The bronchi are air passages of the lungs.  Bronchitis is inflammation of the bronchi.

 It can make breathing difficult. It can also be painful.

 

Acute bronchitis—is a sudden onset of symptoms. It only lasts a short time. There is full recovery of lung function. Chronic bronchitis —is a long term condition. It causes obstruction and erosion of the lungs. It is often the result of many years of cigarette smoking. This is a serious condition. It is a type of chronic obstructive pulmonary disease (COPD). Asthmatic bronchitis—occurs in people with asthma. Occurs during an asthma attack. It is most common with allergies. Irritative bronchitis—due to frequent contact with certain irritants. This often happens because of work setting. (also known as industrial or environmental bronchitis)

The inflammation may be caused by:  Bacterial and viral infections  Smoking (cigarettes or marijuana)  Inhalation of certain respiratory irritants (usualy in work setting) such as:
 Ammonia  Chlorine  Minerals  Vegetable dusts

 Smoking  Exposure to second-hand smoke  Contact with a person infected with bronchitis  Viral upper respiratory tract infection ( cold or flu)  Asthma  Chronic sinusitis  Occupational exposures to respiratory inhalants  Smog, in susceptible individuals  Enlarged tonsils and/or adenoids  Malnutrition

 Symptoms

will depend on the type of

bronchitis.

 Runny nose  Malaise  Slight fever  Back and muscle pain  Sore throat  Cough, initially dry, then

produces mucus that may be thick, yellow, green, blood-streaked  Wheezing

Persist cough with sputum production for at least 3 months in at least 2 consecutive years.  Cough that brings up yellow-green mucus, often worse in the morning  Difficulty breathing  Bluish tint to lips and skin (in severe cases)

BRONCHI AND AIR SACS OF LUNGS

 The

doctor will ask about your symptoms and medical history. A physical exam will be done.

 Tests

are rare. The following may be recommended for severe or questionable cases:  Blood test  Chest x-rays —to rule out pneumonia, a complication of bronchitis  Pulse oximetry—to measure the amount of oxygen in the blood  Bronchoscopy with culture of the sputum

 Tests may include:  Blood test  Chest x-rays  Pulmonary function

tests or spirometry—to evaluate lung function  Sputum culture  Arterial blood gas—to test for levels of oxygen, carbon dioxide, and acid in the blood  Pulse oximetry  Bronchoscopy with culture of obtained sputum

 Labored

breathing : use of respiratory accessory muscles.  Deep seated cough , productive may be purulent but not foul.

 No

change in vocal fremitus.

 No

change in mild cases but if associated with emphysema – Hyperresonance.

 Early

stage ; moist rales at the base of lung and does not disappear after coughing .

 Treatment

is aimed at relieving the symptoms. It includes:  Aspirin or acetaminophen to treat pain and fever  Expectorants or cough suppressants  Increased fluid intake  Cool mist humidification  Herbs and supplements — Pelargonium sidoides extract may help resolve symptoms in patients with acute bronchitis  Antibiotics will not be helpful if the infection is viral.

Oral antibiotics and bronchodilators, particularly clarithromycin
 If you have chronic bronchitis and mild-to-moderate

        

Bronchodilators Oral or intravenous corticosteroid medications Inhaled bronchodilators or corticosteroids Expectorants to loosen secretions Mucolytics. Supplemental oxygen Cool mist humidification Lung reduction surgery —removal of the most damaged part of the lungs (in severe cases) Lung transplant (in end-stage cases)

COPD, you may not need antibiotics  A study found that shorter antibiotic treatment (five days or less) is as effective as longer treatment (more than five days)

 To

reduce your chance of getting bronchitis:  Stop smoking or never start.  Avoid passive smoke.  Avoid exposure to respiratory irritants.  Avoid contact with people who have bronchitis.

COPD
Chronic obstructive pulmonary disease (COPD) is a progressive disorder even when contributing factors are eliminated and aggressive therapy is instituted.

 Emphysema

and chronic bronchitis are often clinically grouped together and referred to as (COPD), since many patients have overlapping features of damage at both the acinar level (emphysema) and bronchial level (bronchitis), almost certainly because one extrinsic trigger— cigarette smoking—is common to both. 10% of patients are nonsmokers

 about

 Emphysema

is a condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole, accompanied by destruction of their walls and without obvious fibrosis.  results in loss of alveolar and capillary surface area, elastic recoil of the lung, air trapping, and hyperexpansion of the lungs

Types of Emphysema

Centriacinar (Centrilobular) Emphysema -involvement of the lobules; the central or proximal parts of the acini, formed by respiratory bronchioles, are affected, whereas distal alveoli are spared, occurs predominantly in heavy smokers, often in association with chronic bronchitis. Panacinar (Panlobular) Emphysema. -the acini are uniformly enlarged from the level of the respiratory bronchiole to the terminal blind alveoli , entire acinus but not to the entire lung. associated with α1antitrypsin (α1-AT) deficiency Distal Acinar (Paraseptal) Emphysema. -proximal portion of the acinus is normal, but the distal part is predominantly involved Airspace Enlargement with Fibrosis (Irregular Emphysema). -acinus is irregularly involved, is almost invariably associated with scarring. In most instances, are asymptomatic and clinically insignificant

PATHOGENESIS
 

proteaseantiprotease mechanism oxidant-antioxidant imbalance.

**Tissue breakdown is enhanced as a consequence of inactivation of protective antiproteases by reactive oxygen species in cigarette smoke.

PHYSICAL EXAMINATION

INSPECTION
 Dyspnea  barrel-chested  Accessory muscle move  pursed lip breathing  Thin

patients

PALPATION
 Decrease

Vocal fremitus

PERCUSSION
Generalized hyperresonance may be heard over the hyperinflated lungs of emphysema

AUSCULTATION

Breath sounds may be decreased when air flow is decreased or when the transmission of sound is poor (as in pleural effusion, pneumothorax, or emphysema) Mid-inspiratory crackles (may reflect disease of moderate-size airways) Wheezing (inconstant finding and does not predict degree of obstruction or response to therapy)

Manifestations when at least one third of the functioning pulmonary parenchyma is damaged. Dyspnea is usually the first symptom; it begins insidiously but is steadily progressive. cough or wheezing is the chief complaint, confused with asthma. Cough and expectoration Weight loss barrel-chested and dyspneic, with obviously prolonged expiration, sits forward in a hunched-over position, and breathes through pursed lips to reduce dyspnea. Expiratory airflow limitation, is the key to diagnosis. severe emphysema, overdistention is severe, diffusion capacity is low, and blood gas values are relatively normal at rest. Such patients may over-ventilate and remain well oxygenated and therefore are somewhat ingloriously designated as pink puffers Development of cor pulmonale and eventual congestive heart failure, related to secondary pulmonary vascular hypertension, is associated with a poor prognosis. Death in most patients with COPD is due to (1) respiratory acidosis and coma, (2) right-sided heart failure, and (3) massive collapse of the lungs secondary to pneumothorax. Treatment options include bronchodilators, steroids, bullectomy, and, in selected patients, lung volume reduction surgery and lung transplantation.

   

 

prolonged expiratory phase (decreased FEV1 ), poor exercise tolerance, and oxygen dependence in those Radiographically, lungs are hyperinflated and the hemidiaphragms are flattened. On CT, blebs of various sizes are usually seen in the upper lobes but may be distributed throughout the lung. Compression of normal parenchyma by blebs results in further impairment of gas exchange.

TREATMENT

    

Smoking Cessation-Although lost lung function is not regained, the rate of decline in FEV1 reverts rapidly to that of nonsmokers. Bronchodilators Glucocorticoids Oxygen Transplantation Lung Volume Reduction Surgery

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