BRONCHIT

IS
 Introduction
I t is a condition where the lining of bronchial
tubes become inflamed or infected. I t have
reduce ability to breath in air & oxygen into the
lungs, they have also heavy mucus forming in the
ai•rways.
Incidence
The recent 'Indian Study of Asthma, Respiratory
Symptoms and Chronic Bronchitis' study of
85,105 men and 84,470 women from 12 urban
and 11 rural sites reported the incidence of
chronic bronchitis to be 3.49% (4.29% in males
and 2.7% in females) in adults > years.
35
Healthy
bronchus

Inflamed
bronchus
 Normal mechanism of inflammation
Infection enter into Thebody
Chemical release from WBC are released into the
blood or affected tissue to protect your body from
Foreign substances
This release of chemicals increases the blood flow to
The area of infection
may result in redess and warmth
Some of the chemicals cause a leak of fluid into the
tissues, resulting in swelling
This protective process may stimulate nerves and
cause pai•n
 Definition
I t is an inflammation and swelling of the
bronchial tubes (bronchi), the air passage
between the lungs.
Anatomy of Bronchi
Trachea divide it form two primary bronchi
Right bronchus - this is wider, shorter &
more vertical then the left bronchus. I t is
approximately 2.5 cm long. After entering
into the right lun it divide into three
branches, one tog each lobe. Each branches it
subdivided into numerous smaller branches.
Left bronchus - 5 cm long, & narrower then
the right. After entering into the lung it divide into
the two branches , one to each lobe, each branch
then sbdivide into the numerous smaller branches.
Structure - it lined with ciliated columnar
epithelium. The bronchi progressively subdivide into
the bronchioles, terminal bronchioles, respiratory
bronchioles, alveolar duct & finally alveoli.
In trachea & bronchi cartilages, ciliated epithelium,
goblet cells is present, at the bronchiolar level
there is no cartilage it replace with smooth muscle,
ciliated replaced with non-ciliated epithelium &
goblet cell disappear.
Nasal cavity

N o s t r i l g s
Oral cavity

Larynx
Carina of
trachea
Right main
(primary)
bronchus
Left main
Right lung ,[primary)
bronchus

d Left lung

+ D i a p h r a g m
 Tscbea h

Primary
bronchus

bron - Z chus Passages

of air
conduction

bronchus

BronchJole.s.,_,_......,...c._...-1--.i..... ~..,_..,,.---~·------•

nesoratory
b ro n c h i o l e s
Passages
where
Lobule ~ -------------- -- gases

-.
·-··· exchange

A l v e o l u s
.. _ _ _ _ _ _ _ f ig ure 1 0 . 1 3 L o w e r resp r s_ tory J

tract
 Types
1. Acute - it is a shorter illness t h a t commonly
follow a cold or viral infection such as flu.
I t consist of a cough with mucus, chest
discomfort, throat soreness, fever,
shortness of breath. I t is usually a last a
few days or weeks (1-3 week).
2. Chronic - it is a serious ongoin illness, it is
g
a persistent, mucus producing cough t h a t
last longer then three month. The person is
having severe breathing difficulties & it may
get worsen. It occurs with emphysema and
it may become COPD.
 ACUTE BRONCHITIS
trache
a
Nom
al
bronchiole bron
s
lung
chial
(insi tube
de
vie 4

w)•
Inflame
d
diaphragm• bronchia
l
I tube
@ 2006 Encyclopedia Britannica,
Chronic Bronchitis
 Etiology
1. Acute - I t is caused by virus, the same
virus that cause cold & flu. I t can be
caused by bacterial infection & exposure to
substance that irritate the lungs such as
tobacco smoke, dust, fumes, vapours & air
pollution.
2. Chronic - it is caused by repeated irritation
& damage of the lungs & airway tissue.
Smoking is most common cause with other
causes including long term exposure to air
pollution, dust & fumes from the
environment & repeated episodes of a c u t e
bronchitis. . ,
 Etiology

• Etiologic agent - bacteria, virus

• Predisposing factor (contribute to the
problem)- smoking, long term illness,
immune deficiency and immobilization.
• Precipitating factor (trigger the
problem)- hospitalization, environment,
smoking and malnutrition.
 aw en
ad euc a i A

Cigarette smoking, or
exposure to second-
hand
cigarette smoke, is the
p r i m a r y cause o f c h r o n i c
bronchitis symptoms.
 Pathophysiology
Du e t o E / F
M 1 . croorgan . sm enter mnto respiratory tract
by inalation
Wi d e s p r e a d i n f l a m m a t i o n o c c u r s
Thin mucus lining of ■the bronchi can become
irritated & swollen
Cell that makes up thi ■s lining may leak fluid in
response to the in flam ma t ion- co ughing
to cl ear secre ti on from t he lungs
Alveola r f ■luid re s pons e
airways
Ventilation decrease as a secretion thickens

Mucus within produces resistance

in small airways and can cause severe
v e n t i l a t i on pe r fus i o n i m ba l a nc e
..
Bronchi ti s
 Clinical man ifestation
Sign & symptoms for both acute and chronic bronchitis.
• Persistent cough
• Production of mucus which can be clear, white,
yellowish gray or green in color, rarely it may be
streaked with blood.
• Crackles and Wheezing sound
• Low fever, chills, Headache
• Chest tightening
• Sore throat, dyspnoea
• Blocked nose & sinuses
 Diagnostic evaluation
• History
• Physical examination
• Chest x-ray
• Sputum- for gram stain, culture and
sensitivity t e s t may be obtained t o
determine presence of bacterial inf ect ion.
• Pulmonary function t e s t by using spiromet
- to determine peak expiratory flow er
(person's maximum speed of expiration)
• ABG Level
 P ati e n t ta ke s a d e e p br ea t h
a nd b lo w s as h a rd as
po ss i b le in t o t u b e

Chip Technician monitors

and encou rages
p a t i e n t d u ri n g t e s t

M a c h in e
re c o r d s the
re s u lt s o f the
s p i r o m e t r y t es t
Monitor
Nose clip
Spir om et ry me asu r es
Spiromneter
how f ast and how much
air you breat he out
 Management
People with bronchitis are instruct to rest, drink
fluid, breath warm & moist air, & take
cough suppressant & pain relieve in order to
manage symptoms & ease breathing.
Many case of acute condition may go away without
any specific treatment, but there is a no cure
for chronic condition.
To keep bronchitis symptoms under control &
relieve symptoms, doctor may prescribe -
Antibiotics - Azithromycin, for 7-10 days
Antitussive - Codeine for suppressing t he
cough
Bronchodilators - To dilate the bronchi
• Beta2-adrenergic agonist agents -
Salbutamol, Terbutaline

• Anticholinergic agents - Ipratropium bromide

• Methylxanthines - Theophylline
Mucolytics - e.g. Acet ylcyst eine thin the secretions.
to
Corticosteroids - Dexamethasone, Methylprednisolone to
relieve the inflammation

Antipyretics - for fever

Ot her - Oxygen t herapy, Pulmonary rehabilit at ion
program, chest physiot herapy, nut rit ional t herapy
Additional behaviour remedies include -

• Removing the source of irritants from the

lungs
• Using a humidifier - loosen mucus
• Exercise
• Breathing exercise - pursed lip breathing
 Complication

• Pneumonia
• Asthma
• COPD
2. Nursing diagnosis - Impaired respiratory
functioning related to ineffective breathing pattern
as evidence by increased respiratory rate.
Goal - To improve the respiratory functioning
Intervention - Always stay with patient to reduce
the anxiety.
• To give instruction regarding the pursed lip &
diaphragmatic breathing to assist with slowing
respiratory rate.
• To provide water to drink help in loosen the secretion
& lessen the dryness in mucus membrane.
• To provide oxygen therapy .
• Te provide suct io ning
help
in r emoving the secr "" 4
3. Nursing diagnosis - acute pain related to
inflammation, cough as evidence by report of
discomfort and facial expression.
Goal - To relieve the pain
Intervention
• Administer acetaminophen medication.
• Monitor vital sign for respiratory suppression
associated with pain medication.
• To apply pillow to chest while
coughing.
• Help the patient increase level of comfort in hospital
bed by elevating the head of the bed, to help assist
in less painful breathing. _ , A
 Research study
Smoking Cessation and Lung Function in Mild-to•
Moderate Chronic Obstructive Pulmonary Disease

It was conducted at 10 North American medical centres, we

studied 3,926 smokers with mild-to-moderate airway
obstruction randomized to one of two smoking cessation
groups. We measured lung function annually for 5 yr.
Participants who stopped smoking experienced an
improvement in FEV, (forced expiratory volume) in the
year after quitting. The subsequent rate of decline in FEV,
among sustained quitters was half the rate among
cont inuing smoker s, 31 ± 48 ver sus ± 55 ml (mean ±
62 compar able t o t hat of never - SD), Smoker s wit h
airflow obstruction benefit from quitting despite previous
smoker s.
heavy smoking.