the bronchi are air passages of the lungs. bronchitis
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The bronchi are airpassages of the
lungs. Bronchitis isinflammation of the bronchi.
It can makebreathing difficult.It can also bepainful.
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Acute bronchitis—is a sudden onset of symptoms. It onlylasts a short time. There is full recovery of lung function.
Chronic bronchitis —is a long term condition. It causesobstruction and erosion of the lungs. It is often the resultof 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 withallergies.
Irritative bronchitis—due to frequent contact with certainirritants. This often happens because of work setting.(also known as industrial or environmental bronchitis)
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The inflammation may be caused by:Bacterial and viral infectionsSmoking (cigarettes or marijuana)
Inhalation of certain respiratory irritants(usualy in work setting) such as:
Ammonia
Chlorine
Minerals
Vegetable dusts
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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
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Symptoms will depend on the type of bronchitis.
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Runny noseMalaiseSlight feverBack and muscle painSore throat Cough, initially dry, then produces
mucus that may be thick, yellow,green, blood-streaked
Wheezing
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BRONCHI AND AIR SACSOF LUNGS
Persist cough withsputum production for atleast 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)
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The doctor will ask about yoursymptoms and medical history. A
physical exam will be done.
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Tests are rare. The following may berecommended for severe orquestionable cases:
Blood testChest x-rays —to rule out pneumonia, a
complication of bronchitis
Pulse oximetry—to measure theamount of oxygen in the blood
Bronchoscopy with culture of thesputum
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Tests may include:Blood testChest x-rays
Pulmonary function tests or spirometry—toevaluate lung function Sputum cultureArterial blood gas—to test for levels of oxygen,
carbon dioxide, and acid in the blood
Pulse oximetryBronchoscopy with culture of obtained sputum
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Labored breathing : use of respiratory accessory muscles.
Deep seated cough , productive maybe purulent but not foul.
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No change in vocal fremitus.
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No change in mild cases but if associated with emphysema –
Hyperresonance.
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Early stage ; moist rales at the baseof lung and does not disappear after
coughing .
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Treatment is aimed at relieving thesymptoms. It includes:
Aspirin or acetaminophen to treat pain andfever
Expectorants or cough suppressants Increased fluid intakeCool mist humidificationHerbs and supplements — Pelargonium
sidoides extract may help resolve symptoms
in patients with acute bronchitisAntibiotics will not be helpful if the infection
is viral.
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Oral antibiotics and bronchodilators, particularlyclarithromycin If you have chronic bronchitis and mild-to-moderate
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 fivedays) 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)
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To reduce your chance of gettingbronchitis:
Stop smoking or never start.Avoid passive smoke.Avoid exposure to respiratory
irritants.Avoid contact with people who have
bronchitis.
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COPD
Chronic obstructive pulmonary disease(COPD) is a progressive disorder
evenwhen contributing factors areeliminated and aggressive therapy isinstituted.
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Emphysema and chronic bronchitis areoften clinically grouped together andreferred to as (COPD), since many patientshave overlapping features of damage atboth the acinar level (emphysema) and
bronchial level (bronchitis), almostcertainly because one extrinsic trigger—cigarette smoking—is common to both.
about 10% of patients are nonsmokers
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Emphysema is a condition of the lungcharacterized by abnormal permanentenlargement of the airspaces distal to the
terminal bronchiole, accompanied bydestruction of their walls and withoutobvious fibrosis.
results in loss of alveolar and capillarysurface area, elastic recoil of the lung, airtrapping, and hyperexpansion of the lungs
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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 inheavy smokers, often in association with chronic bronchitis.
Panacinar (Panlobular) Emphysema. -the acini are uniformly enlarged from the level of therespiratory bronchiole to the terminal blind alveoli , entireacinus but not to the entire lung. associated with α1-antitrypsin (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
Types of Emphysema
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PATHOGENESIS
**Tissue breakdown is
enhanced as aconsequence of inactivation of protectiveantiproteases by reactiveoxygen species in cigarettesmoke.
protease-antiproteasemechanism
oxidant-antioxidant imbalance.
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PHYSICALEXAMINATION
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INSPECTION
Dyspnea barrel-chested
Accessory muscle move pursed lip breathing Thin patients
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PALPATION
Decrease Vocal fremitus
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PERCUSSION
Generalized hyperresonance maybe heard over the hyperinflatedlungs of emphysema
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AUSCULTATION
• Breath sounds may be decreasedwhen air flow is decreased or whenthe transmission of sound is poor (asin pleural effusion, pneumothorax, oremphysema)
• Mid-inspiratory crackles (may reflectdisease of moderate-size airways)
• Wheezing (inconstant finding anddoes not predict degree of obstructionor response to therapy)
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Manifestations when at least one third of the functioning pulmonaryparenchyma is damaged.
Dyspnea is usually the first symptom; it begins insidiously but is steadilyprogressive.
cough or wheezing is the chief complaint, confused with asthma.
Cough and expectoration
Weight loss
barrel-chested and dyspneic, with obviously prolonged expiration, sitsforward 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 mayover-ventilate and remain well oxygenated and therefore are somewhatingloriously designated as pink puffers
Development of cor pulmonale and eventual congestive heart failure,related to secondary pulmonary vascular hypertension, is associatedwith 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. Treatmentoptions include bronchodilators, steroids, bullectomy, and, in selected
patients, lung volume reduction surgery and lung transplantation.
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prolonged expiratory phase (decreasedFEV1 ), poor exercise tolerance, and oxygendependence in those
Radiographically, lungs are hyperinflatedand the hemidiaphragms are flattened. On CT, blebs of various sizes are usually
seen in the upper lobes but may bedistributed throughout the lung.Compression of normal parenchyma byblebs results in further impairment of gasexchange.
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TREATMENT
Smoking Cessation-Although lost lungfunction 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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