Respiratory - Class 3 Flashcards
An acute infection of the bronchial tree, causing inflammation of medium and large sized bronchi and trachea.
Acute Bronchitis
Bronchial mucosal irritation, hyperemia and edema leads to diminished bronchial mucociliary function.
Acute Bronchitis
Airways can become blocked, clogged by debris and irritation increases secretion of mucus, leading to coughing.
Acute Bronchitis
Commonly related to bacterial infection but may be viral, allergic or caused by exposure to toxins/pollutants.
Acute Bronchitis
Often associated with smoking, or being immune-suppressed (specifically seen in young children and with advanced age).
Acute Bronchitis
Usually self-limiting (lasting approximately 10 days) and if bacterial, can be effectively treated with antibiotics. If the inflammation extends into the bronchioles and alveoli, bronchopneumonia results.
Acute Bronchitis
Recurrence can damage mucosa, mucociliary elevator, leading to impairment of the removal of mucous and particles, and can contribute to bronchial epithelial metaplasia (cancer).
Acute Bronchitis
Productive intense cough: sputum is clear, yellow, green (occasionally blood-tinged)
Acute Bronchitis Signs & Symptoms
this is associated with an abnormal reaction of the lungs to inhaled noxious particles/gases, and there are 3 main different types (emphesyma, bronchiectasis & chronic bronchitis).
COPD
COPD
Chronic Obstructive Pulmonary Disease
there is a progressive, chronic or recurrent airflow limitation, often leading to prolonged forced exhalations and predominately irreversible damage to lungs.
COPD
Pathological changes in COPD occur mainly in the ______ ______ and the small bronchioles. Lung parenchyma can also be affected.
large airways
- inflammation and edema of lung mucosa
- thickened basement membrane
- mucus gland hypertrophy
- goblet cell hyperplasia
- bronchial smooth muscle hypertrophy/ constriction
- airway wall remodelling (chronic inflammation will result in thickening of the mucosa)
Pathological features of COPD
Destruction of alveolar walls and capillary beds supplying the alveoli - leading to abnormal, permanent enlargements of the air spacesdistal to the terminal bronchioles, distention and expansion of the airspaces/ alveoli into larger air sacs – inefficient for gas exchange
Emphysema
Damage to elastic fibres that function to hold airways open - leads to loss of lung elastic recoil and impaired gas exchange. During expiration (especially forced expiration), small airways collapse and air is trapped in the lungs distal to the collapsed airways.
Emphysema
Lung compliance increases (the lung becomes easy to distend), but recoil is decreased so the airway empties slowly. As the patient exhales, the airways begin to collapse before the air has been expelled, resulting in a chronically over-inflated lung. This can affect the diaphragm function and the patient is faced with the increasingly difficult task of constantly trying to expand an already over-expanded thorax…
Emphysema
Abnormal enlargements of air spaces distal to the terminal bronchioles are known as BULLA. Once they have enlarged to greater than 1 cm (they may reach sizes of greater than 7 cm in some cases), bulla may compress adjacent healthy lung tissue, further impairing ventilation and perfusion.
How does emphysema develop
In cases of advanced emphysema, bulla may be surgically removed, both to reduce compression and avoid their “bursting”, which could lead to a ___________.
Pneumothorax
- smoking (primary and secondary smoke)
- small percentage related to genetic defects in the structure of the respiratory unit
- repeated respiratory infections (especially chronic bronchitis)
- atmospheric pollution
Causes of Emphysema
Centriacinar (Centrilobular) & Panacinar (Panlobular)
Types of Emphysema
- focal destruction of respiratory bronchiole and the central portions of acinus with edema, inflammation and thickening of the bronchiolar wall
- most common in upper lobes
- rare in non-smokers, almost exclusively disease of smokers
- begins at alveolar duct
Centriacinar (Centrilobular)
- destructive enlargement of the entire alveoli distal to the terminal bronchiole (begins at terminal bronchiole)
- can be found throughout the entire lung, more severe in lower lung
- most common occurrence is in smokers, also a genetic correlation
Panacinar (Panlobular)
T/F Patients with advanced emphysema are described as “RED PUFFERS” (fighters)
FALSE IT’S PINK PUFFERS
The presence of a chronic persistent cough with sputum for 3 months, in at least 2 consecutive years (other causes of cough being excluded).
Chronic Bronchitis
The pathological changes of chronic bronchitis are found in the_______ and/ or________.
bronchi AND/OR bronchioles
simple chronic bronchitis, chronic asthmatic bronchitis and obstructive chronic bronchitis
3 types of Chronic Bronchitis
no evidence of airway obstruction
simple chronic bronchitis
increased wheezing and hyperactive airway
chronic asthmatic bronchitis
abnormal airflow
obstructive chronic bronchitis
tenacious, thick, purulent sputum that is difficult to expectorate through chronic cough
Signs & Symptoms of Chronic Bronchitis
T/F QOL issues: progressive withdrawal from physical activity can lead to obesity, patients with chronic bronchitis are often called “BLUE BLOATERS” (non- fighters)
TRUE
Rapid weight gain (possibly leading to diabetes and HBP), more often in chronic bronchitis, due to sedentary lifestyle
Clinical Presentation of Chronic Bronchitis relating to Cardiovascular health
A chronic obstructive pulmonary disease involving abnormal permanent dilation of medium sized conducting bronchi, due to weakening of the muscular and elastic components of the bronchial walls.
Bronchiectasis
is most often associated with a previous chronic necrotizing infection within the airways – the infection damages and weakens the bronchial walls leading to dilation of the bronchial walls.
Bronchiectasis
Commonly presents as a focal process involving a lobe or segment of the lung but can present diffusely, involving both lungs (most often associated with systemic illnesses, such as _______ _______).
Bronchiectasis
cystic fibrosis
Mucosa is edematous and ulcerated, damage to elastic tissues and smooth muscle lead to dilation and scarring.
How does bronchiectasis develop
Hyperplasia of bronchiolar walls – non-ciliated mucus secreting cells replace ciliated epithelium, leading to interruption of mucociliary blanket, leading to retention of the mucus and poor clearance of airways.
How does bronchiectasis develop
Combination of dilated airways, formation of pockets of stretched mucosa and lack of ciliated epithelium allow pooling of infected secretions (germs, dust and mucus) which may lead to abscess formation.
How does bronchiectasis develop
Distal lung parenchyma may also be damaged, secondary to persistent microbial infection or pneumonia.
How does bronchiectasis develop
Bronchiectasis can develop to continue the destruction/ scarring of lung tissue and increase pulmonary resistance, which may lead to _____ ________.
Cor Pulmonale
It can develop after a primary lung infection (pneumonia or TB – TB scarring is most common cause worldwide)
Causes of Bronchiectasis
childhood illness, which can cause permanent scarring of the bronchi (Staphylococcus aureus, Mycobacterium tuberculosis, Mycoplasma pneumoniae, measles virus, pertussis virus, influenza virus, herpes simplex virus and certain types of adenovirus).
Causes of Bronchiectasis
Occasionally will develop due to blockage caused by foreign object.
Causes of Bronchiectasis
May have an inherited immunodeficiency that presents as recurrent lung infections, that could ultimately lead to __________
Bronchiectasis
ay have an inherited immunodeficiency that presents as recurrent lung infections, that could ultimately lead to __________
HIV/AIDS can lead to_________, as a result of repeated infections that accelerate bronchial damage in immunosuppressed patients.
bronchiectasis
Chronic, violent, disabling mucoid cough often lasting months to years
Clinical Presentation of Bronchiectasis
T/F CI for massage therapy if bronchiectasis infection is present
TRUE!!!
CI for massage therapy if infection is present!
Barrel Chest: hyper-inflated lungs, with flattening of diaphragm
Common Features of COPD
Enlargement and failure of the right ventricle, in response to increased vascular resistance
cor pulmonale
short-acting (inhaler/pills, for episodic use); long-acting (meds taken regularly, regardless of whether symptoms are present)
bronchodilators
to relax smooth muscle (can relieve symptoms)
beta-agonists
