bronchitis (pathology and treatment)by srota dawn

04/12/2023

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BYSROTA DAWN.

M.PHARM [PHARMACOLOGY]SUBJECT - PHARMACOLOGY -∏

VELS SCHOOL OF PHARMACEUTICAL SCIENCES

BRONCHITIS[PATHOLOGY & TREATMENT]

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Chronic obstructive pulmonary disease.Bronchitis, emphysema, and asthma may

present alone or in combination.

AsthmaBronchitis

Emphysema

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DescriptionDescription

Characterized by presence of airflow obstruction

Caused by emphysema or chronic bronchitisGenerally progressive May be accompanied by airway

hyperreactivityMay be partially reversible

Characterized by presence of airflow obstruction

Caused by emphysema or chronic bronchitisGenerally progressive May be accompanied by airway

hyperreactivityMay be partially reversible

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EmphysemaEmphysema

Abnormal permanent enlargement of the air space distal to the terminal bronchioles

Accompanied by destruction of bronchioles

Abnormal permanent enlargement of the air space distal to the terminal bronchioles

Accompanied by destruction of bronchioles

Muscle contraction

Mucosal oedema

Sticky mucusR2

R2

Bronchitis case

Normal

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COPD CausesCOPD Causes

Infection Major contributing factor to the

aggravation and progression of COPDHeredity

-Antitrypsin (AAT) deficiency (produced by liver and found in lungs); accounts for < 1% of COPD cases Emphysema results from lysis of lung tissues by

proteolytic enzymes from neutrophils and macrophages

Infection Major contributing factor to the

aggravation and progression of COPDHeredity

-Antitrypsin (AAT) deficiency (produced by liver and found in lungs); accounts for < 1% of COPD cases Emphysema results from lysis of lung tissues by

proteolytic enzymes from neutrophils and macrophages

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TYPES OF BRONCHITIS:

CHRONIC BRONCHITIS ACUTE

BRONCHITIS

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Chronic bronchitis •Chronic bronchitis  is

a chronic inflammation  of the bronchi (medium-size airways) in the lungs.• It is generally considered one of the two forms of chronic obstructive pulmonary disease (COPD), the other being emphysema.•Chronic bronchitis It is defined clinically as a persistent cough that produces sputum and mucus, for at least three months per year in two consecutive years.

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Signs and symptomsBronchitis may be indicated by –

Cough (also known as a productive cough, i.E. One that produces sputum),

Shortness of breath and Wheezing.

Occasionally ,chest pains, fever, and fatigue or malaise may also occur.

Mucus is often green or yellowish green and also may be orange or pink, depending on the pathogen causing the inflammation.

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Causes: Tobacco smoking is the most common cause.Pneumoconiosis and long-term fume inhalation are other causes.Allergies can also cause mucus hypersecretion, thus leading to symptoms similar to asthma or bronchitis

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Pollution is a major cause of COPD

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Chronic Bronchitis PathophysiologyChronic Bronchitis Pathophysiology

Pathologic lung changes are: Hyperplasia of mucus-secreting glands

in trachea and bronchi Increase in goblet cells Disappearance of cilia Chronic inflammatory changes and

narrowing of small airways Altered function of alveolar macrophages

infections

Pathologic lung changes are: Hyperplasia of mucus-secreting glands

in trachea and bronchi Increase in goblet cells Disappearance of cilia Chronic inflammatory changes and

narrowing of small airways Altered function of alveolar macrophages

infections

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Chronic Bronchitis Pathophysiology

Chronic inflammation Primary pathologic mechanism causing changes

Narrow airway lumen and reduced airflow hyperplasia of mucus glandsInflammatory swellingExcess, thick mucus

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Chronic Bronchitis PathophysiologyChronic Bronchitis Pathophysiology

Greater resistance to airflow increases work of breathing

Hypoxemia and hypercapnia develop more frequently in chronic bronchitis than emphysema

Greater resistance to airflow increases work of breathing

Hypoxemia and hypercapnia develop more frequently in chronic bronchitis than emphysema

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Chronic Bronchitis PathophysiologyChronic Bronchitis Pathophysiology

Bronchioles are clogged with mucus and pose a physical barrier to ventilation

Hypoxemia and hypercapnia , lack of ventilation and O2 diffusion

Tendency to hypoventilate and retain CO2

Frequently patients require O2 both at rest and during exercise

Bronchioles are clogged with mucus and pose a physical barrier to ventilation

Hypoxemia and hypercapnia , lack of ventilation and O2 diffusion

Tendency to hypoventilate and retain CO2

Frequently patients require O2 both at rest and during exercise

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Chronic Bronchitis PathophysiologyChronic Bronchitis Pathophysiology

Cough is often ineffective to remove secretions because the person cannot breathe deeply enough to cause air flow distal to the secretions

Bronchospasm frequently develops

More common with history of smoking or asthma

Cough is often ineffective to remove secretions because the person cannot breathe deeply enough to cause air flow distal to the secretions

Bronchospasm frequently develops

More common with history of smoking or asthma

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Chronic BronchitisClinical Manifestations

Chronic BronchitisClinical Manifestations

Earliest symptoms:

Frequent, productive cough during winter

Frequent respiratory infections

Earliest symptoms:

Frequent, productive cough during winter

Frequent respiratory infections

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Chronic BronchitisClinical Manifestations

Chronic BronchitisClinical Manifestations

Bronchospasm at end of paroxysms of coughing

Cough History of smoking Normal weight or heavyset Ruddy (bluish-red) appearance d/t

polycythemia (increased Hgb d/t chronic hypoxemia)) cyanosis

Bronchospasm at end of paroxysms of coughing

Cough History of smoking Normal weight or heavyset Ruddy (bluish-red) appearance d/t

polycythemia (increased Hgb d/t chronic hypoxemia)) cyanosis

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Chronic Bronchitis Clinical ManifestationsChronic Bronchitis Clinical Manifestations

Hypoxemia and hypercapnia

Results from hypoventilation and airway resistance + problems with alveolar gas exchange

Hypoxemia and hypercapnia

Results from hypoventilation and airway resistance + problems with alveolar gas exchange

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Diagnosis:

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Diagnosis:

A variety of tests may be performed in patients presenting with cough and shortness of breath:•Pulmonary Function Tests (PFT) (or spirometry) •A chest X-ray • chest radiography.•A sputum sample showing neutrophil granulocytes (inflammatory white blood cells) and Check for pathogenic microorganisms such as Streptococcus spp.•A blood test would indicate inflammation •High Resolution Computed Tomography (HRCT)

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COPD ComplicationsCOPD Complications

Pulmonary hypertension (pulmonary vessel constriction alveolar hypoxia & acidosis)

Pneumonia

Acute Respiratory Failure

Pulmonary hypertension (pulmonary vessel constriction alveolar hypoxia & acidosis)

Pneumonia

Acute Respiratory Failure

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Acute bronchitis Acute bronchitis  is an inflammation of the large bronchi (medium-size airways) in the lungs that is

Usually caused by viruses or bacteria and may last several days or weeks. Characteristic symptoms :• cough, • sputum (phlegm) production, • shortness of breath • wheezing related to the obstruction of the inflamed airways. Diagnosis is by clinical examination and sometimes microbiological examination of the phlegm. Treatment For acute bronchitis is typically symptomatic. As viruses cause most cases of acute bronchitis, antibiotics should not be used unless microscopic examination of gram-stained sputum reveals large numbers of bacteria.

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Anti-inflammatory drugs: steroids

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Membrane phospholipid

Arachidonic acid

Phospholipase A2

Leukotrienes:

B’constrictor

COX-I

PGs with gastric protective effects

COX-II

PGs with inflammatory effects

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Membrane phospholipid

Arachidonic acid

Phospholipase A2

Leukotrienes

COX-I

PGs with gastric protective effects

COX-II

PGs with inflammatory effects

Xste

roids

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Anti-inflammatory drugs: steroids

Life-saving.Take at least 12 h to work: so start early in

severe cases.Systemic steriods: acute severe asthma.Inhaled steroids: maintenance

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Anti-inflammatory drugs: steroids

Systemic steroid: intolerance ‘Cushingoid’ features Hypertension Salt and water retention Infection

Topical steroid Hoarseness

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Anti-inflammatory drugs: cromoglycate{mast cell stabilizer}

Prevent release of histamine from mast cells

By inhaler only.Useful maintenance therapy.No role in severe episodes.Few, if any, adverse effects.

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Anti-inflammatory drugs: leukotriene receptor antagonists

Arachidonic acid

Leukotrienes

PGs with gastric protective effects

PGs with inflammatory effectsx

Receptors

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• Leukotrienes cause capillary leakiness and bronchoconstriction

• Used orally for maintenance therapy (e.g. montelukast).

• Additive with inhaled steroids.

Anti-inflammatory drugs: leukotriene receptor antagonists

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Bronchodilators

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Catecholamines, receptors and effects.

receptors vasoconstrict1 receptors increase heart rate2 receptors vasodilate and bronchodliate

• Adrenaline , 1, 2.

• Noradrenaline , 1.• Dobutamine () 1.• Isoprenaline 1, 2.• Salbutamol (1)

2.

HR, BP, Bdilate

(HR), BPHR, BPHR, (? BP)(HR), Bdilate

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2-agonists.

Salbutamol, terbutilineInhalers (of various types).Maintenance:

Regularly in more severe casesAcute severe asthmaTachycardia and tremor

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Aminophylline

Is not a catecholamine, but has analgous effects.

Narrow therapeutic range.Given by mouth or by IV infusion.Toxic:

Fatal if injected too fast. Convulsions. Tachyarrhythmia

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Antimuscarinics

Atropine is the classical antimuscarinic, and this is b’dilator.

Atropine: too many diverse effects.Ipratropium.By inhaler.Add to salbutamol.Dry mouth.

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