The Respiratory System

Anatomy and Physiology

Physical Examination
Inspection
Inspect the mental alertness of the patient. Is there blueness in the face (cyanosis) or breathlessness at rest? Is the patient using accessory muscles to breathe? Is there any clear deformities or scars and is there equal movement of the chest on each side?

Palpation and percussion
The chest can be palpated for broken ribs but this is rarely seen by a herbalist. The chest expension should be noted through palpation. Check the trachea position as it moves away from a pneumothorax and toward a collapsed lung. Also, palpate the lymph nodes; if enlarged lymph is found in the supraclavicular area it may indicate bronchial carcinoma. if dullness is discovered on percussion pneumonia, lung collapse, fibrosis or pleural effusion may be present. If hyperresonance is discovered a pneumothorax may be the cause.

Auscultation
The lungs must be listened to on normal breathe sounds as well as whispering and spoken voice if necessary. If a wheeze is heard this may indicate asthma or COPD. If crackles are heard there may be airflow limitation as in oedema, fibrosis and bronchiectasis. A pleural rub can be heard when there is inflammation and roughening of the pleural surface, this is also painful for the patient. When the lung is consolidated high pitches are extenuated and low pitches are very difficult to hear, whereas, when there is fluid on the lungs almost no low pitches can be heard.
A peak flow test is useful to assess the abilities for the lungs to take in oxygen it also gives an idea of consolidation, fluid in the lungs or constriction of the alveoli or bronchioles.

Respiratory Diseases
Rhinitis/ Hayfever is an inflammation due to irritation of the mucous membrane in the nasal passage.

Bronchitis is inflammation of the bronchioles. Usually this is caused by a virus. It results in an irritating dry cough followed by chest tightness, wheezing and shortness of breath (SOB). The cough eventually becomes productive with yellow or green sputum. Sometimes it is accompanied by a mild fever and usually it is resolved within 4-8 days.

COPD is a set of diseases which are characterised by obstruction to normal breathing. Usually they are caused by the inhalation of toxins which results in sputum and wheezing with breathlessness. It is aggravated by cold, foggy weather and atmospheric pollution. The lungs are hyperinflated which means the liver and heart can no longer be percussed for. It can lead to respiratory failure characterised by hypoxia and hypercapnea.

Bronchiectasis (a COPD) occurs when the alveoli and bronchi are abnormally dilated which gives them a more likely chance that they will collapse. Before this happens they produce large quantities of sputum which obstructs air flow. The sputum leads to a high chance of recurrent infections and gives a chronic productive cough. Halitosis, malaise, pneumonia and clubbing of the fingers can be observed.

Cystic fibrosis is hereditary and occurs in the lungs and the pancreas. It affects the pancreas by creating scarring and cysts which is what the name refers to. In the lungs it creates very thick (viscose) and sticky (tenacious) sputum. This increases the chances of infection. Sinusitis, breathlessness and haemoptysis are sometimes seen.

Pneumonia is usually caused by viruses or bacteria creating inflammation in the lungs. This leads to sputum production and a productive cough. Chest pain, fever, difficulty breathing are also seen.

Tuberculosis is an infectious disease which can infect other organs but is most commonly seen in the lungs. It presents with a chronic cough, blood tinged sputum, fever, night sweats, chest pain, and weight loss.

Bronchial carcinomas can cause chest pain, discomfort but more commonly they show no symptoms. However, it may be possible to feel raised lymph nodes in the supraclavicular area.

Pleurisy is pain arising from any disease of the pleura caused by inflammation.
Pleural effusion is fluid in the pleural cavity.

Pneumothorax occurs when air seeps into the pleural cavity. As the pleura expands with the air it pushes the lung over to the other side creating tracheal deviation away from the pneumothorax. It causes pressure which can be painful and fainting. It can also cause shortness of breathe and eventually cardiac arrest. In serious cases the lung may collapse under the growing pressure from the air. On auscultation a lack of breathe sound will be heard. Urgent intervention is needed.

Emphysema (a COPD) is caused by localised inflammation which leads to septal degradation. It is similar to bronchiectasis, another COPD.

Respiratory Herbs
Inula helenium is a strong expectorant which steadily dissolves thick green mucous to a much thinner and clearer consistency so it can be coughed up.
Thymus vulgaris is an anti-viral herb used when bacteria causes infections.
Glycyrrhiza glabra can be used to soothe the respiratory tract and helps dissolve sputum and is an expectorant. It is particularly useful in asthma.
Tussilago farfara is an expectorant which helps for those with congestive coughs.