The Bronchi Are Air Passages of the Lungs. Bronchitis

8/14/2019 The Bronchi Are Air Passages of the Lungs. Bronchitis

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The bronchi are airpassages of the

lungs. Bronchitis isinflammation of the bronchi.

It can makebreathing difficult.It can also bepainful.



Acute bronchitis—is a sudden onset of symptoms. It onlylasts a short time. There is full recovery of lung function.

Chronic bronchitis —is a long term condition. It causesobstruction and erosion of the lungs. It is often the resultof many years of cigarette smoking. This is a serious

condition. It is a type of chronic obstructive pulmonary disease (COPD).

Asthmatic bronchitis—occurs in people with asthma.Occurs during an asthma attack. It is most common withallergies.

Irritative bronchitis—due to frequent contact with certainirritants. This often happens because of work setting.(also known as industrial or environmental bronchitis)

http://www.doctorsofusc.com/condition/document/220849










The inflammation may be caused by:Bacterial and viral infectionsSmoking (cigarettes or marijuana)

Inhalation of certain respiratory irritants(usualy in work setting) such as:

Ammonia

Chlorine

Minerals

Vegetable dusts



Smoking Exposure to second-hand smoke Contact with a person infected with bronchitis Viral upper respiratory tract infection ( cold or flu)

Asthma Chronic sinusitis Occupational exposures to respiratory inhalants Smog, in susceptible individuals Enlarged tonsils and/or adenoids

Malnutrition











Symptoms will depend on the type of bronchitis.



Runny noseMalaiseSlight feverBack and muscle painSore throat Cough, initially dry, then produces

mucus that may be thick, yellow,green, blood-streaked

Wheezing





BRONCHI AND AIR SACSOF LUNGS

Persist cough withsputum production for atleast 3 months in at least

2 consecutive years. Cough that brings up

yellow-green mucus,often worse in the

morning

Difficulty breathing Bluish tint to lips and skin

(in severe cases)



The doctor will ask about yoursymptoms and medical history. A

physical exam will be done.



Tests are rare. The following may berecommended for severe orquestionable cases:

Blood testChest x-rays —to rule out pneumonia, a

complication of bronchitis

Pulse oximetry—to measure theamount of oxygen in the blood

Bronchoscopy with culture of thesputum









Tests may include:Blood testChest x-rays

Pulmonary function tests or spirometry—toevaluate lung function Sputum cultureArterial blood gas—to test for levels of oxygen,

carbon dioxide, and acid in the blood

Pulse oximetryBronchoscopy with culture of obtained sputum





Labored breathing : use of respiratory accessory muscles.

Deep seated cough , productive maybe purulent but not foul.



No change in vocal fremitus.



No change in mild cases but if associated with emphysema –

Hyperresonance.



Early stage ; moist rales at the baseof lung and does not disappear after

coughing .



Treatment is aimed at relieving thesymptoms. It includes:

Aspirin or acetaminophen to treat pain andfever

Expectorants or cough suppressants Increased fluid intakeCool mist humidificationHerbs and supplements — Pelargonium

sidoides extract may help resolve symptoms

in patients with acute bronchitisAntibiotics will not be helpful if the infection

is viral.













Oral antibiotics and bronchodilators, particularlyclarithromycin If you have chronic bronchitis and mild-to-moderate

COPD, you may not need antibiotics A study found that shorter antibiotic treatment (five days

or less) is as effective as longer treatment (more than fivedays) Bronchodilators Oral or intravenous corticosteroid medications Inhaled bronchodilators or corticosteroids Expectorants to loosen secretions Mucolytics. Supplemental oxygen Cool mist humidification Lung reduction surgery —removal of the most

damaged part of the lungs (in severe cases)

Lung transplant (in end-stage cases)









To reduce your chance of gettingbronchitis:

Stop smoking or never start.Avoid passive smoke.Avoid exposure to respiratory

irritants.Avoid contact with people who have

bronchitis.





COPD

Chronic obstructive pulmonary disease(COPD) is a progressive disorder

evenwhen contributing factors areeliminated and aggressive therapy isinstituted.



Emphysema and chronic bronchitis areoften clinically grouped together andreferred to as (COPD), since many patientshave overlapping features of damage atboth the acinar level (emphysema) and

bronchial level (bronchitis), almostcertainly because one extrinsic trigger—cigarette smoking—is common to both.

about 10% of patients are nonsmokers



Emphysema is a condition of the lungcharacterized by abnormal permanentenlargement of the airspaces distal to the

terminal bronchiole, accompanied bydestruction of their walls and withoutobvious fibrosis.

results in loss of alveolar and capillarysurface area, elastic recoil of the lung, airtrapping, and hyperexpansion of the lungs



Centriacinar (Centrilobular) Emphysema -involvement of the lobules; the central or proximal parts of the acini, formed by respiratory bronchioles, are affected ,whereas distal alveoli are spared, occurs predominantly inheavy smokers, often in association with chronic bronchitis.

Panacinar (Panlobular) Emphysema. -the acini are uniformly enlarged from the level of therespiratory bronchiole to the terminal blind alveoli , entireacinus but not to the entire lung. associated with α1-antitrypsin (α1-AT) deficiency

Distal Acinar (Paraseptal) Emphysema. - proximal portion of the acinus is normal, but the distal part is predominantly involved

Airspace Enlargement with Fibrosis (Irregular Emphysema). -acinus is irregularly involved, is almost invariably associated with scarring. In most instances, are

asymptomatic and clinically insignificant

Types of Emphysema



PATHOGENESIS

**Tissue breakdown is

enhanced as aconsequence of inactivation of protectiveantiproteases by reactiveoxygen species in cigarettesmoke.

protease-antiproteasemechanism

oxidant-antioxidant imbalance.



PHYSICALEXAMINATION



INSPECTION

Dyspnea barrel-chested

Accessory muscle move pursed lip breathing Thin patients



PALPATION

Decrease Vocal fremitus



PERCUSSION

Generalized hyperresonance maybe heard over the hyperinflatedlungs of emphysema



AUSCULTATION

• Breath sounds may be decreasedwhen air flow is decreased or whenthe transmission of sound is poor (asin pleural effusion, pneumothorax, oremphysema)

• Mid-inspiratory crackles (may reflectdisease of moderate-size airways)

• Wheezing (inconstant finding anddoes not predict degree of obstructionor response to therapy)



Manifestations when at least one third of the functioning pulmonaryparenchyma is damaged.

Dyspnea is usually the first symptom; it begins insidiously but is steadilyprogressive.

cough or wheezing is the chief complaint, confused with asthma.

Cough and expectoration

Weight loss

barrel-chested and dyspneic, with obviously prolonged expiration, sitsforward in a hunched-over position, and breathes through pursed lips to reduce dyspnea. Expiratory airflow limitation, is the key to diagnosis.

severe emphysema, overdistention is severe, diffusion capacity is low,and blood gas values are relatively normal at rest. Such patients mayover-ventilate and remain well oxygenated and therefore are somewhatingloriously designated as pink puffers

Development of cor pulmonale and eventual congestive heart failure,related to secondary pulmonary vascular hypertension, is associatedwith a poor prognosis. Death in most patients with COPD is due to (1)respiratory acidosis and coma, (2) right-sided heart failure, and (3)massive collapse of the lungs secondary to pneumothorax. Treatmentoptions include bronchodilators, steroids, bullectomy, and, in selected

patients, lung volume reduction surgery and lung transplantation.



prolonged expiratory phase (decreasedFEV1 ), poor exercise tolerance, and oxygendependence in those

Radiographically, lungs are hyperinflatedand the hemidiaphragms are flattened. On CT, blebs of various sizes are usually

seen in the upper lobes but may bedistributed throughout the lung.Compression of normal parenchyma byblebs results in further impairment of gasexchange.



TREATMENT

Smoking Cessation-Although lost lungfunction is not regained, the rate of decline

in FEV1 reverts rapidly to that of nonsmokers.

Bronchodilators Glucocorticoids

Oxygen Transplantation Lung Volume Reduction Surgery

The Bronchi Are Air Passages of the Lungs. Bronchitis

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