Chronic bronchitis

Question 1

etiology :

Answer 1

• Smoking
• Chemical agent
• Congenital disorders: deficiency ά1- antitrypsin, deficiency serum elastase inhibitors
• Infection: Gram (+) and (-), virus, mycoplasma, influenza
• Air pollution
• Environmental - changes of weather
• Climate: autumn and spring
• dysfunction of cilia transport, chronic inflammation with sclerosis

Question 2

pathogenesis

Answer 2

1. Problem with mucociliary transport
2. Infection develop
   - infiltration of cells
   - hyperproduction of mucous
   - sclerotic changes in parabronchial tissue
   - inflammation develops, edema, atrophy of epithelium
3. Obstruction syndrome
   - Functional component –result of spasm, edema & high mucous production
   - Organic component – sclerotic changes
4. development of emphysema - present problem with gas metabolism in lung
   - develop increased arterial pressure in pulmonary system
   - development of hypertrophy and enlargement of right atrium and ventricle of heart leading to Cor Pulmonale

Question 3

classification

Answer 3

1. Acc to character of sputum
   - Mucous : catarrhal/ simple bronchitis
   - Purulent : purulent bronchitis
   - Catarr-purulent: mixed form / mucopurulent
   - Hemorrhage
   - Fibrinogen form
2. Acc to localization:
   - Distal – aseptic, obstructive with pus
   - Proximal - with/without pus purulent
   - simple, superficial
3. Acc to obstructive syndrome:
   - Obstructive bronchitis
   - Non-obstructive bronchitis
4. Acc to phase:
   - Relapsing
   - Remission
5. Acc to complication:
   - Emphysema
   - Pneumosclerosis
   - Chronic respi failure
   - Bleeding
   - Pulmo insufficiency, hpt
   - Bronchiectasis (secondary)
   - Cor pulmonale

Question 4

syndromes

Answer 4

1. Obstructive syndrome
   - Dry cough, dry rales, expiratory dyspnea
2. Intoxication syndrome
   - fever ( <38°C ), myalgia, athralgia, Loss of appetite
3. Sign of inflammation: increase temperature, leukocytosis, fibrinogen, increase ESR&CRP

Question 5

investigation

Answer 5

Investigation
1. General blood analysis: leucocytosis shift to the left, ↑ ESR, erythrocytosis

2. Biochemical blood analysis: increase C protein, serous mucoid, fibrinogen
3. Sputum examination: vol, character, colour, epithelium & neutrophiles in sputum
   - clinical: serum, serum-purulent, purulent
   - microbial: pneumococcus, hemophilic influenze, staphylococcus
4. X-ray
   - enlargement root of the lung & diffusion pneumosclerosis
   - if develop emphysema, present features of emphysema
   - increase transparency
5. Fibrobronchoscopy: differential diagnosis in cancer & bronchoectatic disease
6. U/S : changes in right heart in case of lung hypertension
7. ECG: right ventricle, atrium hypertrophy, R wave II,III >7mm, parodoxal S wave in V5 and V6
8. Pnemotocography: registration of rapid phase of expiration and inspiration
9. Spirometry: registration of constant volume in breathing
10. radionuclide isotope: see lung perfusion, reduction of pulm system

Question 6

treatment

Answer 6

1. Antibiotics - penicillin, cephalosporin, erythromycin
2. Correction of immune system - T-activin, deucifrom
3. Broncholytics - xanthines: theophylline, euphyline, methylxanthines, salbutamol, albuterol (atropine)
4. M-cholinoblockers, Adrenomimetics
5. Mucoregulators - bromixin, bronhexin
6. Detoxification therapy
   - drink alkalines: hydration of sputum ( eg: mineral water )
   - IV detoxication therapy: glucose, Ringer‘s solution
7. Ca2+ antagonist
8. O2 inhalation
9. Diuretics
10. Cardioglycosides
11. immunocorrection drugs – Thimollin
12. α-antitripsin
13. expectorants: mucolytics-acetylcysteine, trypsin
14. heparin
15. stabilise immunity: anabol,tactirin