BY
SROTA DAWN.
M.PHARM [PHARMACOLOGY]
SUBJECT - PHARMACOLOGY -∏
VELS SCHOOL OF PHARMACEUTICAL SCIENCES
BRONCHITIS
[PATHOLO...
 Chronic obstructive pulmonary disease.
 Bronchitis, emphysema, and asthma may
present alone or in combination.
AsthmaBr...
Description
 Characterized by presence of airflow
obstruction
 Caused by emphysema or chronic bronchitis
 Generally pro...
Emphysema
 Abnormal permanent enlargement of the air
space distal to the terminal bronchioles
 Accompanied by destructio...
Muscle contraction
Mucosal oedema
Sticky mucus
R2
R2
Bronchitis case
Normal
9/25/20135
9/25/20136
COPD Causes
 Infection
 Major contributing factor to the
aggravation and progression of COPD
 Heredity
 -Antitrypsin ...
TYPES OF BRONCHITIS:
CHRONIC
BRONCHITIS ACUTE
BRONCHITIS
9/25/20138
Chronic bronchitis
•Chronic bronchitis is
a chronic inflammation
of the bronchi (medium-size airways) in
the lungs.
• It i...
Signs and symptoms
Bronchitis may be indicated by –
 Cough (also known as a productive
cough, i.E. One that produces sput...
Causes:
 Tobacco smoking is the most common cause.
Pneumoconiosis and long-term fume inhalation
are other causes.
Aller...
Pollution is a major cause of COPD
9/25/201312
Chronic Bronchitis Pathophysiology
Pathologic lung changes are:
 Hyperplasia of mucus-secreting glands
in trachea and bro...
Chronic Bronchitis Pathophysiology
Chronic inflammation
Primary pathologic mechanism causing
changes
Narrow airway lumen...
Chronic Bronchitis Pathophysiology
 Greater resistance to airflow increases
work of breathing
 Hypoxemia and hypercapnia...
Chronic Bronchitis Pathophysiology
 Bronchioles are clogged with mucus and
pose a physical barrier to ventilation
 Hypox...
Chronic Bronchitis Pathophysiology
 Cough is often ineffective to remove secretions
because the person cannot breathe dee...
Chronic Bronchitis
Clinical Manifestations
 Earliest symptoms:
Frequent, productive cough during
winter
Frequent respir...
Chronic Bronchitis
Clinical Manifestations
 Bronchospasm at end of paroxysms of
coughing
 Cough
 History of smoking
 N...
Chronic Bronchitis Clinical Manifestations
 Hypoxemia and hypercapnia
Results from hypoventilation and 
airway resistan...
Diagnosis:
9/25/201321
Diagnosis:
A variety of tests may be performed in patients
presenting with cough and shortness of breath:
•Pulmonary Funct...
COPD Complications
 Pulmonary hypertension (pulmonary vessel
constriction alveolar hypoxia & acidosis)
 Pneumonia
 Acut...
Acute bronchitis
Acute bronchitis is an inflammation of the large bronchi (medium-
size airways) in the lungs that is
Usua...
Anti-inflammatory drugs: steroids
9/25/201325
Membrane
phospholipid
Arachidonic acid
Phospholipase A2
Leukotrienes:
B’constrictor
COX-I
PGs with gastric
protective effe...
Membrane
phospholipid
Arachidonic acid
Phospholipase A2
Leukotrienes
COX-I
PGs with gastric
protective effects
COX-II
PGs ...
Anti-inflammatory drugs: steroids
 Life-saving.
 Take at least 12 h to work: so start early in
severe cases.
 Systemic ...
Anti-inflammatory drugs: steroids
 Systemic steroid:
 intolerance
 ‘Cushingoid’ features
 Hypertension
 Salt and wate...
Anti-inflammatory drugs:
cromoglycate{mast cell stabilizer}
 Prevent release of histamine from mast cells
 By inhaler on...
Anti-inflammatory drugs:
leukotriene receptor antagonists
Arachidonic acid
Leukotrienes
PGs with gastric
protective effect...
• Leukotrienes cause capillary leakiness
and bronchoconstriction
• Used orally for maintenance therapy
(e.g. montelukast)....
Bronchodilators
9/25/2013
33
Catecholamines, receptors and effects.
  receptors vasoconstrict
 1 receptors increase heart rate
 2 receptors vasod...
2-agonists.
 Salbutamol, terbutiline
 Inhalers (of various types).
 Maintenance:
 Regularly in more severe cases
 Ac...
Aminophylline
 Is not a catecholamine, but has analgous effects.
 Narrow therapeutic range.
 Given by mouth or by IV in...
Antimuscarinics
 Atropine is the classical antimuscarinic, and this
is b’dilator.
 Atropine: too many diverse effects.
...
9/25/201338
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bronchitis (pathology and treatment)by srota dawn

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this presentation contains a detailed description about bronchitis ,its types, pathology,causes, treatment etc.

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bronchitis (pathology and treatment)by srota dawn

  1. 1. BY SROTA DAWN. M.PHARM [PHARMACOLOGY] SUBJECT - PHARMACOLOGY -∏ VELS SCHOOL OF PHARMACEUTICAL SCIENCES BRONCHITIS [PATHOLOGY & TREATMENT] 9/25/2013 1
  2. 2.  Chronic obstructive pulmonary disease.  Bronchitis, emphysema, and asthma may present alone or in combination. AsthmaBronchitis Emphysema 9/25/20132
  3. 3. 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 9/25/2013 3
  4. 4. Emphysema  Abnormal permanent enlargement of the air space distal to the terminal bronchioles  Accompanied by destruction of bronchioles 9/25/2013 4
  5. 5. Muscle contraction Mucosal oedema Sticky mucus R2 R2 Bronchitis case Normal 9/25/20135
  6. 6. 9/25/20136
  7. 7. 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 9/25/2013 7
  8. 8. TYPES OF BRONCHITIS: CHRONIC BRONCHITIS ACUTE BRONCHITIS 9/25/20138
  9. 9. 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. 9/25/20139
  10. 10. 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. 9/25/201310
  11. 11. 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 9/25/201311
  12. 12. Pollution is a major cause of COPD 9/25/201312
  13. 13. 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 9/25/2013 13
  14. 14. 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 9/25/2013 14
  15. 15. Chronic Bronchitis Pathophysiology  Greater resistance to airflow increases work of breathing  Hypoxemia and hypercapnia develop more frequently in chronic bronchitis than emphysema 9/25/2013 15
  16. 16. Chronic Bronchitis Pathophysiology  Bronchioles are clogged with mucus and pose a physical barrier to ventilation  Hypoxemia and hypercapnia , lack of ventilation and O2 diffusion  Tendency to hypoventilate and retain CO2  Frequently patients require O2 both at rest and during exercise 9/25/2013 16
  17. 17. 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 9/25/2013 17
  18. 18. Chronic Bronchitis Clinical Manifestations  Earliest symptoms: Frequent, productive cough during winter Frequent respiratory infections 9/25/2013 18
  19. 19. 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 9/25/2013 19
  20. 20. Chronic Bronchitis Clinical Manifestations  Hypoxemia and hypercapnia Results from hypoventilation and  airway resistance + problems with alveolar gas exchange 9/25/2013 20
  21. 21. Diagnosis: 9/25/201321
  22. 22. 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) 9/25/201322
  23. 23. COPD Complications  Pulmonary hypertension (pulmonary vessel constriction alveolar hypoxia & acidosis)  Pneumonia  Acute Respiratory Failure 9/25/2013 23
  24. 24. 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. 9/25/201324
  25. 25. Anti-inflammatory drugs: steroids 9/25/201325
  26. 26. Membrane phospholipid Arachidonic acid Phospholipase A2 Leukotrienes: B’constrictor COX-I PGs with gastric protective effects COX-II PGs with inflammatory effects 9/25/201326
  27. 27. Membrane phospholipid Arachidonic acid Phospholipase A2 Leukotrienes COX-I PGs with gastric protective effects COX-II PGs with inflammatory effects X 9/25/201327
  28. 28. 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 9/25/2013 28
  29. 29. Anti-inflammatory drugs: steroids  Systemic steroid:  intolerance  ‘Cushingoid’ features  Hypertension  Salt and water retention  Infection  Topical steroid  Hoarseness 9/25/2013 29
  30. 30. 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. 9/25/2013 30
  31. 31. Anti-inflammatory drugs: leukotriene receptor antagonists Arachidonic acid Leukotrienes PGs with gastric protective effects PGs with inflammatory effectsx Receptors 9/25/201331
  32. 32. • Leukotrienes cause capillary leakiness and bronchoconstriction • Used orally for maintenance therapy (e.g. montelukast). • Additive with inhaled steroids. Anti-inflammatory drugs: leukotriene receptor antagonists 9/25/201332
  33. 33. Bronchodilators 9/25/2013 33
  34. 34. 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 9/25/2013 34
  35. 35. 2-agonists.  Salbutamol, terbutiline  Inhalers (of various types).  Maintenance:  Regularly in more severe cases  Acute severe asthma  Tachycardia and tremor 9/25/2013 35
  36. 36. 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 9/25/2013 36
  37. 37. Antimuscarinics  Atropine is the classical antimuscarinic, and this is b’dilator.  Atropine: too many diverse effects.  Ipratropium.  By inhaler.  Add to salbutamol.  Dry mouth. 9/25/2013 37
  38. 38. 9/25/201338
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