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The mucous sheaths of both the superior and the inferior airways are enclosed by a pseudostratified columnar ciliated epithelium with an unbroken vaulted sheath. These airways share a mucosal susceptibility to inhaled allergens. The pathophysiology of allergic rhinitis is much related to that of allergic asthma, and the reactions of the two disorders to pharmacologic and immunologic interventions are similar (Bergeron & Hamid, 2005). The most frequently used drugs for both disorders are corticosteroids. Other anti-inflammatory drugs with systemic outcomes have been recently proposed for the management of both diseases (Bergeron & Hamid, 2005).
Discuss pathophysiology of lung cancer, clinical manifestations, and diagnostic tests.
Experts have concluded that lung cancer develops from a number of causes. Environmental pollutants and carcinogens as well as genetic mutations that play a part in the development of lung cancer have been distinctly identified and confirmed through research. The early clinical manifestations of lung cancer are varied and may occur with or without warning signs. Manifestations of pulmonary malignant lesions are made by local growth or invasion, metastatic disease, or paraneoplastic processes (Latimer, 2018). Outlines of local invasion such as Pancoast’s syndrome or the superior vena cava syndrome are somewhat uncommon but well recognized. Metastatic lung cancer can contain almost any anatomic area by hematogenous, lymphatic, or, sometimes, interalveolar dissemination (Latimer, 2018). Problems related to malnutrition, infection, electrolyte disturbances, and coexisting diseases impact the early manifestations. Individual tumor cell types are connected with characteristic features, no pattern of findings is pathognomonic for a specific histologic alternate. Because successful treatment of pulmonary carcinoma depends on early detection, understanding of the classic clinical manifestations is important (Hirsch et al., 2001). Lung cancer may be discovered in different variations. Sometimes, there may not be any indications or warning sign of the disease, but it may be discovered during other medical procedures e.g. a chest X-ray during a routine checkup prior to other surgery. For individuals who do experience symptoms, these may give reasons to suspect lung cancer, which is then established by medical tests. Others may not have any early signs of the disease, but may go to the doctor due to other symptoms which may indicate advanced stage disease. Other tests used to diagnose lung cancer are blood tests, imaging tests (eg. X-ray, Computerised Tomography or CT scan, Magnetic Resonance Imaging or MRI and Positron Emission Tomography or PET scan) bone scans – a nuclear scanning test to find abnormalities in bone, body tissue tests (eg. pathology, sputum cytology and biopsies) gene mutation testing, tests to determine tumor growth (Hirsch et al., 2001).
Both conditions are distinguished by various degrees of airflow limitation, mucus and inflammation, and patients often have symptoms of coughing and wheezing. Though, they differ in their pathophysiology, clinical presentation, lung function measurements and drug management. In asthma, airway obstruction is caused from constriction of bronchial smooth muscle, airway hyper-reactivity to allergens, and inflammation accompanied by elevated eosinophils and activated T-cells (Cukic et al., 2012). In COPD, airway smooth muscle is not typically constricted and obstruction is accompanying mainly with mucus hypersecretion and mucosal infiltration by inflammatory cells, leading to cellular damage and the loss of alveolar structure. The cellular destruction and structural changes associated with COPD intervene with oxygenation and pulmonary circulation. The classic initial clinical presentation of asthma is a young patient with recurrent, intermittent episodes of wheezing and coughing that may be accompanied by chest tightening or shortness of breath. Wheezing on breathing out is the classic symptom, but some patients present mainly with cough, especially at night. COPD is almost unknown in children and rare in adults under the age of 40 years. The classic presentation is an older current or ex-smoker with progressively worsening shortness of breath and possible cough and mucus production accompanied with decreasing physical. COPD is almost always associated with a long history of smoking, while asthma occurs in non-smokers as well as smokers (Cukic et al., 2012).
Physicians may be recommend oxygen therapy if the level of oxygen in the patients’ bloodstream is too low. Feeling breathless is not a sure way of telling that a patient is not getting enough oxygen. This has to be done using a blood test to measure the level of oxygen, known as an arterial blood gas. The amount of oxygen a patient needs, and how often it should be used, depends upon the results of the blood-oxygen tests (McDonald, 2014). The amount of oxygen a patient needs is called the oxygen flow rate, this describes the number of liters of oxygen that is delivered per minute (McDonald, 2014). The amount a patient needs during exercise or sleeping might be different than the amount they need while at rest. If patients with a hypoxic drive are given a high concentration of oxygen, their primary urge to breathe is removed and hypoventilation or apnea may occur. It is important to note that not all COPD patients have chronic retention of CO2, and not all patients with CO2 retention have a hypoxic drive (McDonald, 2014). Oxygen toxicity, caused by unwarranted or unacceptable supplemental oxygen, can cause severe damage to the lungs and other organ systems. High concentrations of oxygen, over a long period of time, can increase free radical formation, leading to damaged membranes, proteins, and cell structures in the lungs. Oxygen should be administered so that appropriate target saturation levels are maintained. Supplemental oxygen should be administered cautiously to patients with herbicide poisoning and to patients receiving bleomycin. These agents have the ability to increase the rate of development of oxygen toxicity.
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