Bronchitis

Question 1

What is bronchitis?

Answer 1

Inflammation of the bronchial tubes which carry air to and from the lungs

Question 2

What are the 2 main types of bronchitis?

Answer 2

Acute bronchitis - short term
Chronic bronchitis - long term & more serious

Question 3

What causes bronchitis?

Answer 3

Smoking, the chemicals in the smoke irritate the lining of your bronchi and they begin to become inflamed

Question 4

What do goblet cells do and where are they?

Answer 4

In the epithelial layer inside the airways, produce mucus to try and clear the chemical irritants

Question 5

Why is mucus important?

Answer 5

Traps dust, microbes and other irritants preventing them from entering the lungs

Question 6

How does the body attempt to clear the bronchitis irritants?

Answer 6

by producing excess amounts of mucus

Question 7

What can excessive mucus production lead to?

Answer 7

Clogged airways
increased coughing
potential for infection

Question 8

What are the symptoms of bronchitis?

Answer 8

cough, wheezing, SOB, chest discomfort

Question 9

What is the treatment for bronchitis?

Answer 9

rest and hydration, cough suppressants, bronchodilators, avoiding irritants

Question 10

What happens when the excess mucus picks up the chemicals, tar and other products from cigarette smoke?

Answer 10

Causes continuous irritation and inflammation of the bronchi and causes a cough reflex due to the airways being sensitive to irritants - this is in an attempt to clear the airways of irritants and excess mucus

Question 11

What are expectorants?

Answer 11

A medication which helps to loosen mucus

Question 12

What are the effects of the coughing in bronchitis?

Answer 12

The continual coughing leads to further irritation and inflammation and over time chronic inflammation results in structural changes in the airways - hypertrophy & hyperplasia

Question 13

What is hypertrophy?

Answer 13

The enlargement of existing goblet cells which increases mucus production

Question 14

What is hyperplasia?

Answer 14

An increase in the number of goblet cells - further contributing to excessive mucus secretion

Question 15

What is treatment for the excess coughing associated with bronchitis?

Answer 15

Bronchodilators - to help open airways
corticosteroids - to reduce inflammation
expectorants - to aid in mucus clearance

Question 16

What condition does the chronic inflammation and irritation lead to?

Answer 16

pulmonary fibrosis

Question 17

What is pulmonary fibrosis?

Answer 17

A condition which causes the bronchial walls to thicken - fibroses tissue does not contract so lung function is impaired as the lungs cannot expand or contract effectively during breathing. It also causes narrowing of the lumen (opening) of the airways which can significantly disrupt airflow

Question 18

What are treatments for pulmonary fibrosis?

Answer 18

Anti-inflammatory medications
Pulmonary rehabilitation
Oxygen therapy in severe cases

Question 19

What is the result of bronchitis progressing and pulmonary fibrosis

Answer 19

Inadequate oxygen exchange in the lungs resulting in hypoxia and hypercapnia

Question 20

What are the symptoms of hypoxia?

Answer 20

SOB
Fatigue
Cyanosis

Question 21

what is hypercapnia?

Answer 21

Elevated carbon dioxide levels in the blood

Question 22

Why does hypercapnia occur?

Answer 22

Impaired ventilation so co2 becomes trapped in the lungs and reduced ability to expel co2 effectively due to thickened airway walls and excessive mucus

Question 23

What are peripheral chemoreceptors and what do they do?

Answer 23

sensitive to changes in the levels of oxygen and co2 in the blood, normally these signal the brain to increase the rate and depth of breathing in response to rising co2 levels and falling oxygen levels

Question 24

What do the peripheral chemoreceptors do in patients with chronic bronchitis?

Answer 24

Become less sensitive due to prolonged exposure to elevated co2 levels, so they send less signals to the brain to drive breathing effectively - this can contribute to a state of hypoventilation

Question 25

What are treatments of hypoxia and hypercapnia?

Answer 25

Oxygen therapy Ventilatory support

Question 26

What is the hypoxic drive?

Answer 26

Now the peripheral chemoreceptors don't send signals to the brain from the rising levels of co2, the body shifts to the hypoxic drive, the peripheral chemoreceptors now stimulate the respiratory centres in the brain to increase the rate and depth of breathing when the oxygen levels drop

Question 27

What does hypoxia do to the pulmonary arteries?

Answer 27

causes a reflex vasoconstriction of pulmonary arteries in an attempt to increase perfusion - this is known as hypoxic pulmonary vasoconstriction - this leads to pulmonary hypertension and is often seen on an ECG as taller pointy P waves

Question 28

What effect does pulmonary hypertension have?

Answer 28

Leads to increased workload on the right side of the heart which must work harder to pump blood through the narrowed vessels

Question 29

What treatment can be given for pulmonary hypertension?

Answer 29

vasodilators to reduce pressure and improve blood flow

Question 30

Explain what happens as a result of pulmonary hypertension

Answer 30

Increases the workload on the right side of the heart so it must work harder to maintain adequate blood flow, as the right ventricle is working much harder it leads to right ventricular hypertrophy (enlargement of the right ventricle)

Question 31

What is cor pulmonale?

Answer 31

Specifically right ventricular hypertrophy or failure that occurs as a result of lung disease - particularly conditions that cause pulmonary hypertension

Question 32

Symptoms of right ventricular failure

Answer 32

SOB Fatigue Swelling in legs and ankles distended neck veins

Question 33

What does blue bloaters mean?

Answer 33

blue - cyanosis bloaters - edema

Question 34

What is polycythemia?

Answer 34

In an attempt to provide more oxygen carrying capabilities the body produces new red blood cells at an alarming rate

Question 35

How does polycythemia occur?

Answer 35

The kidneys detect low oxygen levels and respond by increasing the production of erythropoietin

Question 36

What are the effects of polycythemia?

Answer 36

Thickened blood Elevated blood pressure Increased risk of thrombosis (blood clots) Strain on the heart

Question 37

What is erythropoietin?

Answer 37

A hormone that stimulates the bone marrow to produce more red blood cells

Question 38

How does erythropoietin work?

Answer 38

It travels through the bloodstream to the bone marrow where it binds to receptors on the erythroid progenitor cells - which then signals for more red blood cells to be produced

Question 39

How do patients with polycythemia present?

Answer 39

Sluggish Cyanosed Bloated

Question 40

What are management strategies for polycythemia?

Answer 40

Hydration Phlebotomy (removal of blood) Oxygen therapy

Question 41

Why does cyanosis occur?

Answer 41

The body’s tissues use up oxygen, so the blood that returns to the heart is less oxygenated but in chronic bronchitis, the circulation is sluggish (due to thick blood), so deoxygenated blood doesn’t return to the lungs quickly enough to get more oxygen.