Structural characteristics of the airway passage structure division Trachea 0 Main bronchi 1 Lobar bronchi 2-3 Segmental bronchi 4 Small bronchi 5-11 Bronchioles & terminal 12-16 bronchioles Respiratory bronchioles 17-19 Alveolar duct 20-22 Alveolar sacs 23
Bronchitis Bronchitis is inflammation of the mucous membranes of the large and medium bronchi. Inflammation stimulates the glands in the wall of the bronchi to produce abundant amounts of mucus. 3
Bronchitis Acute bronchitis caused by infection and inflammation, if limited in duration, does not cause permanent damage. Chronic bronchitis is a result of repeated infection or inflammation. 4
Acute Bronchitis Symptoms Phlegm producing cough. Mild fever Possible wheezing Treatment Medications to reduce mucus production -- antihistamines. If the cough produces green or yellow phlegm, the doctor will prescribe antibiotics. 5
Healthy Bronchi Mucus produced by goblet cells and mucus glands forms a thin protective layer on the inside of each bronchi. The mucus traps inhaled particles and small hair like protrusions called cilia move the mucus upward to be coughed out or swallowed. 6
Acute Bronchitis Cilia Goblet Cells Limiting the infection Cilia (fine hairs) lining the airways transport mucus upward, preventing infection of the lung. The infection may spread to the lungs in young children, older people, people with compromised immune systems, or diseased lungs. 7
Chronic Bronchitis Repeated infection or inflammation (caused Damaged More goblet More mucous by irritating smoke) Cilia cells glands causes increased mucus production. Mucus glands and goblet cells increase in number. Cigarette smoke damages the cilia and reduces their ability to move mucus upward. 8
Chronic Bronchitis When cilia can no Retained Mucous Bacteria longer move excess mucus, it stays in the airways, narrowing them. Retained mucus encourages bacterial growth which increases inflammation. 9
Chronic Bronchitis Eventually, the bronchial lining Inflammation becomes do Cells without cilia damaged that the cilia are completely destroyed and chronic inflammation, infection and mucus build-up occur. 10
Normal versus Diseased Bronchi
Classification of Chronic Bronchitis Simple type of Chronic Cough Bronchitis Sputum expectoration (without gasping) Chronic Cough Bronchitis Sputum expectoration with Gasping gasping
Stages of Chronic Bronchitis Stages Time Courses Exacerbation In a week Chronic lag One month or longer phase stable Lasts for two months
PATHOPHYSIOLOGY Smoking, chemical fumes and dust. Recent infections. Hypertrophy and hyperplasia of mucus glands. Increase mucus production blocks the trachea. Secondary infections destroys the cilia. Abnormal lung expansion and V/Q mismatch.
CLINICAL FEATURES Cough :- . severity increases every yr . initially without sputum . later with sputum Wheezing :- . Early morning . Both inspiratory and expiratory Sputum :- .mainly mucoid and tenacious . Mucopurulent during infective exacerbations. Dyspnea :- .early morning Deformity :- .barrel chest due to hyperinflation. Cyanosis :- . central cyanosis. . Presence of desaturated Hb
INVESTIGATIONS PFTs ABG analysis Chest X ray MRI ECG CT scan Bronchoscopy Exercise testing
Figure 11-2. Chest X-ray film of a patient with chronic bronchitis. Note the translucent (dark) lung fields, depressed diaphragms, and long and narrow heart.
This condition , usually called as “blue bloaters”
Overweight and bloated “Blue bloaters” often have a severely low blood oxygen level that gives their lips and tongue a blue appearance. They tend to be overweight, breathless, and have swollen ankles and abdomens from fluid retention.
TREATMENT Smoking cessation Medications :- pneumococcal and influenza vaccines Beta 2 agonists Bronchodilators Corticosteroids Avoidance of environmental irritants Avoidance of beta adrenergic blockers and antihistamines Early treatment of infections O2 therapy
MESSAGE A cigarette is a pinch of tobacco, Rolled in a paper With the fire on one end and……….. ………………a fool on another end.