The document discusses bronchitis and related respiratory conditions. It defines acute bronchitis as a self-limiting inflammation of the bronchial passages typically caused by bacterial or viral infection. Symptoms include productive cough, dyspnea, and possible fever. Chronic bronchitis is defined as the presence of cough and sputum production for at least three months in two consecutive years, often caused by smoke or environmental pollutants. Bronchiectasis is characterized by irreversible dilation of the bronchi due to destruction of supporting structures, resulting in reduced mucus clearance and airway obstruction.

1. Bronchitis

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General symptoms of respiratory disease
Hypoxia : Decreased levels of oxygen in the tissues
Hypoxemia : Decreased levels of oxygen in arterial blood
Hypercapnia : Increased levels of CO2 in the blood
Hypocapnia : Decreased levels of CO2 in the blood
Dyspnea : Difficulty breathing
Tachypnea : Rapid rate of breathing
Cyanosis : Bluish discoloration of skin and mucous
membranes due to poor oxygenation of the blood
Hemoptysis : Blood in the sputum

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 Bronchitis is an obstructive respiratory disease that may occur in both acute
and chronic forms.
 Acute bronchitis: Inflammation of the bronchial passages most commonly
caused by infection with bacteria or viruses.
 Acute bronchitis is generally a self-limiting condition in healthy individuals but
can have much more severe consequences in individuals who are
weakened with other illness or who are immunocompromised.
 Symptoms of acute bronchitis often include productive cough, Dyspnea and
possible fever.
Obstructive Respiratory Disorders
Bronchitis

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Acute Bronchitis:
- Definition:
is an inflammation of the
lining of the bronchial
tubes, the airways that
connect the trachea
to the lungs i.e., the
Organs and tissues involved in breathing.

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Pathophysiology
 Primarily viral etiology, & bacterial agents.
 Airways become inflamed
 Irritated
 increased mucous production
Clinical Manifestations
 Dyspnea, fever, tachypnea, Productive cough, clear to purulent sputum.
 Pleuritic chest pain, occasionally, crackles heard on auscultation.

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Diagnostic Evaluation
 Chest X-ray
 Sputum for gram stain, culture, and sensitivity tests may be
obtained to determine presence of bacterial infection.
 Spirometry to determine peak expiratory flow (may be
decreased).
Management
 Antibiotic therapy for 7 to 10 days.
 Hydration and humidification.
 Secretion clearance interventions (controlled cough, chest
physical therapy).
 Bronchodilators.
 Symptom management for fever, cough.

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Chronic Bronchitis
It is a disease of the airways
and is defined as the presence
of cough and sputum
production for at least 3
months in each of 2
consecutive years.
Etiology
smoke or other environmental
pollutants

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Chronic Bronchitis: Pathophysiology
 Environmental Pollutants or Smoke results in hypersecretion
of mucus and inflammation.
 This constant irritation causes the mucus-secreting glands and
goblet cells to increase in number, ciliary function is reduced,
and more mucus is produced.
 The bronchial walls become thickened, the bronchial lumen is
narrowed, and mucus may plug the airway.
 Alveoli adjacent to the bronchioles may become damaged and
fibrosed, resulting in altered function of the alveolar
macrophages.
 A wide range of viral, bacterial, and mycoplasmal infections
 Chronic bronchitis.

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Manifestations of chronic bronchitis:
• Productive, chronic cough
• Production of purulent sputum
• Frequent acute respiratory infections
• Dyspnea
• Hypoxia, cyanosis
• Fluid accumulation (edema) in later stages

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Treatment of chronic bronchitis:
1. Cessation of smoking or exposure to irritants
2. Bronchodilators to open airway passages
3. Expectorants to loosen mucus
4. Anti - inflammatory to relieve airway inflammation and reduce mucus
secretion
5. Prophylactic antibiotics for respiratory infections
6. Oxygen therapy

13. Bronchiectasis

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Bronchiectasis is characterized by
chronic, irreversible abnormal
dilation of one or more large
bronchi due to destruction of
supporting structures of bronchi
such as elastic and muscular
structures.
The disease process results in a
reduced ability to clear mucus from
the lungs and decreased expiratory
airflow.
Thus bronchoectasis is classified as
an obstructed lung disease.
Introduction

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Etiology
Causes of Bronchiectasis
Congenital  Ciliary dysfunction syndromes
 Young Syndrome
 Cystic fibrosis
Acquired  Pneumonia
 Respiratory tract infections with Haemophilus
influenzae, Staphylococcus aureus, Adenovirus and
influenza virus
 Primary tuberculosis
 Foreign body
 Bronchial tumors

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Pathophysiology
Inflammatory Reaction and Release of
Neutrophils
Presence of Trigger/Etiological
Agent
Up-regulation of enzymes elastase & metalloproteinases
Increased vascuarity of bronchial wall
Destruction of bronchial wall including cartilage, muscle & elastic tissue
Replacement of the bronchial wall with fibrous tissue
Bronchial Dilatation
Collection of thick, purulent material in the dilated bronchi
Enlargement of bronchial arteries
Association between bronchial and pulmonary arterial circulation
Airway Obstruction & Necrotizing Pulmonary Parenchyma

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Bronchiectasis: Types
Type of Bronchiectasis Description
Cylindrical bronchiectasis bronchi appear as uniformly dilated tubes
that end abruptly at the point that smaller
airways are obstructed by secretions
Varicose bronchiectasis Affected bronchi have an irregular or
beaded pattern of dilatation resembling
varicose veins
Saccular (cystic)
bronchiectasis
Bronchi have a ballooned appearance at
the periphery, ending in blind sacs
without recognizable bronchial structures
distal to the sacs.

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Clinical Manifestations
 Persistent or recurrent cough with production of large amounts of purulent sputum
 Fever
 Dyspnea
 Crackles, Rhonchi, Wheezing
 Pleuritic Chest pain
 Hemoptysis
 Hypoxia
 Clubbing
 Fatigue, Myalgias, Weight loss

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Diagnostic Approach
Appropriate Clinical Scenario
Chest X-Ray, PFT, Sputum analysis
High Resolution CT-Scan
Consider:
Close Observation
Bronchoscopy
Evaluation for GERD/Aspiration

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Management: Goals

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Management
 Antibiotic Therapy
 Usually Amoxicillin, trimethoprim-sulfamethoxazole
or levofloxacin
 If Pseudomonas infection: Oral quinolone or IV
Aminoglycoside, Cephalosporin
 Bronchodilator Therapy: B-2 Agonists
 Mucolytic agents

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Management
 Supportive Therapy
 Providing Warm humidified environment
 Increased Intake of Fluids
 Chest Physiotherapy: Percussion, Vibration
 Postural Drainage
 Surgical Management
 Surgical Resection of the involved segment or lobe of the
lung
 Bronchial arterial embolization: if bleeding from
hypertrophied bronchial circulation worsens
 Other
 Reduction of exposure to excessive air pollutants &
irritants
 Cigarette Smoking cessation
 Vaccination with Pneumococcal & Influenza Vaccine

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Nursing Interventions
1. Providing Semi-to-High-Fowler’s Position
2. Providing Warm humidified environment
3. Increased Intake of Fluids
4. Chest Physiotherapy: Percussion, Vibration
5. Postural Drainage
6. Steam Inhalation
7. Nebulization with Normal Saline
8. Deep-breathing exercise
9. Effective Coughing techniques
10. Suctioning, if indicated
11. Providing Oral-Hygiene
12. Administration of medications and observing the patient for side-effects
or adverse effects
13. Providing rest to prevent over-exertion
14. Maintaining adequate nutritional status

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