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BRONCHIECTASIS Definition: It is a chronic irreversible dilation of the bronchi or bronchioles.

Chronic permanent dilation of one or more bronchi that will cause impairment in the drainage. This will leads to persistent infection. Impairment Of Bronchial Clearance Increased Bronchial Secretion Stasis Of Secretion Infection Further Weakening & Destruction Of Bronchial Wall Increased Bronchial Dilation Atelectasis Inflammatory Scaring Fibrosis Respiratory Insufficiency Ventilation & Perfusion Imbalance Hypoxemia There are 2 pathologic types of bornchiectasis: Saccular and Cylindric. Saccular bronchiectasis occurs mainly in large bronchi and is characterized by cavity-like dilations. The affected bronchi end in large sacs. Cylindric bronchiectasis involves medium-sized bronchi that are mildly to moderately dilated. It is mainly associated with bacterial infections. (Adenovirus, influenza virus, S.aureus, klebsiella and anaerobes). Infection causes the bronchial wall to weaken, and pockets of infection begin to form. When the walls of the bronchial system are injured, the mucocillary mechanism is damaged, allowing bacteria and mucus to accumulate within the pockets. The infection becomes worse and results in bronchiectasis. ASTHMA Definition: Asthma is a chronic inflammatory disease of the airways that causes airway hyper-responsiveness, mucosal edema, and mucous production

Triggers Infection, allergens Exercise, Irritants IgE-mast cell mediated response Release of mediators from mast cells, eosinophils, macrophages, lymphocytes Early phase Response Peaks in 30 to 60 Late phase response Peaks in 5 to 6 hr Infiltration with Eosinophils & neutrophils Inflammation Bronchial hyperreactivity Within 1 to 2 days Infiltration with monocytes $ lymphocytes

Bronchial smooth muscle Constriction Mucus secretion Vascular leakage Mucosal rdema

Obstruction of large and small airways Air trapping Respiratory acidosis Hypoxemia The hallmark of asthma are airway inflammation and nonspecific hypersensitivity or hyperresponsiveness of the tracheobronchial tree. It is due to physical, chemical, and pharmacologic agents. The early -phase of asthma is characterized by bronchospasm, which includes the inflammatory sequelae of the late response. The early-phase response is triggered when an allergen or irritant cross-links IgE receptors on mast cells found beneath the basement membrane of the bronchial wall. The mast cell become activated, with subsequent release of granules and disruption of the phospholipid cell membrane. Both processes result in the release of inflammatory mediators, including histamine, bradykinin, leukotrienes, prostaglandins, etc. They causes intense inflammation associated with the classic immediate reaction of asthma, which consists of bronchial smooth muscle constriction, increased vasodilation and permeability, and epithelial damage. This response peaks within 30 to 60 minutes of exposure to the trigger and subsides in another 30-90 minutes. Clkinically the patient has wheezing, chest tightness, dyspnea, and cough. The late-phase response in asthma peaks 5 to 6 hours after exposure and may last for several hours or days. It is characterized primarily by inflammation. Eosinophils and neutrophils infiltrate the airways. These cells can subsequently release mediators

that cause mast cell to release histamine and other mediators that eventually set up a self-sustaining cycle. In addition, lymphocytes and monocytes influx into the area. These events, which define the late-phase response, increase airway reactivity, which may worsen the symptoms of future asthma attacks. The prominent pathophysiologic features of asthma are a reduction in airway diameter and an increase in airway resistance related to mucosal inflammation, constriction of bronchial smooth muscle, and excess production of mucus. Accompanying these changes are bronchial smooth muscle hypertrophy, basement membrane thickening, mucus gland hypertrophy, thick and tenacious sputum, hyperinflation, and air trapping in the alveoli leading to an increased work of breathing. As a consequence of these events, alterations in respiratory muscle function, abnormal distribution of both ventilation and perfusion, and altered ABG occurs. CHRONIC OBSTRUCTIVE PULMONARY DISEASE Definition COPD refers to several disorders that affect the movement of air in and out of the lungs. Although the most important of these obstructive bronchitis, emphysema, and asthma. Tobacco smoke Air pollution Continual bronchial Irritation $ inflammation Chronic bronchitis Airway obstruction Air trapping Dyspnea,infections Abnormal ventilation perfusion ratio Hypoxemia; hypoventilation Cor-Pulmonale Alpha -1 antitrypsin deficiency Breakdown of elastin in connective tissue of lung Emphysema