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2. BRONCHITIS
PRESENTED BY
M.MATHIVATHANI
MSC(N)-II YEAR
V.C.O.N

3. INTRODUCTION
Acute lower respiratory infections are a leading cause of sickness and mortality
both in children and adults worldwide. Unfortunately, acute lower respiratory
infections are not uniformly defined and this may hamper a true appreciation of
their epidemiological importance. From an epidemiological point of view, the
definition of acute lower respiratory infections usually includes acute bronchitis
and bronchiolitis, influenza and pneumonia.

4. DEFINITION
Bronchitis is inflammation or swelling of the bronchial tubes (bronchi), the air
passages between the nose and the lungs. More specifically, bronchitis is when the
lining of the bronchial tubes becomes inflamed or infected. Bronchitis is caused by
viruses, bacteria, and other particles that irritate the bronchial tubes.

5. INCIDENCE
 The incidence of acute bronchitis in adults is high, between 30 and 50 per 1000
people per year.
 The clinical syndrome lasts approximately 2 weeks and has a clear impact on
daily activities
 The major risk factor is cigarette smoking. Smoking accounts for 900,000 deaths
annually in India. In India about 57% of males and11% of females use tobacco in
some form. The alarming fact is the rising trend in minors. Various estimates
reveal that nearly 55% of children between the age 13 to 15 are using tobacco
in one form or the other, and a total of 36.9% children initiate smoking before
the age of 10.

6. TYPES
Acute bronchitis
 Acute bronchitis is a shorter illness that commonly follows a cold or
viral infection, such as the flu Acute bronchitis usually lasts a few
days or weeks .
 Infection or other factor that irritate the lungs cause acute
bronchitis.
 The same viruses that cause colds and the flu often cause acute
bronchitis.
 These viruses are spread through the air when people cough. They
also are spread through physical contact.

7. Chronic bronchitis
 it occurs when the lining of the bronchial tubes is constantly
irritated and inflamed .
 Chronic bronchitis if have a cough with mucus on most days for at
least 3 month a year.
 Repeatedly breathing in fumes that irritate and damage lungs and
airway tissues causes chronic bronchitis .smoking is the major
causes of this condition .
 Breathing is air pollution and dust or fumes from the environment
or the workplace also can lead to chronic bronchitis

8. ETIOLOGY
Cigarette smoking
 Cigarette smoke has several direct effects.(The irritating - causes hyperplasia of
cells, including goblet cells, which subsequently results in increased production
of mucus. Hyperplasia reduces airway diameter and increases the difficulty in
clearing secretions.
 Smoking reduces the ciliary activity and may cause actual loss of ciliated cells.
Smoking also produces abnormal dilation of the distal air space with destruction
of alveolar walls.
 Passive smoking is the exposure of second hand tobacco smoke (E lS) or also
known as environmental tobacco smoke or second hand smoke

9. Occupational chemical and dust
 Air pollution are harmful to the person with existing lung disease
 The effect of outdoor air pollution also risk as like cigarette smoking
 Another risk factor is indoor heating and cooking
 Person is intense to prolonged exposure to vapour. Irritant and fumes in work
place

10. Infection
 Severe reoccurring of Respiratory infection in childhood
cause reduced lung function for kids cause later on
adulthood respiratory symptoms
 The most viral and bacterial respiratory infection which
commonly caused by .Influenza,S.pneumonia,Moraxella
catarrhalis

11. Hereditary
AAT(Alpha 1-Anti trypsin-serine ptotease inhibitor) Deficiency is the
genetic risk factor .It is an autosomal recessive Disorder
It is produced by Liver and normally found in lungs.
The symptoms of disease aggravated by patient with smoking cause
subsequent destruction of lung disease

12. Age
 Children with lower immunity
 Old age people due to Changes in lung structure ,Thoracic cavity and
lung muscles

13. Person with GERD
 Bronchitis may also occur when acids from stomach consistently back up into
esophagus and a few drops go into upper airway.
 The chances of bronchitis having more sever symptoms including the elderly,
those with weakened immune system ,smokers , and repeated exposure to
lungs.

15. Clinical manifestation
 Inflammation or swelling of the bronchi
 Coughing
 Production of clear, white, yellow, grey, or green mucus (sputum)
 Shortness of breath
 Wheezing
 Fatigue
 Fever and chills
 Chest pain or discomfort
 Blocked or runny nose

16. Diagnostic studies
 History collection
 Physical examination
 Chest x- rays -no evidence of infiltrates or consolidation
 Sputum cultures -Gram stain, culture, and sensitivity tests may be
obtained to determine presence of bacterial infection.
 Pulmonary function test-Spirometry to determine forced vital
capacity (FVC),.
 Spirometer exercises
 Bronchoscopy

17. MANAGEMENT
GOAL
 Reduce exacerbation
 Reduce infection
 Regular routine

18. Air flow optimization
Expectorants
 one must be careful not to completely suppress the cough, for it is an important
way to bring up mucus and remove irritants from the lungs.
 Acefylline, Piperazine, Diphenhydramine
 Acetyl (Acetylcysteine 200mg
 Ammonium cholride, Diphenhydramine HCl , Ephedrine HCl

19. Bronchodilators –
 These open the bronchial tubes and clear out mucus.
 Bronchodilators They don’t alter the lung function but they improve
symptoms of the disease
 Mucolytics - these thin or loosen mucus in the airways, making it
easier to cough up sputum.(N-Acetyl
cystine,erdosteine,carbocysctine)
 Anti-inflammatory medicines and glucocorticoid steroids - these are
for more persistent symptoms.
 Anticholinergic ( Ipratropium bromide 2-4 puffs every 6 hour)
 Beta-2 agonist (Albuterol)

20. Corticosteroids -Beclomethasone (inhaled) Prednisone (oral)
 Corticosterids In combination with long acting beta-2 agonist
 Inhaled corticosteroids are preffered because oral corticosteroids have marked
adverse effects.
 Theophylline Improve haemoglobin saturation in patients with sleep related
breathing disorders.
 It provides Bronchodilation and Anti-inflammatory effect

21.  Antibiotics - these are effective for bacterial infections, but
not for viral infections. They may also prevent secondary
infections
Antibiotics First line agents
• Doxycycline
• Amoxicillin
2nd line agents
• Co-amoxicalv
• Clarithromycin
• Cefixime

22. Treatment of chronic bronchitis
Smoking cessation
Oxygen therapy (supplemental oxygen for patients with resting
hypoxemia)
Aerobic physical exercise (walking 20 min or bicycling )
Adequate systemic hydration increases the mobilization of
secretions.
Chest physiotheraphy

23. Complication
Asthma
Bronchiectasis
Tuberculosis
 Sinusitis

24. Nursing management
Nursing Assessment
 Determine smoking history, exposure history, positive family history of
respiratory disease, onset of Dyspnea.
 Obtain history of upper airway infection, course, and length of symptoms.
 Assess severity of cough and characteristics of sputum production. Auscultate
chest for diffuse rhonchi and crackles as opposed to localized crackles usually
heard with pneumonia.

25. Nursing Diagnoses
 Ineffective Breathing Pattern related to chronic airflow limitation
 Ineffective Airway Clearance related to bronchoconstriction, increased
mucus production, ineffective cough, possible bronchopulmonary
infection
 Risk for Infection related to compromised pulmonary function, retained
secretions, and compromised defence mechanisms
 Impaired Gas Exchange related to chronic pulmonary obstruction, V/Q
abnormalities due to destruction of alveolar capillary membrane

26.  Imbalanced Nutrition: Less Than Body Requirements related to
increased work of breathing, air swallowing, drug effects with resultant
wasting of respiratory and skeletal muscles
 Activity Intolerance related to compromised pulmonary function,
resulting in shortness of breath and fatigue
 Disturbed Sleep Pattern related to hypoxemia and hypercapnia
 Ineffective Coping related to the stress of living with chronic disease,
loss of independence, depression, anxiety disorder

27.  Improving Airway Clearance
 Improving Breathing Pattern
 Controlling Infection
 Improving Gas Exchange
 Improving Nutrition
 Increasing Activity Tolerance
 Improving Sleep Patterns
 Enhancing Coping

28. Evaluation: Expected Outcomes
 Coughs up secretions easily; decreased wheezing and crackles
 Reports less dyspnea, effectively using pursed-lip breathing
 No fever or change in sputum
 ABG levels and/or SpO2 improved on low-flow oxygen
 Tolerates small, frequent meals; weight stable
 Reports walking longer distances without tiring
 Sleeping in 4- to 6-hour intervals; uses low-flow oxygen at night as prescribed
 Demonstrates more effective coping; expresses feelings; seeks support group

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