8.5 Pathogenesis & Pathophysiology of Acute & Chronic Chest Infection

Question 1

Acute vs chronic chest infection duration

Answer 1

Acute: <3 weeks
Chronic: >3 weeks

Question 2

What is chronic chest infection also known as?

Answer 2

Persistent chest infection

Question 3

List some specific conditions that can predispose someone to chronic chest infection

Answer 3

• COPD
• Bronchiectasis
• Cystic fibrosis

Question 4

What are some risk factors for chronic chest infection?

Answer 4

• Immunocompromised
• Inability to clear secretions
• Reduced cough/gag reflex
• Reduced respiratory effort

Question 5

Describe the vicious cycle of chronic chest infection pathogenesis

Answer 5

• infection
• Inflammation
• Impaired mucocilliary clearance
• Mucus hypersecretion -> colonisation
• Bronchial dilation and airway destruction

Question 6

List some common organisms that can cause chronic chest infection

Answer 6

• Mycobacteria (TB and non-TB)
• Fungi
• Haemophilus influenzae

Question 7

What are the symptoms of a chronic chest infection in a patient with no underlying lung disease?

Answer 7

• Productive cough
• Malaise
• Chest pain
• Fever

Question 8

What are the symptoms of a chronic chest infection in a patient with an underlying lung disease?

Answer 8

• Increased purulence/production of sputum
• Change in sputum colour

Question 9

List some preventative measures for chronic chest infection

Answer 9

• Vaccinations
• Patient education
• Smoking cessation
• Emergency pack use (tailored antibiotics)

Question 10

General approach to management of chronic chest infection in a patient with pre-existing chronic lung condition.

Answer 10

• Early identification of acute exacerbation
• Tailored antimicrobial therapy (guided by sputum culture)
• Airway clearance

Question 11

Describe how chronic chest infection can cause a lung abscess, and how this is managed

Answer 11

• Caused by aspiration (typically bacteria)
• Extended antibiotic therapy (4-6 weeks), surgical intervention if needed

Question 12

What is a lung abscess?

Answer 12

Pus-filled cavity in the lung surrounded by inflamed tissue

Question 13

How can pneumonia cause parapneumonic effusion?

Answer 13

• Inflammation
• Increased vascular permeability
• Effusion of fluid into pleura

Question 14

How is parapneumonic effusion managed in acute and chronic chest infection?

Answer 14

• Antibiotic therapy
• Consideration of drainage

Question 15

Management of empyema? Is intervention always needed?

Answer 15

• Always require intervention
• Drainage +/- intrapleural fibrinolytics
• May require surgical intervention