Submitted to: B.P. Satish Kumar Assistant.Professor Submitted
by: P.Deepak Pharm D (P.B) 1s t Yr
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ACUTE BRONCHITIS DEFINITION : Acute bronchitis or chest cold,
is a condition that occurs when the bronchial tubes in the lungs
become inflamed. The bronchial tubes swell and produce mucus, which
causes a person to cough. This often occurs after an upper
respiratory infection like a cold. Most symptoms of acute
bronchitis (chest pain, shortness of breath, etc.) last for up to 2
weeks, but the cough can last for up to 8 weeks in some
people.
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PATHOGENESIS Acute bronchitis is a self limiting illness.
Infection of trachea and bronchi produce hyperemic and edematous
mucous membranes with an increase in bronchial secretions which can
become thick and tenacious impairing mucociliary activity.
Recurrent respiratory infections may be associated with increase
airway hyperreactivity and leads to pathogenesis of asthma and
COPD.
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Causes of Bronchitis Several types of viruses, most often:
Respiratory syncytial (sin-SIH-shull) virus (RSV) Adenovirus
Influenza Parainfluenza Bacteria, in rare cases Pollutants
(airborne chemicals or irritants)
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CLINICAL PRESENTATION Signs and Symptoms : Cough persisting
> 5 days to weeks Coryza,sore throat,malaise,headache Fever
rarely > 39c Physical examination : Rhonchi or coarse Purulent
sputum in 50% of patients
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PHARMACOLOGICAL THERAPY Mild analgesic or antipyretics therapy
is helpful in removal of malaise, lethargy and fever. Aspirin 650
mg in adults or 10-15 mg/kg in children Ibuprofen 200-800 mg in
adults or 10 mg/kg in children.
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Chronic Bronchitis Definition: Chronic bronchitis is defined as
chronic cough and expectoration. Excessive tracheo bronchial mucus
production sufficient to cause cough with expectoration for most
days of at least 3 months of the year for 2 consecutive years.
Etiology: The most important etiologic factor in the development of
chronic bronchitis is cigarette smoking.
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CHRONIC BRONCHITIS Classification: 1. Simple chronic bronchitis
2. Chronic mucopurulent bronchitis 3. Chronic bronchitis with
obstruction 4. Chronic bronchitis with obstruction and airway
hyperreactivity.
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CHRONIC BRONCHITIS PATHOPHYSIOLOGY : Chronic inflammation
Hypertrophy & hyperplasia of bronchial glands that secrete
mucus Increase number of goblet cells Cilia are destroyed
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Chronic Bronchitis Pathophysiology Narrowing of airway Starting
w/ bronchi smaller airways airflow resistance work of breathing
Hypoventilation & CO2 retention hypoxemia &
hypercapnea
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Chronic Bronchitis Pathophysiology Bronchospasm often occurs
End result Hypoxemia Hypercapnea Polycythemia (increase RBCs)
Cyanosis Cor pulmonale (enlargement of right side of heart)
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Chronic Bronchitis: Clinical Manifestations In early stages
Clients may not recognize early symptoms Symptoms progress slowly
May not be diagnosed until severe episode with a cold or flu
Productive cough Especially in the morning Typically referred to as
cigarette cough Bronchospasm Frequent respiratory infections
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Chronic Bronchitis: Clinical Manifestations Advanced stages
Dyspnea on exertion Dyspnea at rest Hypoxemia & hypercapnea
Polycythemia Cyanosis Bluish-red skin color Pulmonary hypertension
Cor pulmonale
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Goals of Treatment: Chronic Bronchitis Improved ventilation
Remove secretions Prevent complications Slow progression of signs
& symptoms Promote patient comfort and participation in
treatment
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Its an acute viral infection of lower respiratory tract
infection affecting nearly 50% of children during 1 st year of life
and 100% by age of 3 years. Respiratory syncytial virus is the most
common cause of bronchiolitis accounting for 70 % of cases.
BRONCHIOLITIS
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INFLUENZA Influenza is an acute, viral respiratory infection.
Fever, chills, headache, aches and pains throughout the body, sore
throat which may lead to bronchitis or pneumonia.
NON-PULMONARY COMPLICATIONS myositis (rare, > in children,
> with type B) cardiac complications recent studies report
encephalopathy studies of patients 50 yo, those at risk for
influenza complic">
Prevention Smoking cessation Vaccination per ACIP
recommendations Influenza Inactivated vaccine for people >50 yo,
those at risk for influenza complications, household contacts of
high-risk persons and healthcare workers Intranasal live,
attenuated vaccine: 5-49yo without chronic underlying dz
Pneumococcal Immunocompetent 65 yo, chronic illness and
immunocompromised 64 yo
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Pharmacological therapy for lower respiratory tract infections
ASPIRIN: ORAL ADULTS: PO 325 to 650 mg prn q 4 to 6 hr or 1 g 3 to
4 times/day. Do not exceed 4 g/day. CHILDREN: PO 10 to 15 mg/kg
dose prn q 4 to 6 hr; do not exceed 5 doses/24 hr. Interactions
Ethanol: Chronic excessive use may increase risk of hepatotoxicity.
Hydantoins, sulfinpyrazone: May decrease therapeutic effect of
APAP; concomitant long-term use may increase risk of
hepatotoxicity. Adverse Reactions HEMA: Hemolytic anemia;
neutropenia; leukopenia; pancytopenia; thrombocytopenia. HEPA:
Jaundice. OTHER: Hypoglycemia; allergic skin eruptions or
fever.
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AMOXICILLIN Capsules: 250 mg (as trihydrate), 500 mg (as
trihydrate) Class: Antibiotic/Penicillin Action Inhibits bacterial
cell wall mucopeptide synthesis. Clavulanic acid inactivates a wide
range of beta-lactam enzymes found in bacteria resistant to
penicillins and cephalosporins. Contraindications Hypersensitivity
to penicillins, cephalosporins, or imipenem. Not used to treat
severe pneumonia,pericarditis, meningitis, and purulent or septic
arthritis during acute stage. Lower Respiratory Tract Infections
ADULTS AND CHILDREN WEIGHING AT LEAST 40 KG: PO 875 mg q 12 hr or
500 mg q 8 hr. CHILDREN (OLDER THAN 3 MO AND WEIGHING LESS THAN 40
KG): PO 45 mg/kg/day in divided doses q 12 hr or 40 mg/kg/day in
divided doses q 8 hr. Adverse Reactions: CNS: Dizziness; fatigue;
insomnia; GI: Gastritis; anorexia; nausea; vomiting;HEPA: Transient
hepatitis; cholestatic jaundice;GU: Interstitial nephritis
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TRIMETHOPRIM- SULFAMETHOXAZOLE(COTRIMOXAZOLE) Action
Sulfamethoxazole (SMZ) inhibits bacterial synthesis of dihydrofolic
acid by competing with PABA. Trimethoprim (TMP) blocks production
of tetrahydrofolic acid by inhibiting the enzyme dihydrofolate
reductase. This combination blocks two consecutive steps in
bacterial biosynthesis of essential nucleic. Pneumocystis Carinii
Pneumonitis ADULTS: PO 20 mg/kg TMP/100 mg/kg SMZ daily in divided
doses q 6 hr for 14 days. IV 1520 mg/kg/day (based on TMP) in 34
divided doses for up to 14 days. Exacerbation of Chronic Bronchitis
ADULTS: PO 160 mg TMP/800 mg SMZ q 12 hr for 14 days. acids and
proteins and is usually bactericidal. Adverse Reactions;CNS:
Headache; depression; seizures;GI: Nausea; vomiting; anorexia;
abdominal pain; diarrhea;Stevens-Johnson syndrome
