BRONCHITIS (PATHOLOGY AND TREATMENT) by SROTA DAWN

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BRONCHITIS [PATHOLOGY & TREATMENT]:

BY SROTA DAWN. M.PHARM [PHARMACOLOGY] SUBJECT - PHARMACOLOGY -∏ VELS SCHOOL OF PHARMACEUTICAL SCIENCES BRONCHITIS [PATHOLOGY & TREATMENT] 9/1/2013 1

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Chronic obstructive pulmonary disease. Bronchitis, emphysema, and asthma may present alone or in combination. Asthma Bronchitis Emphysema 9/1/2013 2

Description:

Description Characterized by presence of airflow obstruction Caused by emphysema or chronic bronchitis Generally progressive May be accompanied by airway hyperreactivity May be partially reversible 9/1/2013 3

Emphysema:

Emphysema Abnormal permanent enlargement of the air space distal to the terminal bronchioles Accompanied by destruction of bronchioles 9/1/2013 4

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Muscle contraction Mucosal oedema Sticky mucus R 2 R 2 Bronchitis case Normal 9/1/2013 5

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9/1/2013 6

COPD Causes:

COPD Causes Infection Major contributing factor to the aggravation and progression of COPD Heredity -Antitrypsin (AAT ) deficiency (produced by liver and found in lungs); accounts for < 1% of COPD cases Emphysema results from lysis of lung tissues by proteolytic enzymes from neutrophils and macrophages 9/1/2013 7

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TYPES OF BRONCHITIS: CHRONIC BRONCHITIS ACUTE BRONCHITIS 9/1/2013 8

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Chronic bronchitis Chronic bronchitis  is a  chronic inflammation   of the bronchi ( medium-size airways ) in the lungs. It is generally considered one of the two forms of chronic obstructive pulmonary disease (COPD), the other being emphysema. Chronic bronchitis It is defined clinically as a persistent cough that produces sputum and mucus, for at least three months per year in two consecutive years. 9/1/2013 9

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Signs and symptoms Bronchitis may be indicated by – Cough (also known as a productive cough, i.E. One that produces sputum), Shortness of breath and Wheezing. Occasionally , chest pains, fever, and fatigue or malaise  may also occur. Mucus is often green or yellowish green and also may be orange or pink , depending on the pathogen causing the inflammation. 9/1/2013 10

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Causes : Tobacco smoking is the most common cause. Pneumoconiosis and long-term fume inhalation are other causes. Allergies can also cause mucus hypersecretion, thus leading to symptoms similar to asthma or bronchitis 9/1/2013 11

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Pollution is a major cause of COPD 9/1/2013 12

Chronic Bronchitis Pathophysiology:

Chronic Bronchitis Pathophysiology Pathologic lung changes are: Hyperplasia of mucus-secreting glands in trachea and bronchi Increase in goblet cells Disappearance of cilia Chronic inflammatory changes and narrowing of small airways Altered function of alveolar macrophages infections 9/1/2013 13

Chronic Bronchitis Pathophysiology:

Chronic Bronchitis Pathophysiology Chronic inflammation Primary pathologic mechanism causing changes Narrow airway lumen and reduced airflow hyperplasia of mucus glands Inflammatory swelling Excess, thick mucus 9/1/2013 14

Chronic Bronchitis Pathophysiology:

Chronic Bronchitis Pathophysiology Greater resistance to airflow increases work of breathing Hypoxemia and hypercapnia develop more frequently in chronic bronchitis than emphysema 9/1/2013 15

Chronic Bronchitis Pathophysiology:

Chronic Bronchitis Pathophysiology Bronchioles are clogged with mucus and pose a physical barrier to ventilation Hypoxemia and hypercapnia , lack of ventilation and O 2 diffusion Tendency to hypoventilate and retain CO 2 Frequently patients require O 2 both at rest and during exercise 9/1/2013 16

Chronic Bronchitis Pathophysiology:

Chronic Bronchitis Pathophysiology Cough is often ineffective to remove secretions because the person cannot breathe deeply enough to cause air flow distal to the secretions Bronchospasm frequently develops More common with history of smoking or asthma 9/1/2013 17

Chronic Bronchitis Clinical Manifestations:

Chronic Bronchitis Clinical Manifestations Earliest symptoms: Frequent, productive cough during winter Frequent respiratory infections 9/1/2013 18

Chronic Bronchitis Clinical Manifestations:

Chronic Bronchitis Clinical Manifestations Bronchospasm at end of paroxysms of coughing Cough History of smoking Normal weight or heavyset Ruddy (bluish-red) appearance d/t polycythemia (increased Hgb d/t chronic hypoxemia)) cyanosis 9/1/2013 19

Chronic Bronchitis Clinical Manifestations:

Chronic Bronchitis Clinical Manifestations Hypoxemia and hypercapnia Results from hypoventilation and  airway resistance + problems with alveolar gas exchange 9/1/2013 20

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Diagnosis: 9/1/2013 21

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Diagnosis: A variety of tests may be performed in patients presenting with cough and shortness of breath: Pulmonary Function Tests (PFT) (or  spirometry ) A  chest X-ray   chest radiography. A sputum sample showing  neutrophil granulocytes  (inflammatory white blood cells) and Check for pathogenic microorganisms such as  Streptococcus spp. A blood test would indicate inflammation High Resolution Computed Tomography (HRCT) 9/1/2013 22

COPD Complications:

COPD Complications Pulmonary hypertension (pulmonary vessel constriction alveolar hypoxia & acidosis ) Pneumonia Acute Respiratory Failure 9/1/2013 23

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Acute bronchitis Acute bronchitis  is an inflammation of the large bronchi (medium-size airways) in the lungs that is Usually caused by viruses or bacteria  and may last several days or weeks. Characteristic symptoms : cough,  sputum (phlegm) production, shortness of breath wheezing related to the obstruction of the inflamed airways. Diagnosis is by clinical examination and sometimes  microbiological examination of the phlegm. Treatment For acute bronchitis is typically symptomatic. As viruses cause most cases of acute bronchitis, antibiotics should not be used unless microscopic examination of gram-stained sputum reveals large numbers of bacteria . 9/1/2013 24

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Anti-inflammatory drugs: steroids 9/1/2013 25

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Membrane phospholipid Arachidonic acid Phospholipase A2 Leukotrienes: B’constrictor COX-I PGs with gastric protective effects COX-II PGs with inflammatory effects 9/1/2013 26

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Membrane phospholipid Arachidonic acid Phospholipase A2 Leukotrienes COX-I PGs with gastric protective effects COX-II PGs with inflammatory effects X steroids 9/1/2013 27

Anti-inflammatory drugs: steroids:

Anti-inflammatory drugs: steroids Life-saving. Take at least 12 h to work: so start early in severe cases. Systemic steriods : acute severe asthma. Inhaled steroids: maintenance 9/1/2013 28

Anti-inflammatory drugs: steroids:

Anti-inflammatory drugs: steroids Systemic steroid: intolerance ‘ Cushingoid ’ features Hypertension Salt and water retention Infection Topical steroid Hoarseness 9/1/2013 29

Anti-inflammatory drugs: cromoglycate{mast cell stabilizer}:

Anti-inflammatory drugs: cromoglycate{mast cell stabilizer} Prevent release of histamine from mast cells By inhaler only. Useful maintenance therapy. No role in severe episodes. Few, if any, adverse effects. 9/1/2013 30

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Anti-inflammatory drugs: leukotriene receptor antagonists Arachidonic acid Leukotrienes PGs with gastric protective effects PGs with inflammatory effects x Receptors 9/1/2013 31

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Leukotrienes cause capillary leakiness and bronchoconstriction Used orally for maintenance therapy (e.g. montelukast ). Additive with inhaled steroids. Anti-inflammatory drugs: leukotriene receptor antagonists 9/1/2013 32

Bronchodilators:

Bronchodilators 9/1/2013 33

Catecholamines, receptors and effects.:

Catecholamines , receptors and effects.  receptors vasoconstrict 1 receptors increase heart rate 2 receptors vasodilate and bronchodliate Adrenaline , 1, 2. Noradrenaline , 1. Dobutamine () 1. Isoprenaline 1, 2. Salbutamol (1) 2. HR,  BP, Bdilate (HR),  BP HR,  BP HR, (? BP) (HR), Bdilate 9/1/2013 34

2-agonists.:

2-agonists. Salbutamol , terbutiline Inhalers (of various types). Maintenance : Regularly in more severe cases Acute severe asthma Tachycardia and tremor 9/1/2013 35

Aminophylline:

Aminophylline Is not a catecholamine, but has analgous effects. Narrow therapeutic range. Given by mouth or by IV infusion. Toxic: Fatal if injected too fast. Convulsions. Tachyarrhythmia 9/1/2013 36

Antimuscarinics:

Antimuscarinics Atropine is the classical antimuscarinic , and this is b’dilator . Atropine: too many diverse effects. Ipratropium . By inhaler. Add to salbutamol . Dry mouth. 9/1/2013 37

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9/1/2013 38

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