced against the impact increased intravascular volume would have on congestive heart failure and fluid overload status. Thyroid hormone replacement as above should improve hypotension. However, vasopressor agents may be used to maintain vital organ perfusion targeting a mean arterial pressure of greater than 65 mm Hg as needed. BP improved after fluid bolus, and eventually, the norepinephrine was stopped. Serial echocardiograms were obtained to ensure that the patient did not develop tamponade physiology. Total CK was elevated, which was likely due to Hypothyroidism compounded with chronic renal disease.

Infectious Disease

Blood cultures, urine analysis, and sputum cultures were obtained. The patient's white blood cell count was normal. This is likely secondary to her being immunocompromised due to hypothyroidism and diabetes. In part, the pulmonary findings of diffuse edema and bilateral pleural effusions can be explained by cardiac dysfunction. Thoracentesis of pleural fluid was attempted, and the fluid was analyzed for cytology and gram staining to rule out infectious or malignant causes as both a therapeutic and diagnostic measure. Until these results return, broad-spectrum antibiotics are indicated and may be discontinued once the infection is ruled out completely.

Gastrointestinal

Nasogastric tube feedings were started on the patient after intubation. She tolerated feedings well. AST and ALT were mildly elevated, which was thought to be due to hypothyroidism, and as the TSH and free T4 improved, her AST and ALT improved. Eventually, these values became normal once her TSH level was close to 50.

Her baseline creatinine was found to be close to 1.08 in prior medical records. She presented with a creatinine of 1.8 in the emergency department. Since hypothyroidism causes fluid retention in part because thyroid hormone encourages excretion of free water and partly due to decreased lymphatic function in returning fluid to vascular circulation.  Aggressive diuresis was attempted. As a result, her creatinine increased initially but improved on repeated evaluation, and the patient had a new baseline creatinine of 1.6. Overall she had a net change in the fluid status of 10 liters negative by her ten days of admission in the ICU.

Mildly anemic otherwise, WBC and platelet counts were normal. Electrolyte balance should be monitored closely, paying attention to sodium, potassium, chloride, and calcium specifically as these are worsened in both renal failure and myxedema. 

Daily sedation vacations were enacted, and the patient's mental status improved and was much better when TSH was around 20. The bilateral pleural effusions improved with aggressive diuresis. Breathing trials were initiated when the patient's fio2 requirements decreased to 60% and a PEEP of 8. She was eventually extubated onto BiPAP and then high-flow nasal cannula while off of BiPAP. Pericardial fluid remained stable, and no cardiac tamponade pathology developed. As a result, it was determined that a pericardial window was unnecessary. Furthermore, she was not a candidate for pericardiocentesis as the pericardial effusion was located posterior to the heart. Her renal failure improved with improved cardiac function, diuretics, and thyroid hormone replacement.

After extubation patient had speech and swallow evaluations and was able to resume an oral diet. The patient was eventually transferred out of the ICU to the general medical floor and eventually to a rehabilitation unit.

Despite the name myxedema coma, most patients will not present in a coma status. This illness is at its core a severe hypothyroidism crisis that leads to systemic multiorgan failure. Thyroid hormones T3, and to a lesser extent, T4 act directly on a cellular level to upregulate all metabolic processes in the body. Therefore, deficiency of this hormone is characterized by systemic decreased metabolism and decreased glucose utilization along with increased production and storage of osmotically active mucopolysaccharide protein complexes into peripheral tissues resulting in diffuse edema and swelling of tissue. [1]

Myxedema coma is an illness that occurs primarily in females at a rate of 4:1 compared to men. It typically impacts the elderly at the age of greater than 60 years old, and approximately 90% of cases occur during the winter months. Myxedema coma is the product of longstanding unidentified or undertreated hypothyroidism of any etiology. Thyroid hormone is necessary throughout the body and acts as a regulatory hormone that affects many organ systems. [2] In cardiac tissues, myxedema coma manifests as decreased contractility with subsequent reduction in stroke volume and overall cardiac output.  Bradycardia and hypotension are typically present also. Pericardial effusions occur due to the accumulation of mucopolysaccharides in the pericardial sac, which leads to worsened cardiac function and congestive heart failure from diastolic dysfunction. Capillary permeability is also increased throughout the body leading to worsened edema. Electrocardiogram findings may include bradycardia and low-voltage, non-specific ST waveform changes with possible inverted T waves.

Neurologic tissues are impacted in myxedema coma leading to the pathognomonic altered mental status resulting from hypoxia and decreased cerebral blood flow secondary to cardiac dysfunction as above. Additionally, hypothyroidism leads to decreased glucose uptake and utilization in neurological tissue, thus worsening cognitive function.

The pulmonary system typically manifests this disease process through hypoventilation secondary to the central nervous system (CNS) depression of the respiratory drive with blunting of the response to hypoxia and hypercapnia. Additionally, metabolic dysfunction in the muscles of respiration leads to respiratory fatigue and failure, macroglossia from mucopolysaccharide driven edema of the tongue leads to mechanical obstruction of the airway, and obesity hypoventilation syndrome with the decreased respiratory drive as most hypothyroid patients suffer from obesity.

Renal manifestations include decreased glomerular filtration rate from the reduced cardiac output and increased systemic vascular resistance coupled with acute rhabdomyolysis lead to acute kidney injury. In the case of our patient above who has a pre-existing renal disease status post-nephrectomy, this is further worsened.  The net effect is worsened fluid overload status compounding the cardiac dysfunction and edema. [3]

The gastrointestinal tract is marked by mucopolysaccharide-driven edema as well leading to malabsorption of nutrients, gastric ileus, and decreased peristalsis. Ascites is common because of increased capillary permeability in the intestines coupled with coexistent congestive heart failure and congestive hepatic failure. Coagulopathies are common to occur as a result of this hepatic dysfunction.

Evaluation: The diagnosis of myxedema coma, as with all other diseases, is heavily reliant on the history and physical exam. A past medical history including hypothyroidism is highly significant whenever decreased mental status or coma is identified. In the absence of identified hypothyroidism, myxedema coma is a diagnosis of exclusion when all other sources of coma have been ruled out. If myxedema coma is suspected, evaluation of thyroid-stimulating hormone (TSH), free thyroxine (T4), and serum cortisol is warranted. T4 will be extremely low. TSH is variable depending on the etiology of hypothyroidism, with a high TSH indicating primary hypothyroidism and a low or normal TSH indicating secondary etiologies. Cortisol may be low indicating adrenal insufficiency because of hypothyroidism.  [4]

Prognosis: Myxedema coma is a medical emergency. With proper and rapid diagnosis and initiation of therapy, the mortality rate is still as high as 25% to 50%. The most common cause of death is due to respiratory failure. The factors which suggest a poorer prognosis include increased age, persistent hypothermia, bradycardia, low score Glasgow Coma Scale, or multi-organ impairment indicated by high APACHE (Acute Physiology and Chronic Health Evaluation) II score. For these reasons, placement in an intensive care unit with a low threshold for intubation and mechanical ventilation can improve mortality outcomes. [3] [5]

• Pearls of Wisdom
• Not every case of shortness of breath is COPD or congestive heart failure (CHF). While less likely, a history of hypothyroidism should raise suspicion of myxedema coma in a patient with any cognitive changes.
• Myxedema is the great imitator illness that impacts all organ systems. It can easily be mistaken for congestive heart failure, COPD exacerbation, pneumonia, renal injury or failure, or neurological insult.
• Initial steps in therapy include aggressive airway management, thyroid hormone replacement, glucocorticoid therapy, and supportive measures.
• These patients should be monitored in an intensive care environment with continuous telemetry. [6]
• Enhancing Healthcare Team Outcomes

This case demonstrates how all interprofessional healthcare team members need to be involved in arriving at a correct diagnosis, particularly in more challenging cases such as this one. Clinicians, specialists, nurses, pharmacists, laboratory technicians all bear responsibility for carrying out the duties pertaining to their particular discipline and sharing any findings with all team members. An incorrect diagnosis will almost inevitably lead to incorrect treatment, so coordinated activity, open communication, and empowerment to voice concerns are all part of the dynamic that needs to drive such cases so patients will attain the best possible outcomes.

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Case Study of 60 year old female presenting with Shortness of Breath Contributed by Sandeep Sharma, MD

Disclosure: Deepa Rawat declares no relevant financial relationships with ineligible companies.

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Rawat D, Sharma S. Case Study: 60-Year-Old Female Presenting With Shortness of Breath. [Updated 2023 Feb 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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• Acute Exacerbation of COPD. [J Educ Teach Emerg Med. 2023] Acute Exacerbation of COPD. Pappas D, Vempati A. J Educ Teach Emerg Med. 2023 Apr; 8(2):S35-S61. Epub 2023 Apr 30.
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Respiratory System - Essay Samples And Topic Ideas For Free

The respiratory system is a biological system consisting of organs that facilitate the inhalation of oxygen and exhalation of carbon dioxide. Essays on the respiratory system could delve into its anatomy and physiology, common diseases and conditions affecting it, and the impact of environmental factors like pollution on respiratory health. We have collected a large number of free essay examples about Respiratory System you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Respiratory System Function

Imagine your on the labor and delivery floor of a hospital and you hear a loud and robust cry, signaling the birth of a new born baby. A baby's first sounds are highly anticipated, as well as very important . Have you ever wondered why? A baby takes it's first breath about 10 seconds after birth due to the response of temperature change and transition into a new environment . This reaction is displaye d by the central nervous system […]

The Anatomy of the Respiratory System and Asthma

The respiratory system consists of organs that oversee inhaling of oxygen, exchanging gases, and exhaling of carbon dioxide. There are two different types of respiration, external and internal. External is considered the first round of gas exchange, it is between the lungs and pulmonary capillaries; this is where blood becomes oxygenated and is ready to spread through the body (Sullivan & Childress, p.75). Internal respiration or the second gas exchange, involves the systemic capillaries and body cells; tissues are relieved […]

Respiratory and Circulatory System

The human body is comprised of multiple separate systems that work together to maintain homeostasis, regular, stable internal conditions. The maintenance of internal function depends on a variety of variables: body temperature, fluid balance, concentration of sodium, potassium and calcium ions, and blood sugar levels. The respiratory system is responsible for the function of a series of organ in taking in oxygen and expelling carbon dioxide. The circulatory system, also known as the cardiovascular system, is responsible for the organ […]

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The Respiratory System

The functions of the respiratory system are; inhalation and exhalation, External Respiration exchanges gases between the Lungs and the bloodstream, Internal Respiration Exchanges gases between the bloodstream and body tissues and generates sound with speech. The respiratory system includes the nose, pharynx, larynx, trachea, bronchi and lungs. The respiratory system has two important functions: it brings oxygen into our bodies, which we need for our cells to live and function properly; and it helps us get rid of carbon dioxide, […]

Breathing is Main of the Respiratory System

The respiratory system is a system that is responsible for a few things. The respiratory system is responsible for the swallowing, speech, and most importantly the breathing. The body must inhale the oxygen and exhale the carbon dioxide. The respiratory system has the responsibility of getting the oxygen to the blood. The oxygen must enter the body so the blood can circulate throughout the entire body. The nose, mouth, pharynx, trachea, larynx, lungs, and bronchi are all parts of the […]

Pathophysiology and Etiology of the Asthma

Asthma, a chronic disease process, affects approximately 18 million people in the United States. While asthma can be reversible, failure to control symptoms and provide adequate and timely treatment can lead to a decrease in respiratory function, which ultimately increases the risk of death (Durham, Fowler, Smith, & Sterrett, 2017). Accurate and timely nursing care can help patients manage their symptoms and increase their quality of life while decreasing hospitalizations and related costs (Keep, Reiffer, & Bahl, 2016). Disease Condition […]

Respiratory System Research Paper

I did the respiratory system for my project. I choose this system because It's the one most Interested in because of some of the disorders I have involving this system. I have asthma and a couple other things and because of the challenges I face it has made me more enticed about learning these things. Now I will tell you about the things I have learned while participating in this project. A very important question to ask is, can you […]

Organs of the Respiratory System

This system consists of "the nose, pharynx, larynx, trachea, bronchi and their smaller branches, and the lungs which contain the alveoli" IMarieb, 2015). The nose is superior to the mouth. The pharynx is posterior to the nasal and oral cavities. The larynx is inferior to the pharynx and connects the pharynx to the trachea. The (main) bronchi are medial to the arms and are formed by the division of the trachea. The lungs are superior to the diaphragm and occupy […]

A Chronic Inflammatory Disease Asthma

Asthma is a chronic inflammatory disease of the airways which occurs in genetically predisposed individuals. Asthma is a reactive airway disease. This common disease has an epidemic progression in western countries (Wenzel, 2003). Environmental factors are likely to be the cause of the progression of this disease. Asthma can be triggered by various stimuli and can result in either a bacterial or viral infection. Asthma occurs when inflammation constricts the airways when the lungs are reacting to physical activities, respiratory […]

Respiratory System – a Group of Respiratory Organs

The respiratory system is a group of organs and structures that helps us breathe. It is composed of the lungs, airways, muscles, and associated blood vessels. The airways, which transport oxygen-rich air to the lungs and remove carbon dioxide, include the nose and connected air passages (nasal cavities), the mouth, the larynx (or voice box), the trachea (windpipe), tubes (bronchial tubes or bronchi) and branches. Upon entering through the nose or mouth, the air is both warmed and moistened to […]

Respiratory System – Releases Waste Gases through Breathing

The respiratory system is the bodies system that introduces gases into the body and releases waste gases through breathing. The main function is to transport air into the lungs, facilitate the diffusion of oxygen into the blood stream, and exhale carbon dioxide from the blood through exhaling. The respiratory system consists of all the organs involved in breathing. These include the nose, pharynx, larynx, trachea, bronchi and lungs. The mouth, nose, and nasal cavity function is to warm, filter, and […]

Pulmonary System: Anatomy, Function, and Diseases

The respiratory system, also known as the pulmonary system, consists of all organs involved with breathing. The organs included are the nose, pharynx, larynx, trachea, bronchi, and lungs. The respiratory system does two very important things. First, it brings oxygen into our bodies. We need oxygen for our cells to function properly. Secondly, it helps our bodies get rid of carbon dioxide. Carbon dioxide is a waste product of cellular function. The nose, pharynx, larynx, trachea, and bronchi work like […]

The Respiratory System Functions and Varieties Across the Animal Kingdom

There are various bodily functions that are staples for all animal life on earth, whether the organism is advanced or primitive, all need a way to obtain oxygen, dispose of waste, and break down food to create energy. One of the main systems that perform a life-giving function is the respiratory; the respiratory system comes in many varieties and can cater to many different organism's needs. The respiratory system in primitive animals is simple, as many of these animals are […]

The Respiratory System Job

The respiratory system job is to supply oxygen to all parts of the body. Oxygen is carried through the body by red blood cells. The cells in our body need constant oxygen to stay alive. If not, our brain cells will die after four minutes without oxygen. The process known as breathing consist of inhaling and exhaling, which is the respiratory systems way of taking in oxygen and getting rid of the waste gas, carbon dioxide. If carbon dioxide were […]

Respiratory System, Respiratory Distress

n include restlessness, dyspnea, tachypnea, tachycardia, and an elevation in blood pressure. While more prominent signs of severe hypoxia are cyanosis, head bobbing, altered mental status, and seizures. While "Hypoxemia is a below-normal level of oxygen in your blood, specifically in the arteries. Hypoxemia is a sign of a problem related to breathing or circulation, and may result in various symptoms, such as shortness of breath known as dyspnea"(Hypoxemia, par. 1). Signs of hypoxemia are not being able to catch […]

Case Respiratory System

1. What are the values for Mary's tidal volume (TV) and the alveolar ventilation rate (AVR)? (Remember to consider the dead space of 150ml). Normal alveolar ventilation is 4.0-5.0L. How does Mary's AVR compare with normal volumes? a. Tidal volume= Minute Ventilation Rate divide by respiratory rate (MVR/RR) MVR= 6.1L/min=6100ml?min RR=30bpm TV= 6100/30=203ml b. Alveolar ventilation rate= the difference between Tidal volume and Dead space multiplied by Respiratory rate (TV-DSV)*RR TV= 203ml DSV=150ml RR=30bpm AVR=(203-150)*30=1590ml=1.6L Mary's AVR is in 2.5-3 […]

What is Asthma?

According to the American Lung Association, asthma is a lung disease that makes it harder for air to transport in and out of your lungs. When someone has asthma, their lungs are inflamed most of the time, which makes them more tactful to their environment and which most likely triggers the asthma. Things that trigger asthma could include cold weather, dust, chemicals and smoke. In the event of an asthma attack, the insides of your airway swell even more than […]

The Physiology of Asthma

Asthma is an inflammatory disease which makes breathing and some physical activities challenging and in some cases, impossible. The Greek meaning of "asthma is short of breath. However, this classifies any short-winded patient as asthmatic. This definition was refined in the 19th century by Henry Hyde Salter, who was also asthmatic. He narrowed down the definition in his scholarly article, "On Asthma and its Treatment, to "paroxysmal dyspnoea of a peculiar character with intervals of healthy respiration between attacks. This […]

About Childhood Asthma

Childhood asthma research analysis is going to explain or clarify the history, symptoms, and diagnosis, Etiology, Pathophysiology etc. As it stated the definition of "Asthma is health disease that makes it hard to breathe. It affects the airway or bronchial tubes in the lungs to come sore and swollen. "Asthma is the most common chronic lung disease of childhood that affects, 6.6 million children in the United States(Guibert, 2014). Childhood asthma develops during childhood period, between 2 to 7 years […]

Pathophysiology of Community Acquired Pneumonia

Pneumonia is a severe infection of the lung that can be caused by a contagious agent such as bacteria, fungus, virus or parasites (Franco, 2017, p. 621). These transmittable agents reach the lungs through various methods, such as inhalation, breathing or hematogenous spread from other infections in the body (Lewis et al., 2017, p. 500). Pneumonia can be categorized as community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). To be classified as CAP, the individual with pneumonia should not have been […]

Asthma Inflammation

Asthma is known to be a chronic disease of the airways that makes breathing difficult for humans. Asthma causes swelling of the airways. Also, this results in the airways that carry the air from the nose and mouth to the lungs to become narrow and causing the individual to have trouble breathing. Although there is no cure for Asthma, it can be maintained with the proper treatment. It is stated in statistics that one out of thirteen people is diagnosed […]

Asthma Pathology Profile

The symptoms of asthma include chest pain, tightness of the chest, shortness of breath, coughing, and wheezing. These symptoms are caused by the constriction of the airways and excess mucus production. Asthma symptoms vary in each person; some may experience symptoms only while exercising, while others experience symptoms every day (Mayo Clinic Staff). Therefore, in some people asthma is a major problem that seriously impacts their life, while in others it is just a minor problem. A physician will commonly […]

CDC Asthma Guidelines: Path to Improved Education and Management in the U.S.

The Center for Disease Control reports that more than 24 million Americans have asthma, affecting 1 in 12 children and 1 in 14 adults. (Most Recent Asthma). "Asthma is a disease that is lifelong and causes wheezing, breathlessness, chest tightness, and coughing ("Vital Signs", 2011). Asthma has become an illness that many people consider 'normal' because once you have asthma, there is no way to cure it. Rather, there are hundreds of ways to control it and make it a […]

The Essential Role of the Respiratory System

The respiratory mechanism assumes a pivotal role in the sustenance of life, orchestrating functions of paramount importance for our existence. At its essence, this intricate apparatus facilitates gas interchange, bestowing oxygen upon the corpus while expelling carbon dioxide, a metabolic byproduct. This foundational process underpins cellular respiration, a cornerstone of energy generation and bodily homeostasis. Beyond its rudimentary function, the respiratory ensemble assumes critical responsibilities in blood pH modulation, immunological defense, and speech facilitation. Oxygen, the lifeblood of cellular metabolism, […]

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Protecting Your Lungs

Sometimes we take our lungs for granted. They keep us alive and well and for the most part, we don't need to think about them. That's why it is important to prioritize your lung health.

Your body has a natural defense system designed to protect the lungs, keeping dirt and germs at bay. But there are some important things you can do to reduce your risk of lung disease. Here are some ways to keep your lungs healthy.

Don't Smoke

Cigarette smoking is the major cause of lung cancer and chronic obstructive pulmonary disease ( COPD ), which includes chronic bronchitis and emphysema. Cigarette smoke can narrow the air passages and make breathing more difficult. It causes chronic inflammation, or swelling in the lung, which can lead to chronic bronchitis. Over time cigarette smoke destroys lung tissue and may trigger changes that grow into cancer. 

If you smoke, it is never too late to benefit from quitting. We can help whenever you are ready.

Avoid Exposure to Air Pollutants That Can Damage Your Lungs

Indoor air quality.

• Indoor Air Quality (IAQ) refers to the air in the buildings and structures that we work, live, and play in as well as the immediate area around these buildings and structures.
• IAQ is important for ALL of us since we spend up to 90% of our time indoors.
• It can be surprising to learn that indoor air can be even more polluted than the air outdoors.
• Secondhand smoke, chemicals in the home and workplace, mold and radon all can cause or worsen lung disease. 
• You can take steps to improve your indoor air quality . 

Talk to your healthcare provider if you are worried that something in your home , school  or work  may be making you sick.

Outdoor Air Pollution

The air quality outside can vary from day to day and sometimes is unhealthy to breathe. Knowing how outdoor air pollution affects your health and useful strategies to minimize prolonged exposure can help keep you and your family well. Climate change and natural disasters can also directly impact lung health.

To protect your lungs from outdoor pollution consider the following:

• Avoid exercising outdoors on bad air days
• Avoid exercising near high traffic areas
• Check Airnow.gov to find out the daily air conditions in your area
• Don’t burn wood or trash

Get Regular Check-ups

Regular check-ups help prevent diseases, even when you are feeling well. This is especially true for lung disease, which sometimes goes undetected until it is serious. During a check-up, your healthcare provider will listen to your breathing and listen to your concerns.

It is best to catch a lung condition in its earliest stages. That is why it is important for you to know what some of the common signs and symptoms are for lung conditions . 

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Whether you are young or old, slender or large, able-bodied or living with a chronic illness or disability, being physically active can help keep your lungs healthy. Learn more about how exercise can strengthen your lungs.

Public Health and Your Lungs

Health begins where we live, learn, work and play, and it's important to ensure that safeguards are in place to protect us and prevent disease.

Page last updated: January 6, 2023

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83 Respiratory Disorders Essay Topics

🏆 best essay topics on respiratory disorders, 👍 good respiratory disorders research topics & essay examples, 🎓 most interesting respiratory disorders research titles, 💡 simple respiratory disorders essay ideas.

• Acute Respiratory Distress Syndrome
• Acute Respiratory Distress Syndrome: A Case Study
• Discussion: Respiratory Assessment
• The Function of Respiratory System
• Benefits and Disadvantages of Prone Positioning in Severe Acute Respiratory Distress: Article Critique
• The Importance of Respiratory Therapist
• Researching of Acute Respiratory Failure
• Nursing Philosophies, Models, and Theories in Preventing Respiratory Complications The paper provides an overview of nursing philosophies, models, and theories on preventing respiratory complications in patients undergoing interventional radiological procedures.
• Nursing Assessment of Patient With Respiratory Disease As the patient has a history of COPD diagnosis, it is vital to consider the pathophysiology of his disease process through the prism of potential exacerbations of COPD.
• Respiratory Compromise and Pneumothorax Flail chest and pneumothorax are severe complications in blunt traumatic injury. The management strategies are still controversial since researchers have different opinions.
• Acute Respiratory Failure: Pathophysiology, Diagnosis, and Management The assessment for acute respiratory failure involves integrating different aspects of diagnosis to determine the risk and intensity levels.
• Discussion of Respiratory Acidosis Respiratory acidosis – accumulation of a large amount of carbon dioxide in the blood, which combines with water to form carbon dioxide.
• Health Promotion Among Australian Aborigines with Respiratory Diseases The high prevalence rate of respiratory diseases among the Aborigines in Australia has prompted an urgency to carry out a need analysis for its causal factors.
• Respiratory Syncytial Virus in Children Respiratory Syncytial Virus is an infection that causes lung inflammation and pneumonia. The virus causes lung airwaves in infants, affecting infants with weak immune systems.
• The Upper Respiratory Infections Treatment Methods Upper respiratory infections do not usually lead to deadly severe diseases; however, in some cases may require the usage of antibiotics.
• Structures of the Respiratory System In this paper explains that the respiratory system comprises of various structures and respiratory centers that facilitate effective respiration.
• Air Flow in the Respiratory System The air flow is governed by Boyle’s law, where it explains not only the way the system functions, but also the biological rationale for all the processes occurring.
• Researching of Respiratory Distress Bacterial reproduction does not always result in the development of pneumonia. The respiratory components of the lungs are the source of the development of an inflammatory response
• The E-Cigarettes Impact on Respiratory Diseases Scientific studies prove that e-cigarettes impede the smoker’s immune system leading to increased levels of pneumonia and respiratory disease.
• Respiratory Failure: Signs and Symptoms, Diagnosis, Treatment Acute Respiratory Distress Syndrome (ARDS) occurs when the lungs have trouble loading blood with oxygen or removing carbon dioxide from it.
• Analysis of the Respiratory System The respiratory system is a set of organs that provide external respiration in the body and several critical non-respiratory functions.
• “The Plan to Stop Every Respiratory Virus at Once” by Zhang The article aims to convince of the feasibility of improving ventilation systems in premises by using ethos and logos, while pathos successfully underpinned these two appeals.
• Examination of the Circulatory and the Respiratory Systems The paper presents information about human body, especially blood circulation system and respiratory system and discusses about possible diseases.
• Universal Healthcare for Chronic Respiratory Diseases from Economic Perspective This paper will examine the economic factors that are connected to Chronic Respiratory Diseases and the concept of universal healthcare.
• Pathology the Respiratory System: Lung Cancer Lung cancer is among the leading causes of death through respiratory illnesses and it has posed a major challenge to the global healthcare system.
• Universal Healthcare for Chronic Respiratory Diseases: Barriers and Supports Chronic Respiratory Diseases are a heavy economic, psychological, and physiological burden on the patients and their families.
• Spirometry Test for Respiratory System The spirometry tests reflect lung compliance which is the feasibility with which the lung space gets occupied or filled.
• New Technology in Diagnosing Respiratory Diseases Regular screenings of patients with conditions that make them susceptible to lung illnesses can be done more quickly and accurately with the help of qXR.
• Universal Healthcare: Chronic Respiratory Diseases Management The paper examines chronic respiratory diseases as pre-existing conditions and universal healthcare as the most appropriate way to manage them.
• Spread of Respiratory Cancer and Ethnicity of the Patient Based on the descriptive statistics, it is possible to study how the spread of respiratory cancer and the ethnicity of the patient are related.
• Respiratory Issue Complicated by Economic Disadvantage In chronic conditions such as asthma, children need to take charge of taking their medication and thus must be guided appropriately
• Database Elements for Acute Respiratory Distress Syndrome Patients Adult patients with acute respiratory distress syndrome (ARDS) require the inclusion of particular elements into a database.
• Preventing Occupational Respiratory Disease The patient in the case under consideration suffers from respiratory disease that occurs several times during the year.
• Respiratory Diseases Caused by Climate Change Respiratory diseases caused by climate change, such as asthma, strike children, pregnant women, the elderly, communities of color, and people living below the poverty level.
• Respiratory Complications Reduction: Stakeholders The paper identifies stakeholders related to the interventional radiological procedures: registered nurses at the intensive care, interventional radiology nurses, and others.
• Patient History with Respiratory Disease The case reveals the most prominent factors that contribute to the development of respiratory diseases. The paper aims to analyze the causes of the disease.
• Respiratory Complications Reduction: Storytelling The paper applies storytelling to promote reducing respiratory complications in patients undergoing interventional radiological procedures under conscious sedation.
• Respiratory Complications Reduction: Barriers The paper identifies non-human barriers to change in preventing respiratory complications in patients undergoing interventional radiological procedures under conscious sedation.
• Respiratory Clinical Case, Assessment and Care Plan This paper describes the respiratory clinical case of a 65-year-old female patient, provides a review of symptoms, assessment, and plan of care.
• Respiratory Symptoms of Sick Building Syndrome Many studies have proved that exposure to dampness may increase the risk for developing many respiratory problems.
• HIV/AIDS, Respiratory Syndrome, Unhealthy Lifestyle This paper discusses three current challenges in public health: HIV/AIDS, Severe Acute Respiratory Syndrome, and the challenge of an unhealthy lifestyle.
• Respiratory Complications Reduction: Negotiations The plan for reducing respiratory complications in patients undergoing interventional radiological procedures involves negotiations with several stakeholders.
• Pulmonary Immunity and Respiratory Infection Impacts The article “Respiratory Infection and the Impact of Pulmonary Immunity on Lung Health and Disease” explains how PI changes depending on the microbes encountered in the lung.
• Overview of Respiratory Syncytial Infection
• The Main Symptoms of Acute Respiratory Viral Infection
• The Importance of Nutrition Management in Respiratory Diseases and Mechanically Ventilated Patients
• The Role of Oxygen in The Work of The Respiratory and The Circulatory Systems
• Symptoms of Respiratory Diseases
• Neonatal Lung Disorders: Pattern Recognition Approach
• Pharmacotherapy for Respiratory Disorders
• The Purpose and Function of The Respiratory System
• Respiratory Diseases Caused by Genetic and Environmental Factors
• Respiratory Disorders: Asthma, Bronchitis, Emphysema, Cystic Fibrosis
• The Role of Digestive System and Respiratory System in Environmental Exchange
• Impact of Air Pollution on Respiratory Diseases in Children With Recurrent Wheezing or Asthma
• Respiratory Disease Research: Hope for Today and Promise for Tomorrow
• Respiratory Diseases and Air Pollution in the United States
• Respiratory System: Functions, Facts, Organs & Anatomy
• Respiratory Disorders in Common Variable Immunodeficiency
• Correction of Respiratory Disorders in a Mouse Model of Rett Syndrome
• Pulmonary Rehabilitation for Respiratory Disorders Other Than Chronic Obstructive Pulmonary Disease
• Oral Health and Related Factors in Cystic Fibrosis and Other Chronic Respiratory Disorders
• Prevalence of Respiratory Disorders in Veal Calves and Potential Risk Factors
• Differential Diagnosis of Acute Respiratory Diseases
• Respiratory Diseases as the Leading Causes of Death and Disability in the World
• The Frequency of Errors in the Diagnosis of Acute Respiratory Diseases
• Problems Faced by Patients and Relatives in Coping With Respiratory Disorders
• General Characteristics of Acute Respiratory Viral Disease
• Adult Respiratory Disorder Syndrome (ARDS)
• Respiratory Hygiene & Cough Etiquette in Healthcare Settings
• Respiratory Disease Control and Prevention
• Effects of Aging on the Respiratory System
• The Effect of Respiratory Therapist-Initiative Treatment Protocols on Patient Outcomes
• The Difference Between Respiratory Therapy and Pulmonology
• Aerosol Therapy for Respiratory Disorders: Advantages and Disadvantages
• Investing in the Fight Against Respiratory Disease Will Pay Multiple Longevity Dividends
• The Effectiveness of the Treatment of Respiratory Diseases With the Help of Traditional Medicine
• Homeostatic Interrelationship of Primary Respiratory System and Secondary Circular System
• The Presence of Respiratory Disorders in Individuals With Low Back Pain
• Statement on Home Care for Patients With Respiratory Disorders
• Epidemiologic Observations on Eosinophilia and Its Relation to Respiratory Disorders
• Lost Income and Work Limitations in Persons With Chronic Respiratory Disorders
• Cesarean Delivery of Twins and Neonatal Respiratory Disorders

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These essay examples and topics on Respiratory Disorders were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

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Respiratory System Diseases

Bronchiolitis.

It is a condition characterized by the inflammation of the bronchioles due to a viral illness. It is common among children under two years and a main cause of respiratory distress in this population. Though the condition is viral, it is common during the winter months.

Pathophysiology and Clinical Presentation

Outbreaks of this condition are linked to a respiratory syncytial virus that causes “inflammation of the lining of the epithelial cells of the small airways in the lungs causing mucus production” (Erickson et al., 2023). One of the most significant clinical presentations is wheezing associated with the inflammation of these cells obstructing the airway hence, the wheezing. The patient will also manifest symptoms like a running nose, reduced appetite, and cough for over three days. Further, they may present nasal congestion, which is linked to the increased production of mucus hence, the congestion. Since the obstruction happens to the tinniest air passages, their blockage can cause shortness of breath and skin discoloration due to a lack of oxygen that warrants emergency treatment. Other clinical manifestations include fever, fatigue, and tachypnea.

Physical Examination and Diagnostic Testing

Physical examination entails listening to the patient’s breathing, where wheezing or abnormality of the lungs can be heard with a stethoscope. The symptoms presented are important physical aspects of the condition, which should be combined with the patient’s medical history. However, this may not be enough to confirm the diagnosis fully; therefore, diagnostic tests like immunofluorescent and enzyme immunoassay techniques should be employed. The two detect any viruses in the patient’s nasopharyngeal specimen because the condition is associated with viral infections (Silver & Nazif, 2019).

Pharmacological and Non-pharmacological Management.

Management of bronchiolitis aims at reducing the possibility of low oxygen in the body or pauses in breathing, especially in infants, which could be fatal. Also, the treatment’s primary focus is relieving symptoms, such as difficulty breathing. The first line of pharmacological treatment is the administration of antibiotics to fight the associated infection. However, Erickson et al. (2023) establish that they should be used when there is another infection on top of bronchiolitis in infants. Further, palivizumab prophylaxis is available to infants at risk, e.g., those born before 29 weeks or who have a chronic lung or heart disease, among other qualifications. In most cases, especially for infants, non-pharmacological management is preferred unless the condition is severe. This includes saline solutions to clear the excess mucus or suction. Insistence on hydration is essential, and close monitoring of the symptoms is vital in managing the condition.

Education /Health Promotion

Patients should be educated on the importance of keeping infants away from people with symptoms of a cough that increases their risk of bronchiolitis. Further, patients should hydrate regularly for effective recovery because the condition reduces appetite and causes fever. It is also important for the caregivers to ensure that the infants are in a humid room which can lighten the excess mucus and reduce obstructions. In this case, patient education aims to ensure close monitoring and reporting of any changes or worsening of the condition, e.g., skin discoloration due to less oxygen.

Need for Referral and Differential Diagnosis

When the condition affects babies involving a pediatrician is necessary; however, the condition is easily manageable by a general practitioner. Bronchiolitis can easily be mistaken for gastroesophageal reflux disease, asthma, and aspiration of a foreign body since it affects the respiratory system.

This condition is characterized by an infection in the lungs caused by bacteria, fungi, and viruses, causing a build-up of fluids or pus in the alveoli. This condition can happen to both lungs or one, with bacterial pneumonia being the most severe, with approximately one million people being diagnosed with different kinds of pneumonia yearly.

The condition compromises the exchange of gases in the alveoli and happens when the immune system is jeopardized. Jain et al. (2022) explain that within the lungs exist organisms at a perfect balance with the body’s immunity that protects the body against foreign organisms. However, when the resident organisms are compromised, the body’s responses cause an inflammatory condition that compromises the lungs. Therefore, some of the clinical presentations of this condition include trouble breathing as the exchange of gases is compromised. Fever with chills, loss of appetite, chest pain, a cough which may produce phlegm or dry cough, and generally feeling unwell.

Physical examination involves the clinician asking questions about the symptoms experienced, including the duration of the cough or chest pain that worsens when breathing in or out. Further, with a stethoscope, the clinician will listen to the chest for differences in breathing. Also, they may tap lighting at the chest where compromised lungs, especially one with fluid, sound different.

Pneumonia shares symptoms with other respiratory conditions, thus the need for further diagnosis, including a chest x-ray for inflammation of the lungs. This can show any abnormalities in the chest, including pneumonia-associated infection. Pulse oximetry is a blood test that measures the amount of oxygen n the blood (NHLBI, 2022).

Pharmacological and Non-pharmacological Management

Pharmacological treatment depends on the causative factor making antibiotics, antiviral and antifungal drugs the first-line treatment. Jain et al. (2022) argue that when there is no underlying condition, an individual should respond effectively to pharmacological treatment; however, people with compromised immunity are at risk of complications, including a lung abscess. Non-pharmacological treatment addresses the signs, but plenty of rest and frequent hydration is necessary. Hydration is necessary to keep up the body fluids, especially with a reduced appetite.

Education/ Health Promotion

Patients with pneumonia should rest until they feel better because somebody’s activities require more oxygen, thus, straining the lungs. Smoking worsens the condition; thus, smoking cessation is mandatory for quick and healthy recovery. Diets with high proteins, like white meat, have anti-inflammatory properties that can help with the condition. Also, ensuring the patient is hydrated may include small amounts of fluids frequently. Using a humidifier helps open up the airways that are filled with fluids (NHLBI, 2022). Medication adherence is essential because bacteria that are not effectively eliminated may become resistant and recurrent, complicating future treatment. Reducing exposure to people with flu-like conditions or covering one’s mouth when sneezing may be a health promotion measure.

Need for a Referral and Differential Diagnosis

The need for a pulmonologist occurs when the patient has other conditions like asthma to ensure proper handling of both conditions. In severe cases of pneumonia, one needs to be treated in the hospital. Differential pneumonia diagnoses include COPD, pulmonary embolism, bronchiolitis, and other respiratory conditions.

Pleural Effusion

This condition is characterized by fluid build-up in the space between the lungs and the chest cavity. This condition is often caused by heart failure, cancer, or leakage into the cavity, interfering with normal breathing by reducing the capacity of the lung.

Krishna et al. (2023) explain that the pleural cavity normally has minimal fluid necessary for the lubrication of the lungs and chest cavity. The hydrostatic pressure regulates this fluid, and any excess is absorbed into the lymphatic system. The excess occurs when the hydrostatic pressure or the absorption process is compromised, hence the accumulation. This situation presents itself in chest pain, especially during a cough which is also a symptom. The individual experiences shortness of breath or fever.

Physical examination and diagnostic testing

Through a light tap to the chest may indicate the presence of fluids in the lungs. Using a stethoscope, the clinician can listen to the difficulties in breathing. Further diagnosis is important where a chest CT or an x-ray are the golden standard tests as they present images of the lung situation. Jany & Welte (2019) highlight that fluid analysis is necessary to check the condition of the fluids, especially for infections or cancer. Also, patients with pneumonia, in addition to pleural effusion, are at increased mortality.

Pharmacological and non-pharmacological management

The goal of treatment is to ensure the proper functioning of the lungs by bringing the fluid to normal levels. Treatment depends on the underlying cause, where severe cases mandate a manual draining of the excess using a chest tube and antibiotics. Non-pharmacological management involves treating the symptoms where rest is most recommended to reduce straining the lungs, causing chest pain and coughs.

The patient needs to have plenty of rest and avoid physical activities that strain the lungs through increased oxygen demand. The fluid may interfere with breathing, with the patient taking shallow breaths to avoid pain. Therefore, deep breathing exercise is important to ensure normal breathing. Smoking may interfere with the healing process or worsen the conditions; thus, smoking cessation is mandatory.

A pulmonologist may be involved in severe cases, or when under other conditions like cancer or heart disease are involved. The differential diagnosis for pleural effusion includes pneumonia, atelectasis, injury to the diaphragm or congestive heart failure, diaphragmatic paralysis, or mesothelioma.

Erickson EN, Bhakta RT, & Mendez MD (2023). Pediatric Bronchiolitis. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK519506/

Jain V, Vashisht R, Yilmaz G, et al. (2022). Pneumonia Pathology. StatPearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK526116/

Jany, B., & Welte, T. (2019). Pleural effusion in adults—etiology, diagnosis, and treatment. Deutsches Ärzteblatt International, 116(21), 377. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647819/

Krishna R, Antoine MH, & Rudrappa M (2023). Pleural Effusion. Treasure Island (FL): StatPearls Publishing: https://www.ncbi.nlm.nih.gov/books/NBK448189/

National Heart, Lung and Blood Institute (2022). What is Pneumonia? https://www.nhlbi.nih.gov/health/pneumonia

Silver, A. H., & Nazif, J. M. (2019). Bronchiolitis. Pediatrics in review, 40(11), 568-576. https://renaissance.stonybrookmedicine.edu/system/files/Acute%20Bronchiolitis.pdf

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Respiratory System Disorders

Table of contents, what are respiratory system disorders, factors affecting respiratory system disorders, types of respiratory system disorders, causes of respiratory disorders, respiratory diseases.

“Respiratory disorders or diseases are diseases of lungs and human airways that affect human respiration.”

A disorder is defined as a state of irregular functioning of the body. Respiratory system disorders or respiratory diseases are the medical terms used to study the various types of infections, allergies and other diseases related to the different organs, tissues and specialized cells of the human respiratory system .

The respiratory system mainly consists of the upper respiratory tract, alveoli, bronchi, bronchioles, trachea, pleura, and pleural cavity. The common cold is an example of a mild respiratory disorder and other serious and life-threatening respiratory disorders include pneumonia, lung cancer and asthma, influenza, tuberculosis, etc.

There are several factors associated with respiratory system disorders. A few of these factors include:

• Air Pollution
• Bacterial and viral infections.

Respiratory system disorders affect millions of people worldwide. There are three main types of respiratory diseases:

Airway Disease

It affects the bronchial tubes which function by transporting oxygen and other gases in and out of the lungs. In airway disease, the passage for air is reduced, which is associated either with narrowing or blocking of bronchial tubes.

Lung Tissue Disease

Human lungs are covered by a thin tissue layer called the pleura. Due to certain viral or bacterial infections, the structure of the lung tissues is affected, which results in scarring or inflammation of the tissue that enables the lungs to expand normally and in turn, makes breathing difficult.

Lung Circulation Disease

This disorder occurs when the blood vessels of the lungs are coagulated, swollen or damaged. This affects the ability of the lungs to receive oxygen and release carbon dioxide. In extreme cases, this disorder may affect the functioning of the heart.

Also Read:  Respiration

Respiratory diseases are caused due to exposure to pollutants, smoking, passively inhaling tobacco smoke, asbestos, radon, etc.

Following are the major respiratory disorders or diseases:

Asthma is a chronic disease which affects the bronchi and bronchioles of the lungs. It causes difficulty in breathing and is followed by severe cough, restlessness, cough and a wheezing sound while breathing.

Asthma might cause due to the following factors:

• Airborne allergens
• Respiratory infections
• Physical activity
• Air pollutants

Chronic Obstructive Pulmonary Disease (COPD)

This includes all the respiratory diseases that cause breathlessness or the inability to exhale. It largely affects people who have been exposed to some sort of smoke. It is a very serious disease and worsens even if you stop smoking.

Emphysema is defined as a chronic disease, reduction of the respiratory surface due to damage to the lung alveolar walls. It is caused mainly by cigarette smoking. The main symptoms of emphysema include shortness of breath and cough. Emphysema might lead to a loss of elasticity of the lungs.

Emphysema may be caused by the following factors:

• Air pollution
• Smoking tobacco
• Exposure to passive cigarette smoking

Occupational Respiratory Disorders

Occupational respiratory disorders are defined as any disorder which affects the respiratory system by long-term inhalation of chemicals, proteins, and dust. For instance, Asbestosis is caused by the inhalation of asbestos dust.

Occupational respiratory disorders might happen due to the inhalation of the following substances:

• Fumes from metals.
• Smoke from burning organic materials.
• Sprays of varnish, paint, acids, and pesticides.
• Dust from cotton, silica, coal, drug powders and pesticides.
• Gases from industries. For instance, Ammonia, chlorine and nitrogen oxides.

It is the inflammation of the mucous membranes in the nasal sinus. The mucous membranes produce mucus that drains into the nasal cavities. Bacterial or viral infections or some airborne allergens cause the inflammation of the mucous membranes.

Lung Cancer

Lung cancer can develop in any part of the lungs. It occurs in the main part of the lungs. The treatment of lung cancer depends upon the type, location and its spread.

Also Read: Cellular Respiration

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• Open access
• Published: 22 April 2024

Respiratory drive: a journey from health to disease

• Dimitrios Georgopoulos   ORCID: orcid.org/0000-0003-3689-9014 1 ,
• Maria Bolaki 2 ,
• Vaia Stamatopoulou 3 &
• Evangelia Akoumianaki 1 , 2  

Journal of Intensive Care volume  12 , Article number:  15 ( 2024 ) Cite this article

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Respiratory drive is defined as the intensity of respiratory centers output during the breath and is primarily affected by cortical and chemical feedback mechanisms. During the involuntary act of breathing, chemical feedback, primarily mediated through CO 2 , is the main determinant of respiratory drive. Respiratory drive travels through neural pathways to respiratory muscles, which execute the breathing process and generate inspiratory flow (inspiratory flow-generation pathway). In a healthy state, inspiratory flow-generation pathway is intact, and thus respiratory drive is satisfied by the rate of volume increase, expressed by mean inspiratory flow, which in turn determines tidal volume. In this review, we will explain the pathophysiology of altered respiratory drive by analyzing the respiratory centers response to arterial partial pressure of CO 2 (PaCO 2 ) changes. Both high and low respiratory drive have been associated with several adverse effects in critically ill patients. Hence, it is crucial to understand what alters the respiratory drive. Changes in respiratory drive can be explained by simultaneously considering the (1) ventilatory demands, as dictated by respiratory centers activity to CO 2 (brain curve); (2) actual ventilatory response to CO 2 (ventilation curve); and (3) metabolic hyperbola. During critical illness, multiple mechanisms affect the brain and ventilation curves, as well as metabolic hyperbola, leading to considerable alterations in respiratory drive. In critically ill patients the inspiratory flow-generation pathway is invariably compromised at various levels. Consequently, mean inspiratory flow and tidal volume do not correspond to respiratory drive, and at a given PaCO 2 , the actual ventilation is less than ventilatory demands, creating a dissociation between brain and ventilation curves. Since the metabolic hyperbola is one of the two variables that determine PaCO 2 (the other being the ventilation curve), its upward or downward movements increase or decrease respiratory drive, respectively. Mechanical ventilation indirectly influences respiratory drive by modifying PaCO 2 levels through alterations in various parameters of the ventilation curve and metabolic hyperbola. Understanding the diverse factors that modulate respiratory drive at the bedside could enhance clinical assessment and the management of both the patient and the ventilator.

Respiratory drive, defined as the output of respiratory centers to respiratory muscles, is crucial in the management of critically ill patients. Recent data indicate that in these patients, both high and low respiratory drive may adversely affect patient outcomes through multiple pathways [ 1 , 2 , 3 , 4 , 5 ]. While the definition of respiratory drive may appear simple, without understanding its determinants and underlying pathophysiology, the term 'respiratory drive' often remains ambiguous. It is imperative to understand that in critically ill patients, ventilatory demands, as reflected by respiratory centers output (RCO) per minute (RCO/min), may deviate from actual minute ventilation (V’ E ) due to various reasons [ 2 , 6 ]. Failure to consider this dissociation could hinder the recognition and management of high or low respiratory drive in critically ill patients. In this review, we aim to analyze the different aspects of respiratory drive to facilitate comprehension of the causes of high and low respiratory drive in spontaneously breathing or mechanically ventilated critically ill patients.

Basic principles of control of breathing

Components of control of breathing system

The control of breathing system consists of three parts, a central control system in the brain (central mechanisms), a motor arm (effector) which executes the act of breathing, and a host of sensory mechanisms that convey information to the central controller (feedback mechanisms) [ 7 , 8 , 9 , 10 ].

For simplicity, the central controller can be considered as comprising two groups of neurons [ 7 , 8 , 9 , 10 ]: the brainstem group and the cerebral cortex group. The former, oversees the automatic (involuntary) aspect of breathing, and is divided into pneumotaxic, apneustic, and medullary centers. Each center includes a diverse group of neurons with specific roles in the breathing process. The cerebral cortex group is responsible both for voluntary (behavioral) and involuntary regulation of breathing.

The effector system consists of the pathways that transfer stimuli from the respiratory centers to neurons and thereafter to the respiratory muscles [ 2 , 6 ]. The respiratory muscles involve the diaphragm, the main inspiratory muscle, as well as other inspiratory and expiratory muscles. Expiratory phase is usually passive at rest but may become active, characterized by expiratory muscles contraction, when high ventilatory demands exist [ 11 ]. Expiratory muscle contraction is common in critically ill patients [ 12 ].

The main feedback mechanisms of the control of breathing are: (1) chemical, (2) reflex, (3) mechanical, (4) metabolic rate, and (5) cortical [ 13 ]. Involuntary breathing is primarily regulated by chemical feedback and, to a much lesser extent, reflex feedback. Mechanical feedback, which involves changes in respiratory muscle pressure with volume (force–length) and flow (force–velocity) [ 14 ], is not relevant in critically ill patients since volume and flow are relatively small. Although the metabolic rate plays a key role in modulating the respiratory drive during exercise by linking CO 2 production and elimination, in critically ill patients metabolic rate affects respiratory centers indirectly via alteration in metabolic hyperbola [ 2 , 6 ]. Finally, the effects of cortical feedback are rather unpredictable, depending on the Intensive Care Unit (ICU) environment and patient factors (i.e., delirium). Furthermore, areas of the cortex (i.e., pre-inspiratory motor area) may be activated under certain circumstances for purposes that are largely unexplored [ 15 ].

2. Automatic act of breathing

The automatic act of breathing entails the rhythmic activation of inspiratory and under certain circumstances expiratory muscles, via electrical bursts (outputs) from respiratory centers located in the medulla oblongata [ 9 ]. During this act of breathing the respiratory center receives inputs from various sources (mainly chemical and reflex feedback) that, through a complicated process, are translated into an output with an oscillatory pattern (Fig.  1 ). This output regulates the whole respiratory cycle which can functionally be divided into three phases: inspiratory, post-inspiratory, and expiratory. The duration of these three phases, although not always discrete, determines the timing of the breath and consequently the respiratory rate, whereas the intensity of the output is referred to as “respiratory drive”. The system employs “gating” to modulate the inputs, which means that the same tonic input may have a different effect on the respiratory centers, depending on the phase of the respiratory cycle [ 16 ]. Notably the neurons that control the breath timing (gate function) are different than these that control respiratory drive [ 17 , 18 , 19 ]. Cortical influences may interrupt this automatic process at any level [ 20 , 21 ].

3. Chemical–reflex feedback mechanisms

The inspiratory flow-generation pathway and the feedback mechanisms affecting it, in a normal subject during passive (no expiratory muscles activity) and active (expiratory muscles activity) expiration. For simplicity and demonstration purpose, RCO I always begins when expiratory muscles activity ceases. Assuming that Pmus E is able to lower lung volume below FRC (negative P EE ), rapid relaxation of expiratory muscles (rapid decrease in Pmus E ) passively generates inspiratory flow. When Pmus E decreases to zero, FRC is reached. At this point Pmus I increases and actively generates inspiratory flow. Notice, compared to passive expiration, the higher V T with active expiration, which corresponds to higher RCO during the whole breath (respiratory drive). Gate: the effects of afferent signals (inputs) on respiratory centers vary, depending on the breath phases (inspiratory, post-inspiratory, expiratory); RCO: total respiratory centers output during the breath (respiratory drive); RCO I , RCO E : respiratory centers output to inspiratory and expiratory muscles, respectively; EA I , EA E : electrical activity of inspiratory and expiratory muscles, respectively; Pmus I , Pmus E : pressure generated by inspiratory and expiratory muscles, respectively; P EE : elastic recoil pressure of respiratory system at end-expiration (zero at FRC, and positive and negative at volume above and below FRC, respectively); Ers: respiratory system elastance; Rrs: respiratory system resistance; ΔV: volume above end-expiratory lung volume; V T : tidal volume; V I : inspired volume; blue areas: RCO I , EA I and Pmus I ; red areas: RCO E , EA E and Pmus E ; I, PI, E: inspiratory, post-inspiratory and expiratory phases, respectively; black double edges vertical arrow: V T ; blue and red dashed double edges vertical arrows: contribution of inspiratory and expiratory muscle activity to V T

Chemical feedback consists of the response of the respiratory centers to changes in arterial blood gases (PaO 2 , PaCO 2 ) and pH [ 22 ]. PaCO 2 is by far the strongest stimulus, acting on the respiratory centers either directly or indirectly, through the others [ 22 ]. A wide range of chemical feedback changes modify the respiratory drive, while the respiratory rate increases when the drive increases several folds above that of resting breathing [ 1 , 23 , 24 , 25 ]. Reflex feedback, at least in adults, is much weaker and affects mainly the duration of the inspiratory and expiratory phases of the breath (i.e., Hering–Breuer reflex) [ 25 , 26 , 27 , 28 ].

4. Response to chemical stimuli

We will particularly focus on the response to PaCO 2 and PaO 2 . The normal response to hypercapnia involves a linear increase of V’ E as PaCO 2 increases. The slope of this increase varies widely in healthy individuals, with an average value of 2–3 l/min/mmHg and a range of 0.6–8 l/min/mmHg [ 23 , 29 , 30 ]. The slope increases when there is hypoxemia or metabolic acidosis and decreases during sleep, sedation or metabolic alkalosis [ 22 , 23 , 31 ]. The hypocapnic response depends on the state of sleep and wakefulness. During wakefulness, the V’ E –PaCO 2 relationship continues to be linear as PaCO 2 decreases. Nevertheless, the slope decreases rather abruptly, approaching zero at a certain PaCO 2 level (dog-leg). This means that a minimum amount of V’ E (wakefulness drive to breath) is maintained at PaCO 2 values well below this level [ 22 ]. During sleep or sedation, the PaCO 2 to V’ E relationship remains linear until PaCO 2 reaches a certain level where V’ E abruptly decreases to zero, resulting in apnea [ 32 , 33 ] (Fig.  2 ).

Ventilatory response to CO 2 in a healthy individual. Notice the difference between the ventilatory response during wakefulness and sleep/sedation. Black square indicates the apneic threshold

Hypoxemia increases V’ E , an effect that is modified by the PaCO 2 and acid–base status [ 22 , 23 , 30 ]. Acute progressive isocapnic hypoxemia increases V’ E in a hyperbolic manner; V’ E remains almost unchanged as PaO 2 drops to ≈ 60 mmHg, but at lower PaO 2 , it increases progressively with hypoxemia [ 34 ]. Although PaO 2 is a weaker modulator of respiratory centers output (RCO) than PaCO 2 , it may significantly affect RCO and thus V’ E by modifying the response to PaCO 2 [ 22 , 23 , 30 ].

Respiratory drive and inspiratory flow-generation pathway

Respiratory centers output to inspiratory muscles travels from the brainstem and upper cervical spine neurons to the nuclei of inspiratory motoneurons (C3–C5 for the diaphragm) and determines the rate of phrenic nerve activity increase, which in turn, determines the rate of diaphragmatic muscle pressure increase. The latter determines the rate of volume increase and thus, depending on the respiratory rate, V’ E (Fig.  1 ) [ 2 , 6 ]. At high ventilatory demands, the contraction of accessory inspiratory muscles supplements diaphragmatic pressure, further increasing the rate of volume expansion. Moreover, in this situation, the respiratory centers may stimulate expiratory muscle contraction. This could reduce the end-expiratory lung volume below functional residual capacity (FRC) [ 11 ]. Subsequent relaxation of expiratory muscles will generate inspiratory flow and contribute to final V T [ 12 ]. Since the aim of expiratory muscle stimulation is to aid in V T and alleviate the workload of inspiratory muscles [ 11 ], the term 'respiratory drive’ is defined as the total RCO to both inspiratory (RCO I ) and expiratory (RCO E ) muscles [ 6 ] (Fig.  1 ). The whole process described in a simplified manner, is collectively termed the ‘inspiratory flow-generation pathway’ [ 2 ].

When the inspiratory flow-generation pathway is intact, the resultant mean inspiratory flow, defined as the ratio between V T and mechanical inflation time (T Im ), aligns with that desired by the respiratory drive (RCO). In other words, the RCO per breath, corresponds to V T and RCO/min to actual V’ E . However, if there is any compromise in the integrity of the inspiratory flow-generation pathway, a dissociation occurs between the respiratory drive and the V T /T Im [ 35 ]. Consequently, a given respiratory drive yields a smaller V T /T Im and, all else being equal, lower V’ E (Fig.  1 and Additional file 1 : Figs. S2 and S3). Although during the involuntary breathing the main determinant of respiratory drive is chemical feedback [ 2 , 6 ], cortical inputs can highly affect respiratory drive when there is voluntary activity (pain, stress) [ 36 ]. However, at rest in the absence of voluntary activity, the cerebral cortex has an inhibitory influence on the respiratory center [ 37 , 38 ]. This explains why patients with cortical lesions may exhibit high respiratory drive.

Since PaCO 2 is the most important controller of the respiratory drive [ 2 ], it is important to briefly discuss what determines its value. At resting steady-state ventilation, PaCO 2 is the point where the metabolic hyperbola intersects with the ventilatory response to CO 2 curve [ 2 , 29 , 39 ]. The metabolic hyperbola graphically represents PaCO 2 as a function of V’ E , rate of CO 2 production (V’CO 2 ) and physiological dead space (V D ) to V T ratio as follows:

where k is constant (0.863) [ 39 ]. The ventilatory response to CO 2 curve describes V’ E as a function of PaCO 2 and depends on the (1) response of respiratory centers to CO 2 and (2) integrity of inspiratory flow-generation pathway [ 2 ].

Brain and ventilation curves

To elucidate the impact of defects in the inspiratory flow-generation pathway on respiratory drive, we have recently introduced the concepts of brain and ventilation curves [ 2 ]. The brain curve is a theoretical representation, outlining the desired V’ E set by the respiratory centers at a given PaCO 2 . In simpler terms, the brain curve is determined exclusively by the respiratory centers’ sensitivity to PaCO 2 , which is controlled by afferent information from peripheral and central chemoreceptors. The term 'ventilation curve' describes the actual V’ E produced by a given RCO/min. Unlike the brain curve, the ventilation curve is influenced not only by the respiratory centers’ sensitivity to PaCO 2 , but also by the integrity of the inspiratory flow-generation pathway (Fig.  1 and Additional file 1 : Figs. S1, S2 and S3). As discussed above, the brain curve is mainly determined by respiratory drive over a wide range of PaCO 2 [ 1 ].

When the inspiratory flow-generation pathway is intact, the brain and ventilation curves are identical. However, if the integrity of the pathway is compromised, the ventilation curve deviates (is shifted down and to the right) from the brain curve (Fig.  3 ). As a result, the metabolic hyperbola and ventilation curve intersect at a higher level of PaCO 2 than that desired by the brain (the PaCO 2 that would result from the intersection of the brain curve and metabolic hyperbola) [ 2 , 6 ]. Elevated PaCO 2 stimulates the respiratory centers, prompting an increase primarily in their output per breath (RCO, respiratory drive) and, to a lesser extent, in respiratory rate [ 1 ]. Consequently, factors that modify the positioning and inclination of the ventilation curve, the brain curve, and/or the metabolic hyperbola influence the respiratory drive [ 2 , 6 ].

Brain curve (red line), ventilation curve (dashed black line), and metabolic hyperbola (blue line) in a spontaneously breathing patient with a disease affecting the inspiratory flow-generation pathway at the equation of motion level [e.g., restrictive disease (↑Ers), obstructive disease (↑Rrs), dynamic hyperinflation (↑P EE )]. Similar effects are anticipated if the integrity is compromised at higher levels of the inspiratory flow-generation pathway. PaCO 2 desired by the brain is 39 mmHg and this corresponds to RCO/min of 6.3 l/min (point 1). In an intact inspiratory flow-generation pathway, the brain and ventilation curves would coincide, resulting in an actual PaCO 2 of 39 mmHg. For simplicity, let us assume that the disease acutely compromises the integrity of inspiratory flow-generation pathway and as a result the ventilation curve is moved to the right with a downward slope. Brain curve and metabolic hyperbola are kept constant. Consequently, the RCO/min corresponding to 6.3 l/min decreases actual ventilation to 4.2 l/min (point 2). This decrease in ventilation triggers a gradual rise in PaCO 2 , stimulating the respiratory centers. RCO/min progressively increases (mainly due to changes in respiratory drive, RCO per breath) along the brain curve in response to the elevated PaCO 2 . As RCO/min increases, so does actual ventilation along the ventilation curve. A steady state is reached when RCO/min (point 3) yields actual ventilation at the intersection of the ventilation curve and metabolic hyperbola (point 4). At this point, PaCO 2 stabilizes at 40 mmHg, and respiratory drive, RCO/min, and ventilation cease increasing as the CO 2 stimulus remains constant. Despite ventilatory demands of 9.3 l/min, only 6.2 l/min are met, resulting in a deficit of 3.1 l/min. The respiratory centers activity and ventilatory output are projected to forebrain via the corollary discharge pathway (re-afferent traffic, black arrows) and create the sense of dyspnea. Given the relatively low RCO/min and unmet demands, this patient is unlikely to experience dyspnea, particularly during resting conditions

Causes of high and low respiratory drive

High or low respiratory drive results from alterations in the (1) brain curve, (2) ventilation curve and (3) metabolic hyperbola. In critically ill patients usually high or low respiratory drive is the result of combined changes in these three curves. Brain curve is altered by PaO 2 changes, acid–base disturbances, neurotransmitters affecting the brain stem and stimulation of various receptors mainly located in the respiratory system [ 30 , 40 , 41 , 42 , 43 ]. In general, hypoxemia, metabolic acidosis, and lung/chest wall receptors stimulations concurrently shift the brain curve leftwards and upwards, whereas hyperoxemia, metabolic alkalosis, and sleep or sedation shift it rightwards and downwards [ 30 , 44 , 45 , 46 ]. In critically ill patients breathing spontaneously, the inspiratory flow-generation pathway is impaired (Table 1 ), shifting the ventilation curve to the right and downwards. This causes a consistent deviation of the ventilation curve from the brain curve (Fig.  3 ). As a result, actual PaCO 2 is higher than that desired by the respiratory centers, which respond by increasing RCO/min along the brain curve. When RCO/min results in an actual V’ E at the intersection of the ventilation curve and the metabolic hyperbola, a steady state occurs. PaCO 2 stabilizes and RCO/min and V’ E do not increase further. Although the ventilatory demands are not met, the RCO/min does not increase further because the CO 2 stimulus remains constant (Fig.  3 ).

Mechanical ventilation may shift the ventilation curve either to the left or to the right of the brain curve, depending on the level of assist provided. The slope of the curve is heavily regulated by the mode of support [ 2 ]. Therefore, during mechanical ventilation, the theoretical PaCO 2 , determined by the intersection between metabolic hyperbola and brain curve, may be higher or lower than the actual PaCO 2 , causing a decrease or increase in respiratory drive, respectively. The decrease in respiratory drive during mechanical ventilation, resulting from leftward shift of the ventilation curve, is common and can induce unstable breathing [ 2 ] (see below). This is infrequent in unsupported breathing, occurring mainly in specific diseases or circumstances (congestive heart failure, sleep apnea syndrome, high altitude) [ 47 , 48 , 49 ].

The metabolic hyperbola determines both the desired PaCO 2 and the actual PaCO 2 levels. Consequently, its upward or downward shifts significantly impact these PaCO 2 levels, thereby affecting the respiratory drive. Increased V’CO 2 and V D /V T ratios shift the metabolic hyperbola upward, whereas decreases in these variables shift it downward [ 29 ]. In critically ill patients, changes in V’CO 2 are induced by alterations in metabolic rate, which can be influenced by the disease itself (e.g., sepsis), body temperature, or vigorous respiratory efforts [ 50 , 51 , 52 ]. Ventilator settings, breathing patterns, V’/Q’ inequalities, right-to-left shunt, and modifications in dead space influence V D /V T [ 39 ]. Notably, a rapid, shallow breathing pattern secondary to delirium or panic reactions may cause an upward shift in the metabolic hyperbola due to an increase in V D /V T .

Respiratory drive—from health to disease

To better understand the interaction between metabolic hyperbola and brain and ventilation curves let us follow the respiratory drive of an adult human from health to disease.

In a healthy individual the inspiratory flow-generation pathway is intact and thus the brain curve and ventilation curve are identical, over a wide range of PaCO 2 . Assuming that in a healthy adult (1) V’CO 2 and V D /V T are normal, 200 ml/min and 0.3, respectively; (2) the ventilatory response to CO 2 is 2.5 l/min/mmHg; and (3) the intersection point between the metabolic hyperbola and ventilation curve is at PaCO 2 of 39 mmHg (eupneic PaCO 2 ), the resulting actual V’ E is 6.3 l/min. Since the brain and ventilation curves are identical, the RCO/min corresponds to 6.3 l/min, identical to the actual V’ E (Fig.  4 A). Because there is no deficit between the ventilatory demands, as reflected by RCO/min, and actual V’ E , the automatic act of breathing remains unnoticed by the forebrain [ 53 , 54 ].

Brain and ventilation curves and metabolic hyperbola in a healthy subject ( A ) and when this individual suffers from pneumonia due to COVID-19 ( B ). A Health. Notice that brain and ventilation curves are similar (black lines) and thus the RCO/min corresponds to actual PaCO 2 and ventilation, set by the intersection point (black circle) between ventilation curve and metabolic hyperbola (blue line). B This human develops severe pneumonia due to COVID-19, causing increased V’CO 2 and V D /V T which move the metabolic hyperbola upward. The concomitant hypoxemia and metabolic acidosis shift the brain curve to the left and increases its slope (red line). Due to increased respiratory system elastance, a given RCO/min results in a lower ventilation and thus, the slope of the ventilation curve (dashed black line) is shifted downward. A dissociation between the ventilation curve and brain curve occurs. The desired PaCO 2 is 25 mmHg (point 1) and at this level of PaCO 2 RCO/min corresponds to 16.6 l/min. The actual PaCO 2 is 30 mmHg (point 2) and ventilation 13.8 l/min. PaCO 2 of 30 mmHg represents hypercapnia for respiratory centers which increase their activity along the brain curve. Respiratory activity stabilizes to a level corresponding to 36.6 l/min (point 3). Unmet ventilatory demands are 22.8 l/min. RCO/min: respiratory centers output per minute

Notably, even in healthy individuals, extreme hyperventilation may cause a deviation between brain and ventilation curves, due to dynamic hyperinflation and/or increases in respiratory system elastance as high tidal volumes approach the total lung capacity towards the end of inspiration [ 6 ].

Let us consider a scenario where this adult develops pneumonia due to COVID-19. The patient is febrile (39 °C) and visits the Emergency Department of the regional Hospital, reporting breathing difficulties (dyspnea). Clinical examination reveals tachycardia and signs of increased work of breathing, while arterial blood gases show hypoxemia (PaO 2 45 mmHg on 21% F I O 2 ) and hypocapnia (PaCO 2 30 mmHg). Acid–base balance evaluation demonstrates high anion gap metabolic acidosis. Chest X-rays are remarkable for diffuse opacities with loss of volume in the dependent lung regions. The patient has PaO 2 /F I O 2  < 300 mmHg on high-flow nasal oxygen and meets acute respiratory distress syndrome (ARDS) criteria [ 55 ].

Let us consider, the expected alteration in brain curve, ventilation curve and metabolic hyperbola in this patient. This approach was recently used to explain the pathophysiology of dyspnea on exertion in patients with pulmonary hypertension [ 6 ].

 Unsupported spontaneous breathing

The inspiratory flow-generation pathway will be altered because of ARDS that induced a considerable increase in respiratory system elastance and slight increase in airway resistance [ 56 , 57 ]. Therefore, compared to healthy status, a given RCO (respiratory drive) results in a lower V T . Hence, at a given respiratory rate, the ventilation curve is shifted to the right with a decreased slope, causing deviation between brain and ventilation curve; the actual PaCO 2 is now higher than the theoretical PaCO 2 .

The brain curve shifts to the left due to increased respiratory centers sensitivity to CO 2 . The higher CO 2 sensitivity is attributed to (1) hypoxemia, (2) metabolic acidosis and stimulation of lung receptors by the inflammatory process and lung mechanics deterioration [ 23 , 30 , 40 , 41 ]. The resulting “theoretical” PaCO 2 , the one determined by the intersection of the brain curve and the metabolic hyperbola, will be much lower than in healthy state. Hence, even if the actual PaCO 2 will be low, and the patient will have hypocapnia, it will be interpreted by the respiratory centers as “hypercapnia” when the desired PaCO 2 is lower.

The metabolic hyperbola is shifted upward for two reasons. Firstly, V’CO 2 increases due to pneumonia, fever and excessive work of breathing [ 50 , 51 , 52 , 58 ]. Secondly, V D /V T is increased due to V’/Q’ inequalities (high and low), the presence of right-to-left shunt (atelectasis) and in situ thrombosis in small pulmonary arteries and capillaries vessels, all of which increase the physiological dead space [ 39 ].

Figure  4 B shows simulation of brain and ventilation curves and metabolic hyperbola, taking into consideration the pathology of this patient.

The brain curve is constructed assuming that the sensitivity of the respiratory centers increases by 60% from that in a healthy state, reaching 4 l/min/mmHg. The theoretical intersection point between the metabolic hyperbola and the brain curve is set at 25 mmHg, which is 5 mmHg lower than the actual PaCO 2 . The metabolic hyperbola is shifted upwards due to a 20% increase in V’CO 2 to 240 ml/min and a 67% increase in V D /V T to 0.5. Finally, the slope of the ventilation curve, mainly due to an increase in respiratory system elastance, decreases to 2 l/min/mmHg, resulting in a considerable deviation between the brain and ventilation curves. At PaCO 2 of 30 mmHg, actual ventilation is 13.8 l/min, while at this level of PaCO 2 the brain curve dictates that RCO/min corresponds to 36.6 l/min, a 22.8 l/min deficit between the ventilatory demands and actual V’ E . This high RCO/min is mainly due to an increase in RCO (respiratory drive) which augments respiratory muscles (inspiratory and expiratory) activity per breath. Respiratory rate may increase when respiratory drive is 3–5 times higher than the baseline [ 1 ]. The high respiratory centers activity and the unmet ventilatory demands are projected via the corollary discharge pathway to the forebrain and create the subjective symptom of dyspnea [ 53 , 54 ].

Consequences of high respiratory drive

The consequences of the high respiratory drive in this patient are numerous. Firstly, the high respiratory muscles activity per breath places the patient at risk of self-inflicted lung injury (P-SILI) [ 3 ]. Indeed, patients with a high respiratory drive may experience increased regional stress and strain in dependent lung regions due to the pendelluft phenomenon, characterized, early in inspiration, by the movement of air within the lung from nondependent to dependent regions without a change in V T [ 59 ]. Secondly, because of high elastance the transpulmonary driving pressure is high, contributing to lung injury [ 60 ]. Thirdly, the intense contraction of the diaphragm is associated with diaphragm damage [ 4 , 61 ]. This should be of great concern in this patient, as increased expression of genes involved in fibrosis and histological evidence for the development of fibrosis in the diaphragm have been reported in COVID-19 ICU patients [ 62 ]. Finally, the vigorous inspiratory efforts that lead to excessive negative esophageal pressure swings increase the trans-capillary pressure of pulmonary vessels and the afterload of the left ventricle, both of which are risk factors for increased capillary leak into the alveoli [ 63 , 64 ].

Estimation of respiratory drive

How can we estimate the respiratory drive in this patient? Although the respiratory drive cannot be measured directly in humans, it can be indirectly estimated via various indices. Since the inspiratory flow-generation pathway is compromised at the level of equation of motion, the V T /T Im no longer corresponds to respiratory drive and thus cannot be used as an index of it [ 2 ]. Provided that the inspiratory flow-generation pathway is intact up to the level of respiratory muscles, in order to estimate respiratory drive, we must obtain indices of respiratory motor output, such as electrical activity of the diaphragm (EAdi), trans-diaphragmatic pressure (Pdi), respiratory muscle pressure (Pmus), airway occlusion pressure (P0.1) and diaphragm thickening during inspiration (quantified by the thickening fraction, TFdi) [ 2 , 5 , 65 ] (Table  2 ). However, obtaining these indices requires expertise, and measuring them presents some challenges in spontaneously breathing patients with acute respiratory failure and distress. Therefore, clinical criteria of respiratory distress must be used to estimate the respiratory drive in this patient. It follows that the physical examination is of paramount importance in respiratory drive evaluation. Clinical signs of respiratory distress, such as hypertension, diaphoresis, tachycardia, accessory inspiratory (sternocleidomastoid, scalenes, external intercostals) and expiratory muscles (abdominals) contraction, nose flaring and intercostal retraction serve as reliable markers of high respiratory drive (Table  2 ). Despite the common belief that the respiratory rate is a sensitive index or respiratory drive, the latter should be markedly increased (3–5 times) before the former can change [ 1 ].

• Mechanical ventilation

The patient is admitted to ICU and although high-flow nasal O 2 therapy was applied, hypoxemia (SaO 2 85–88%) and respiratory distress continued. A decision to intubate was made. The patient was sedated and placed on volume control mode. Since vigorous respiratory efforts were not completely eliminated due to high respiratory drive [ 66 , 67 ], neuromuscular blocking agents were administered. The elimination of respiratory efforts combined with the decrease in body temperature using non steroid anti-inflammatory agents, decreased V’CO 2 production to 200 ml/min and moved metabolic hyperbola downwards. However, despite using a humidifier to prevent the decrease in dead space caused by heat and moisture exchange filters [ 68 ], V D /V T remained high, resulting in minimal downward movement of the metabolic hyperbola. Lung protective strategy was applied, hypoxemia was corrected, while PaCO 2 was maintained at 40 mmHg.

The next day paralysis was interrupted while sedation gradually decreased and stopped. When inspiratory efforts were resumed a premature decision to place the patient on pressure support (PS) was made, assuming that the high respiratory drive can be controlled by assisted mechanical ventilation. Nevertheless, the common belief that mechanical ventilation decreases respiratory drive due to unloading is disputed. Studies have shown that mechanical ventilation reduces respiratory drive indirectly by altering chemical feedback, primarily PaCO 2 levels [ 25 , 69 ]. Respiratory drive consistently follows chemical feedback, whether with or without mechanical ventilation. Therefore, during assisted mechanical ventilation, an intellectual theoretical assessment of brain and ventilation curves, and metabolic hyperbola, remains essential for understanding abnormalities in respiratory drive.

The patient continues to exhibit high anion gap metabolic acidosis. Although brain curve is slightly shifted to the right due to correction of hypoxemia, its slope continues to be high, since stimulation of receptors and metabolic acidosis are maintained [ 41 , 44 ]. Although the desired PaCO 2 by the respiratory centers increased slightly, the respiratory system mechanics were not improved and, therefore, the deviation between the brain and ventilation curves remains considerable (Fig.  5 ). At a given constant respiratory rate PS shifts the unsupported ventilation curve parallel to the left [ 2 ]. The actual PaCO 2 is 29.9 mmHg, 3.8 mmHg higher than the desired PaCO 2 and actual V’ E is 14.2 l/min. Because the actual PaCO 2 is higher than the desired, RCO/min increases along the brain curve to 30 l/min. Provided that respiratory muscles are not compromised, the activity of respiratory muscles also correspond to 30 l/min. This high activity of respiratory muscles is a risk factor for P-SILI and patient–ventilator dyssynchrony [ 3 , 70 ]. Additionally, at this level of respiratory drive there is recruitment of expiratory muscles which contract and decrease end-expiratory lung volume below that determined by PEEP [ 12 ]. This may potentially cause further lung injury (atelectrauma), derecruitment, and gas exchange abnormalities. Deterioration of respiratory system mechanics and gas exchange abnormalities move the brain curve to the left and metabolic hyperbola upwards [ 2 ].

Brain curve (red line), unsupported (dashed black line) and supported with PS (green line) ventilation curves early in the course of critical illness of the patient of Fig.  4 . Point 1: desired PaCO 2 by respiratory centers; Point 2: theoretical PaCO 2 during unsupported spontaneous breathing; Point 3: actual PaCO 2 with PS during stable breathing (steady state); Point 4: RCO/min corresponding to desired V’ E with unsupported spontaneous breathing; Point 5: RCO/min corresponding to desired V’ E with PS ventilation; Notice the unmet demands without (difference in ventilation between points 2 and 4), and with PS (difference in ventilation between points 3 and 5). PS: pressure support; RCO/min: respiratory centers output per min; V’E: minute ventilation

Estimation of respiratory drive during mechanical ventilation

How can we estimate the respiratory drive in this patient? In mechanically ventilated patients respiratory drive can be quantitated using indices of motor output as described above. These indices, contrary to spontaneous breathing patients, can be obtained relatively easily [ 5 , 65 ]. Yet again, it is important to recognize that the presence of a disease that affects the inspiratory flow–generation pathway at or before the anatomical site of measurement always leads to underestimation of the respiratory drive. Respiratory muscles weakness is common in critically ill patients. Nevertheless, despite this limitation, indices of respiratory motor output may provide to the physician information for injurious high drive and assist the decision-making process (Table  2 ). Values for Pdi increase during the inspiratory phase (ΔPdi) ≥ 12 cmH 2 O and respiratory muscle swings during the breath (Pmus sw ) ≥ 15 cmH 2 O are associated with high drive which may be injurious, whereas driving transpulmonary pressure (ΔP lung ) ≥ 12 cmH 2 O and transpulmonary pressure swings (Plung sw ) ≥ 20 cmH 2 O indicate high lung stress and strain [ 4 ]. P0.1 higher than 4 cmH 2 O, easily measured in all ventilators, has an excellent accuracy to detect high effort per breath [ 71 ]. It has been shown recently that P0.1 higher than 3.5 cmH 2 O is associated with increased mortality [ 72 ]. The absolute drop in Paw during a whole breath occlusion correlates also with pleural and respiratory muscles pressures changes during the un-occluded tidal breaths [ 73 , 74 ], but its interpretation might be heavily affected by cortical feedback in awake patient and does not provide more information than P0.1. Finally, TFdi > 30% is an index of intense diaphragm contraction [ 75 ].

In this patient, due to deviation between the supported ventilation curve and brain curve unmet ventilatory demands are 15.8 l/min (30.0–14.2). For this reason, the patient exhibits signs of respiratory distress, which may force the clinicians to increase the level of assist. Since in this patient the desired PaCO 2 is 26 mmHg the PS level should considerably increase to achieve this value, resulting in excessive mechanical power applied on the lung [ 76 ] and increased afterload of the right heart [ 77 ]. The latter is attributed to high transpulmonary pressure which increases the pulmonary vascular resistance by creating zone II and I conditions in pulmonary circulation, potentially leading to acute cor pulmonale [ 78 ]. Therefore, this strategy increases the risk of lung injury and right heart dysfunction.

The indices of respiratory motor output and clinical examination, including dyspnea assessment [ 79 , 80 ], indicate injurious high drive (Table  2 ) and thus the patient was placed back to protective mechanical ventilation. Another attempt for fully assisted modes should be considered when the causes of alterations in brain curve, ventilation curve and metabolic hyperbola will be addressed. It is important to notice that during protective mechanical ventilation, if it is possible, complete inactivity of inspiratory muscles should be avoided in order to reduce the risk of atrophy [ 4 ].

After 3 days the patient meets criteria for assisted mode. Respiratory system mechanics and gas exchange abnormalities have been improved, indicating partial resolution of ARDS, while high anion gap metabolic acidosis has been resolved. The patient exhibits metabolic alkalosis mainly due to hypoalbuminemia.

The patient is placed on PS and a relatively high level of assist was used. At the same time a light sedation strategy is applied and if needed, an analgetic opioid is administered. Sedation, opioid, metabolic alkalosis and resolution of ARDS decrease considerably the sensitivity to CO 2 and shifts the brain curve to the right with a downward slope [ 31 , 43 , 45 ]. This rightward shift of the brain curve combined with high assist level [ 2 ], place the supported ventilation curve to the left of the brain curve (Fig.  6 A). Actual PaCO 2 and V’ E are 39 mmHg and 9.7 l/min, respectively. The desired PaCO 2 by respiratory centers is 42 mmHg and RCO/min at this PaCO 2 corresponds to 9.0 l/min. However, since the actual PaCO 2 is below 42 mmHg, the RCO/min decreases to that dictated by the PaCO 2 of 39 mmHg, which is 2.0 l/min. The respiratory drive is so low that the patient relaxes the diaphragm soon after triggering. This can be confirmed by indices of respiratory motor output as described above and TFdi. Values of ΔPdi and ΔPmus sw  ≤ 3 cmH 2 O, P0.1 < 1.5 cmH 2 O and TFdi < 10% suggest low inspiratory muscles activity and thus low respiratory drive [ 4 ]. However, at presence of muscles weakness the limitation of these indices should be considered. It is of interest to note that P0.1 may be valid even in moderate to severe respiratory muscles weakness. It has been shown in an animal model of severe inspiratory muscles weakness, that P0.1 still increases reliably with increasing PaCO 2 , implying that the initial part of muscle contraction is relatively spared [ 81 ].

Brain curve (red line), unsupported (dashed black line) and supported with PS (green line) ventilation curves, relatively late in the course of critical illness of the patient of Fig.  5 . A High PS, stable breathing. B Unstable breathing with increasing PS. Point 1: PaCO 2 during unsupported spontaneous breathing; Point 2: RCO/min corresponding to desired V’ E with unsupported spontaneous breathing; Point 3: actual PaCO 2 with PS during stable breathing (stable ventilation); Point 4: RCO/min corresponding to desired V’ E with PS ventilation (stable ventilation); closed circles: apneic threshold; Point 5: Actual V’ E that results in apnea; Notice that with PS ventilation curve is shifted to the left of brain curve. See text for further explanation. PS: pressure support; RCO/min: respiratory centers output per min; V’ E : minute ventilation

Consequences of low drive

Now this patient is at risk of diaphragmatic atrophy. Indeed, it has been shown in animals that 12–18 h of PS, with a level of assist that caused diaphragmatic relaxation after triggering, resulted in diaphragmatic atrophy and contractile dysfunction [ 82 ]. Zambon et al. demonstrated in critically ill patients that there is a linear relationship between the level of PS and diaphragmatic atrophy rate [ 83 ]. Finally, Goligher et al. found that diaphragm atrophy is associated with a poor outcome [ 75 ]. Additionally, low respiratory drive is a risk factor of patient–ventilator dyssynchrony, mainly of the type of ineffective efforts [ 84 , 85 ], which may contribute to poor outcome [ 86 ].

Further increase in PS level moves the supported ventilation curve to lower PaCO 2 and when the intersection point is at PaCO 2 lower than apneic threshold repetitive apneas occur, and respiratory drive is hover around zero [ 87 , 88 ] (Fig.  6 B). PaCO 2 is close to apneic threshold. Non-steady state exists since the occurrence of apnea prevents PaCO 2 to decrease considerably below the apneic threshold and reach the steady state. V’ E oscillates between zero to approximately 12 l/min. In addition to diaphragm atrophy, the patient is now at risk of poor sleep quality due to microarousals occurring at the end of each apneic episode. These microarousals result in severe sleep fragmentation and very low levels of deep sleep (sleep deprivation), further compromising the already poor sleep quality in these patients [ 89 ]. It is of interest to note that poor sleep quality is a risk factor for adverse short and long-term outcomes [ 90 , 91 ]. The diaphragm may be also affected since it has been demonstrated that even one night of sleep deprivation in healthy individuals with normal function of the diaphragm may decrease inspiratory endurance due to reduction of cortical contribution to the respiratory centers output [ 15 ]. Finally, since the usual health care personnel response to apneas is to switch to control mechanical ventilation, unnecessary prolongation of mechanical ventilation is also a risk.

In the example provided above, we focus on a patient with pneumonia who developed ARDS. Similar reasoning should be applied to other diseases that affect the brain curve, ventilation curve, and metabolic hyperbola [ 6 , 35 ] (Fig.  7 ). For instance, this analysis demonstrated, contrary to general belief [ 92 ] that in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension the respiratory system is the main determinant of exercise limitation, with the cardiovascular system being an indirect contributor [ 6 ].

Determinants of brain curve (RCO/min/PaCO 2 ), ventilation curve (V’ E /PaCO 2 ) and metabolic hyperbola during unsupported spontaneous breathing (SB) and mechanical ventilation (MV). MV modifies the equation of motion by applying pressure (Paw) to the lungs, which acts in conjunction with the pressure generated by the inspiratory muscles (Pmus I ). During mechanical ventilation respiratory rate (Fr) may differ from the frequency of the electrical bursts (outputs) due to patient–ventilator dyssynchrony (i.e., ineffective efforts). Paw may change (curved arrows) Ers (recruitment/derecruitment/overdistension), Rrs (airway opening/closure) and P EE (dynamic hyperinflation). Notice that tidal volume (V T ) depends on a complex interaction of variables (Modifiers) determining brain curve, ventilation curve and metabolic hyperbola. RCO: respiratory centers output; Pmus: respiratory muscles pressure (inspiratory and expiratory); Ers: respiratory system elastance; Rrs: respiratory system resistance; P EE : elastic recoil pressure of respiratory system at end-expiration; V’: flow; ΔV: volume above end-expiratory lung volume; V’ E : minute ventilation; V’CO 2 : CO 2 production; V D /V T : physiological dead space to tidal volume ratio; PaCO 2 : partial pressure of arterial CO 2 ; PaO 2 : partial pressure of arterial O 2

Our analysis suggests that abnormalities in respiratory drive result from alterations in the brain curve, ventilation curve, and metabolic hyperbola. Considering the significant risks associated with both low and high respiratory drive, it is imperative to address and manage these abnormalities in all three curves. However, this task is complex, due to the significant interaction among the various factors that determine the curves (Fig.  7 ). In this process, it is important to recognize that respiratory drive can be increased by factors that: (1) impair the inspiratory flow-generation pathway (e.g., respiratory system mechanics derangements, dynamic hyperinflation, neuromuscular weakness) [ 35 ]; (2) increase the brain CO 2 sensitivity (e.g., metabolic acidosis, hypoxemia, receptors stimulation) [ 41 , 44 ]; and (3) shift the metabolic hyperbola upward (e.g., increases in V’CO 2 and/or V D /V T ) [ 39 , 50 , 51 , 52 ]. Conversely, respiratory drive can be decreased by interventions/therapy that (1) reduce brain CO 2 sensitivity (e.g., sedation, correction of metabolic acidosis or hypoxemia, metabolic alkalosis) [ 31 , 40 ]; (2) restore the integrity of the pathway from the respiratory centers to tidal volume generation (e.g., mechanical ventilation, mode of support, titration of ventilator settings, improvements in respiratory system mechanics and neuromuscular weakness) [ 80 , 93 , 94 ], and (3) shift the metabolic hyperbola downward (e.g., decreases in V’CO 2 or V D /V T ) [ 39 , 58 ]. By considering all factors that contribute to each of these three curves and employing inductive reasoning to understand their interactions, respiratory drive can be assessed at the bedside, facilitating a more informed decision-making process.

Availability of data and materials

Not applicable.

Abbreviations

Arterial partial pressure of CO 2

Arterial partial pressure of O 2

Respiratory centers output per breath

Respiratory centers output per minute

Minute ventilation

Functional residual capacity

Tidal volume

Respiratory centers output to inspiratory muscles

Respiratory centers output to expiratory muscles

Mechanical inflation time

CO 2 production

Physiological dead space

Ventilation–perfusion ratio

Patient self-inflicted lung injury

Electrical activity of the diaphragm

Trans-diaphragmatic pressure

Respiratory muscle pressure swings

Esophageal pressure

Airway occlusion pressure during the first 100 ms of inspiration

Absolute drop in airway pressure during a whole breath occlusion

Thickening fraction of the diaphragm

Intensive Care Unit

Pressure support

Acute respiratory distress syndrome

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Medical School, University of Crete, Heraklion, Crete, Greece

Dimitrios Georgopoulos & Evangelia Akoumianaki

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DG conceived this study. DG, MB, VS and EA drafted and reviewed the manuscript. All authors finally approved the content of the manuscript to be submitted.

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: Figure S1. Normal (Health). Intact inspiratory flow-generation pathway. Figure S2. Neuromuscular weakness. Figure S3. Dynamic hyperinflation in a patient exhibiting flow limitation during passive expiration.

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Georgopoulos, D., Bolaki, M., Stamatopoulou, V. et al. Respiratory drive: a journey from health to disease. j intensive care 12 , 15 (2024). https://doi.org/10.1186/s40560-024-00731-5

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Received : 22 March 2024

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DOI : https://doi.org/10.1186/s40560-024-00731-5

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EDITORIAL article

This article is part of the research topic.

The Impact of the COVID-19 Pandemic on Dermatology Patients: Diagnosis, Treatment, and Prognosis

Editorial: The Impact of the COVID-19 Pandemic on Dermatology Patients: Diagnosis, Treatment, and Prognosis Provisionally Accepted

• 1 Department of Dermatology, Xiangya Hospital, Central South University, China
• 2 Furong Laboratory, China
• 3 National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, China
• 4 Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, China
• 5 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, China

The final, formatted version of the article will be published soon.

The coronavirus disease 2019 (COVID-19) pandemic has posed a profound impact on the global healthcare systems, including the field of dermatology [1,2]. The causative virus, SARS-CoV-2, primarily targets the respiratory system and compromises the immune system, which can trigger immune-related skin disorders or aggravate pre-existing skin conditions [3][4][5]. Concurrently, the pandemic has reshaped medical practice and patient behaviors worldwide, leading to a notable reduction in dermatology admissions and extended hospital stays for severe cases due to concerns about hospitalization and associated treatment [6,7].Moreover, vaccination against COVID-19 have been associated with dermatological manifestations, including dermatomyositis and new or recurrent immune-related skin diseases [8][9][10][11]. This editorial introduces a collection of seven papers that delve into the impact of the COVID-19 pandemic and COVID-19 vaccines on the diagnosis, treatment, and outcomes of dermatological conditions.In a conprehensive retrospective study, Kalanj et al. analyzed the total number of hospitalized patients with skin diseases, as well as those who underwent conservative treatment and surgical interventions, comparing periods before and during the COVID-19 pandemic [12]. Their findings highlight a significant reduction in hospitalizations and surgical procedures (with the exception of breast reconstruction) during the pandemic. This reduction is largely attributable to the state-enacted pandemic prevention and control measures, including social distancing, travel restrictions, and partial or complete lockdowns. Apostu et al. conducted a retrospective cohort study focusing on the number of diagnosed melanoma patients before and after the pandemic, as well as the age, gender, histological characteristics of confirmed cases [13]. They observed a substantial decline in the incidence of new melanoma cases following the COVID-19 pandemic. Additionally, the study found that patients diagnosed with melanoma during the pandemic were older and exhibited more severe prognostic features, such as higher Breslow indexes, increased mitotic counts, and greater ulceration and thickness. These findings suggest that the pandemic has not deterred patients with more aggressive forms of melanoma from seeking treatment, despite the overall decrease in healthcare engagement. This discovery serves as a reminder for dermatology clinicians to inquire about patients' recent vaccination history when treating patients with AIBDs. Similarly, Ghanaapisheh et al. noted a possible association between COVID-19 vaccinations, especially mRNA vaccines, and the occurrence of bullous pemphigoid (BP) [16]. Notably, the majority of BP patients remain unaffected by COVID-19 vaccinations and even those experiencing worsening conditions typically do not face severe side effects, highlighting the evidence-based safety of vaccines. Olszewska et al.'s reviewed the potential link between COVID-19 vaccination and primary cutaneous lymphoma (CL) [17]. Their analysis of data from 24 patients across various studies indicates that primary cutaneous CD30-positive lymphoproliferative disorders are the most prevalent type of CL following COVID-19 vaccination. Ghanaapisheh et al. also highlighted the potential risk of mRNA vaccine induced-CL [16]. Therefore, researchers specifically advise patients with a history of lymphoproliferative diseases to monitor their health closely post-COVID19 vaccination and to remain vigilant for any signs of disease progression. spontaneous urticaria (CSU) [18], observing a significant increase in the median Urticaria Activity Score post-vaccination compared to pre-vaccination levels. Their study also documented cases where individuals developed vascular edema and allergic reactions subsequent to receiving the vaccine. These findings emphasize the potential side effects associated with COVID-19 vaccines. Dermatologists are therefore urged to remain vigilant and consider the possibility of new or recurring immune-related skin conditions in patients who have been vaccinated against COVID-19.In summary, this research topic outlines the multifaceted effects of the COVID-19 pandemic on the occurrence, development, diagnosis, and treatment of various skin diseases.Firstly, there has been a notable decline in the total number of hospitalized patients with skin diseases and in surgical patients, which provides valuable data for hospitals looking to optimize their service system structure. Secondly, there appears to be an increase in the aggressiveness of melanoma during the pandemic, likely due to delays in diagnosis and treatment. Thirdly, the use of biological agents targeting IL-17 and IL-23 has proven more effective than those targeting TNF-α during pandemic, for reasons yet to be determined.Finally, there is a suggested link between COVID-19 vaccination and the onset of autoimmune bullous diseases, chronic spontaneous urticaria, or primary skin lymphoma.Exploring the potential mechanisms behind these associations could enhance our understanding of the development and progression of these conditions.

Keywords: COVID-19, Dermatology, diagnosis, Treatment, prognosis

Received: 17 Apr 2024; Accepted: 22 Apr 2024.

Copyright: © 2024 Deng, Huang, Guo and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Guangtong Deng, Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China

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