Chapter 22: Bronchitis Flashcards
Etiology of Acute Bronchitis
- acute inflammation of the trachea
- causes include viral or nonviral, heat, smoke inhalation, inhalation of irritant chemicals, and allergic reactions
Asthmatic Bronchitis
- swelling of the bronchial mucosa in children, associated with obstruction, respiratory distress, and wheezing
Pathogenisis of Acute Bronchitis
- airways become inflamed and narrowed from capillary dilation
- swelling from fluid exudation
- infiltration with inflammatory cells
- increased mucus production
- loss of ciliary function
- loss of portions of the cilliated epithelium
Clinical Manifestations of Acute Bronchitis
- usually mild to self limiting
- cough
- low grade fever
- substernal chest discomfort
- sore throat
- postnasal drip
Diagnosis of Acute Bronchitis
- clinical presentation
- DISTINCT HALLMARK OF DISEASE IS RECENT ONSET COUGH**
- chest x ray to distinguish acute bronchitis from pneumonia
Treatment of Acute Bronchitis
- usually no treatment needed if viral
- antibiotic therapy if bacterial
- codeine containing meds for cough
- increased fluid intake
- avoid smoe
- use a vaporizer in bedroom
Causes of Chronic Bronchitis
- cigarette smoking (90%)
- repeated airway infections
- genetic predisposition
- inhalation of physical or chemical irritants
Etiology of Chronic Bronchitis
- type B COPD (blue bloater)
- Hypersecretion of bronchal mucus
- chronic or recurrent productive cough >3 months >2+ successive years
- Persistent, irreversible when paired with emphysema
- 1`:2 male to female ratio
- > 30 to 40 yrs
Pathogenesis of Chronic Bronchitis
- chronic inflammation and swelling of the bronchial mucosa resulting in scarring
- Hyperplasia of bronchial mucous gland/goblet cells
- increased bronchial wall thickness
- Pulmonary Hypertension
- destruction of bronchial walls
Clinical Manifestations of Chronic Bronchitis***
- ascites (accumulation of fluid in the peritoneal cavity)
- distended neck
- typically patient is overweight
- commonly associated with emphysema
- SOB on exertion
- Excessive sputum
- Chronic cough (sever in mornings)
- Evidence of excess body fluids
- Cyanosis
Diagnosis of Chronic Bronchitis
- includes chest x-rays, Pulmonary Function Tests (PFTs) , Arterial Blood Gas (ABG), ECG, Secondary
Diagnosis of Chronic Bronchitis (Chest X-Ray)
- increased bronchial vascular markings which show congested lung fields
- Enlarged horizontal cardiac silhouette
- evidence of previous pulmonary infection
Diagnosis of Chronic Bronchitis (PFT)
- normal total lung capacity (TLC)
- increased residual volume (RV)
- Decreased FEV1 (
Diagnosis of Chronic Bronchitis (ABG)
- elevated PaCO2 due to being unable to breath it out
- Decreased PO2 because hard time breathing in
Diagnosis of Chronic Bronchitis (ECG)
- atrial arrhythmias
- Evidence of right ventricular hypertrophy
Diagnosis of Chronic Bronchitis (Secondary Polycythemia)
- compensatory mechanism because the body isn’t absorbing enough O2
- r/t (related to) continuous or nocturnal hypoxemia
Treatment Goals for Chronic Bronchitis
- block the progression of the disease
- return to optimal respiratory function
- Return to usual activities of daily living (ADLs)
Medicinal Treatment of Chronic Bronchitis
- inhaled short acting B2 antagonists (will cause bronchial dilation) (adrenergic) (wear off in 4-6 hours) (types include ventolin, and albuterol)
- Inhaled anticholinergic bronchodilators (same effect as B2 antagonists) (will dry up secretions) (mimics parasympathetic response)
- “Z-Pac” (includes azithromycin and zythromax)
- Inhaled coritcosteroids
- Theophylline products (have a narrow therapeutic window, must check blood levels, not really used as much, very good for bronchodilation, cardiovascular events
Adrenergic
- something that is adrenergic mimics the effects of the sympathetic nervous system response
Other Treatment of Chronic Bronchitis
- low dose O2 therapy (be careful however as you can overoxygenate)
- Mechanical ventilation may be necessary
- never give over 2L of O2
O2 Saturation
- normal O2 saturation is 94%-100%
- people with chronic bronchitis live w/ about 90% for so long so you cannot give them too much O2 or you will knock out their drive to breath, which will cause a state of high O2 levels in blood and lead to CO2 narcosis
Management of Chronic Bronchitis
- smoking cessation
- Bronchodilator therapy
- reduction to exposure of irritants
- adequate rest
- proper hydration to move mucous
- Physical conditioning
- Influenza (every year) and pneumococcal (every 10 years) vaccines are necessary
