Chapter 22: Bronchitis

Question 1

Etiology of Acute Bronchitis

Answer 1

• acute inflammation of the trachea

- causes include viral or nonviral, heat, smoke inhalation, inhalation of irritant chemicals, and allergic reactions

Question 2

Asthmatic Bronchitis

Answer 2

• swelling of the bronchial mucosa in children, associated with obstruction, respiratory distress, and wheezing

Question 3

Pathogenisis of Acute Bronchitis

Answer 3

• airways become inflamed and narrowed from capillary dilation
• swelling from fluid exudation
• infiltration with inflammatory cells
• increased mucus production
• loss of ciliary function
• loss of portions of the cilliated epithelium

Question 4

Clinical Manifestations of Acute Bronchitis

Answer 4

• usually mild to self limiting
• cough
• low grade fever
• substernal chest discomfort
• sore throat
• postnasal drip

Question 5

Diagnosis of Acute Bronchitis

Answer 5

• clinical presentation
• DISTINCT HALLMARK OF DISEASE IS RECENT ONSET COUGH**
• chest x ray to distinguish acute bronchitis from pneumonia

Question 6

Treatment of Acute Bronchitis

Answer 6

• usually no treatment needed if viral
• antibiotic therapy if bacterial
• codeine containing meds for cough
• increased fluid intake
• avoid smoe
• use a vaporizer in bedroom

Question 7

Causes of Chronic Bronchitis

Answer 7

• cigarette smoking (90%)
• repeated airway infections
• genetic predisposition
• inhalation of physical or chemical irritants

Question 8

Etiology of Chronic Bronchitis

Answer 8

• type B COPD (blue bloater)
• Hypersecretion of bronchal mucus
• chronic or recurrent productive cough >3 months >2+ successive years
• Persistent, irreversible when paired with emphysema
• 1`:2 male to female ratio
• > 30 to 40 yrs

Question 9

Pathogenesis of Chronic Bronchitis

Answer 9

• chronic inflammation and swelling of the bronchial mucosa resulting in scarring
• Hyperplasia of bronchial mucous gland/goblet cells
• increased bronchial wall thickness
• Pulmonary Hypertension
• destruction of bronchial walls

Question 10

Clinical Manifestations of Chronic Bronchitis***

Answer 10

• ascites (accumulation of fluid in the peritoneal cavity)
• distended neck
• typically patient is overweight
• commonly associated with emphysema
• SOB on exertion
• Excessive sputum
• Chronic cough (sever in mornings)
• Evidence of excess body fluids
• Cyanosis

Question 11

Diagnosis of Chronic Bronchitis

Answer 11

• includes chest x-rays, Pulmonary Function Tests (PFTs) , Arterial Blood Gas (ABG), ECG, Secondary

Question 12

Diagnosis of Chronic Bronchitis (Chest X-Ray)

Answer 12

• increased bronchial vascular markings which show congested lung fields
• Enlarged horizontal cardiac silhouette
• evidence of previous pulmonary infection

Question 13

Diagnosis of Chronic Bronchitis (PFT)

Answer 13

• normal total lung capacity (TLC)
• increased residual volume (RV)
• Decreased FEV1 (

Question 14

Diagnosis of Chronic Bronchitis (ABG)

Answer 14

• elevated PaCO2 due to being unable to breath it out

- Decreased PO2 because hard time breathing in

Question 15

Diagnosis of Chronic Bronchitis (ECG)

Answer 15

• atrial arrhythmias

- Evidence of right ventricular hypertrophy

Question 16

Diagnosis of Chronic Bronchitis (Secondary Polycythemia)

Answer 16

• compensatory mechanism because the body isn’t absorbing enough O2
• r/t (related to) continuous or nocturnal hypoxemia

Question 17

Treatment Goals for Chronic Bronchitis

Answer 17

• block the progression of the disease
• return to optimal respiratory function
• Return to usual activities of daily living (ADLs)

Question 18

Medicinal Treatment of Chronic Bronchitis

Answer 18

• inhaled short acting B2 antagonists (will cause bronchial dilation) (adrenergic) (wear off in 4-6 hours) (types include ventolin, and albuterol)
• Inhaled anticholinergic bronchodilators (same effect as B2 antagonists) (will dry up secretions) (mimics parasympathetic response)
• “Z-Pac” (includes azithromycin and zythromax)
• Inhaled coritcosteroids
• Theophylline products (have a narrow therapeutic window, must check blood levels, not really used as much, very good for bronchodilation, cardiovascular events

Question 19

Adrenergic

Answer 19

• something that is adrenergic mimics the effects of the sympathetic nervous system response

Question 20

Other Treatment of Chronic Bronchitis

Answer 20

• low dose O2 therapy (be careful however as you can overoxygenate)
• Mechanical ventilation may be necessary
• never give over 2L of O2

Question 21

O2 Saturation

Answer 21

• normal O2 saturation is 94%-100%
• people with chronic bronchitis live w/ about 90% for so long so you cannot give them too much O2 or you will knock out their drive to breath, which will cause a state of high O2 levels in blood and lead to CO2 narcosis

Question 22

Management of Chronic Bronchitis

Answer 22

• smoking cessation
• Bronchodilator therapy
• reduction to exposure of irritants
• adequate rest
• proper hydration to move mucous
• Physical conditioning
• Influenza (every year) and pneumococcal (every 10 years) vaccines are necessary