A.

Pathophysiology of Pneumonia
Every day, our lungs are exposed to over 10 000 L of air containing many potentially disease causing agents. However, the normal
lung does not contain any bacteria because of different effective defense mechanisms that clear or destroy bacteria:
a) nasal clearance: eg sneezing, blowing nose
b) racheobronchial clearance: mucociliary action clears particles deposited on the mucus film. Particles are moved from the
lung to the oropharynx where they are either swallowed or expectorated.
c)
alveolar clearance: Alveolar macrophages phagocytose particles deposited in the alveoli. Digested particles are contained in
the macrophages which are moved to ciliated bronchioles and then to the oropharynx.

Sometimes these defenses may be impaired, as occurs in chronic diseases, immunodeficiency, immunosuppressive treatments,
leukopenia, very virulent organisms.
Mechanisms of Lung Defense Impairment:
a. loss or decreased cough reflex leading to aspiration of gastric contents
b. impaired or destroyed mucociliary transport: eg cigarette smoking, inhalation of corrosive gases
c. impaired phagocytic or bactericidal action of alveolar macrophages: eg cigarette smoke.
d. pulmonary congestion/edema
e. increased production of pulmonary secretions: eg cystic fibrosis

Bacteria
Viral
Fungal
Aspiration

Chemical Irritants

Infection

Immune Response

Release of
Neutrophils

Release cytokines

General activation of the

immune system.

Fever, Chills, and Fatigue

Increase RR

Inflammation of Lung
Tissue

neutrophils engulf and

kill the offending
organisms

Inflammation of Lung
Tissue

Hypertrophy of Mucous
Membrane

Increase Sputum
Production
Wheezing
Dyspnea
Cough
Rales

Increase in Capillary
Permeability

Inflammation of the
Pleura

Chest Pain
Increase Fluid in ISC
Consolidation
Hypoxemia
Decrease Chest
Expansion

Hypoventilation
Decrease Oxygen
Transport

Respiratory Acidosis