Bronchitis Flashcards
What is bronchitis?
Inflammation of the bronchial tubes which carry air to and from the lungs
What are the 2 main types of bronchitis?
Acute bronchitis - short term
Chronic bronchitis - long term & more serious
What causes bronchitis?
Smoking, the chemicals in the smoke irritate the lining of your bronchi and they begin to become inflamed
What do goblet cells do and where are they?
In the epithelial layer inside the airways, produce mucus to try and clear the chemical irritants
Why is mucus important?
Traps dust, microbes and other irritants preventing them from entering the lungs
How does the body attempt to clear the bronchitis irritants?
by producing excess amounts of mucus
What can excessive mucus production lead to?
Clogged airways
increased coughing
potential for infection
What are the symptoms of bronchitis?
cough, wheezing, SOB, chest discomfort
What is the treatment for bronchitis?
rest and hydration, cough suppressants, bronchodilators, avoiding irritants
What happens when the excess mucus picks up the chemicals, tar and other products from cigarette smoke?
Causes continuous irritation and inflammation of the bronchi and causes a cough reflex due to the airways being sensitive to irritants - this is in an attempt to clear the airways of irritants and excess mucus
What are expectorants?
A medication which helps to loosen mucus
What are the effects of the coughing in bronchitis?
The continual coughing leads to further irritation and inflammation and over time chronic inflammation results in structural changes in the airways - hypertrophy & hyperplasia
What is hypertrophy?
The enlargement of existing goblet cells which increases mucus production
What is hyperplasia?
An increase in the number of goblet cells - further contributing to excessive mucus secretion
What is treatment for the excess coughing associated with bronchitis?
Bronchodilators - to help open airways
corticosteroids - to reduce inflammation
expectorants - to aid in mucus clearance
What condition does the chronic inflammation and irritation lead to?
pulmonary fibrosis
What is pulmonary fibrosis?
A condition which causes the bronchial walls to thicken - fibroses tissue does not contract so lung function is impaired as the lungs cannot expand or contract effectively during breathing. It also causes narrowing of the lumen (opening) of the airways which can significantly disrupt airflow
What are treatments for pulmonary fibrosis?
Anti-inflammatory medications
Pulmonary rehabilitation
Oxygen therapy in severe cases
What is the result of bronchitis progressing and pulmonary fibrosis
Inadequate oxygen exchange in the lungs resulting in hypoxia and hypercapnia
What are the symptoms of hypoxia?
SOB
Fatigue
Cyanosis
what is hypercapnia?
Elevated carbon dioxide levels in the blood
Why does hypercapnia occur?
Impaired ventilation so co2 becomes trapped in the lungs and reduced ability to expel co2 effectively due to thickened airway walls and excessive mucus
What are peripheral chemoreceptors and what do they do?
sensitive to changes in the levels of oxygen and co2 in the blood, normally these signal the brain to increase the rate and depth of breathing in response to rising co2 levels and falling oxygen levels
What do the peripheral chemoreceptors do in patients with chronic bronchitis?
Become less sensitive due to prolonged exposure to elevated co2 levels, so they send less signals to the brain to drive breathing effectively - this can contribute to a state of hypoventilation
What are treatments of hypoxia and hypercapnia?
Oxygen therapy
Ventilatory support
What is the hypoxic drive?
Now the peripheral chemoreceptors don’t send signals to the brain from the rising levels of co2, the body shifts to the hypoxic drive, the peripheral chemoreceptors now stimulate the respiratory centres in the brain to increase the rate and depth of breathing when the oxygen levels drop
What does hypoxia do to the pulmonary arteries?
causes a reflex vasoconstriction of pulmonary arteries in an attempt to increase perfusion - this is known as hypoxic pulmonary vasoconstriction - this leads to pulmonary hypertension and is often seen on an ECG as taller pointy P waves
What effect does pulmonary hypertension have?
Leads to increased workload on the right side of the heart which must work harder to pump blood through the narrowed vessels
What treatment can be given for pulmonary hypertension?
vasodilators to reduce pressure and improve blood flow
Explain what happens as a result of pulmonary hypertension
Increases the workload on the right side of the heart so it must work harder to maintain adequate blood flow, as the right ventricle is working much harder it leads to right ventricular hypertrophy (enlargement of the right ventricle)
What is cor pulmonale?
Specifically right ventricular hypertrophy or failure that occurs as a result of lung disease - particularly conditions that cause pulmonary hypertension
Symptoms of right ventricular failure
SOB
Fatigue
Swelling in legs and ankles
distended neck veins
What does blue bloaters mean?
blue - cyanosis
bloaters - edema
What is polycythemia?
In an attempt to provide more oxygen carrying capabilities the body produces new red blood cells at an alarming rate
How does polycythemia occur?
The kidneys detect low oxygen levels and respond by increasing the production of erythropoietin
What are the effects of polycythemia?
Thickened blood
Elevated blood pressure
Increased risk of thrombosis (blood clots)
Strain on the heart
What is erythropoietin?
A hormone that stimulates the bone marrow to produce more red blood cells
How does erythropoietin work?
It travels through the bloodstream to the bone marrow where it binds to receptors on the erythroid progenitor cells - which then signals for more red blood cells to be produced
How do patients with polycythemia present?
Sluggish
Cyanosed
Bloated
What are management strategies for polycythemia?
Hydration
Phlebotomy (removal of blood)
Oxygen therapy
Why does cyanosis occur?
The body’s tissues use up oxygen, so the blood that returns to the heart is less oxygenated but in chronic bronchitis, the circulation is sluggish (due to thick blood), so deoxygenated blood doesn’t return to the lungs quickly enough to get more oxygen.
