NR 507 Discussion What is the etiology of bronchitis?
NR 507 Discussion What is the etiology of bronchitis?
NR 507 Discussion What is the etiology of bronchitis?
What is the etiology of bronchitis?
There are two kinds of Bronchitis: Acute Bronchitis, that is caused by “Infections or lung irritants,” and Chronic Bronchitis, that is caused by “repeatedly breathing in fumes that irritate and damage lung and airway tissues” (National Heart, Lung, and Blood Institute, 2018). This could be like smoking or inhaling second-hand smoke. The etiology of bronchitis is the same that causes upper respiratory infections. The names of the viruses that cause bronchitis are coronavirus, rhinovirus, respiratory syncytial virus, and adenovirus. Most cases of bronchitis come from a virus instead of bacteria. Current smoking is associated with a more goblet cell hyperplasia and number, and chronic bronchitis is associated with more goblet cells, independent of the presence of airflow obstruction. This provides clinical and pathologic correlation for smokers with and without COPD (Kim et al., 2015).
Describe in detail the pathophysiological process of bronchitis.
The pathophysiological process of bronchitis is very simple. The symptoms of acute bronchitis are due to acute inflammation of the bronchial wall, which causes increased mucus production along with edema of the bronchus (National Heart, Lung, and Blood Institute, 2018). This leads to the productive cough that is the hallmark of a lower respiratory tract infection. While the infection may clear in several days, repair of the bronchial wall may take several weeks. During the period of repair, patients will continue to cough. Pulmonary function studies of patients with acute bronchitis demonstrate bronchial obstruction similar to that in asthma. As the symptoms of acute bronchitis subside, pulmonary function returns to normal. Most patients will cough for less than 2 weeks with the illness. If a patient coughs longer than 1 month then the term is post bronchitis syndrome (National Heart, Lung, and Blood Institute, 2018). The bronchial walls are trying to repair after the clearance of the infection.
Identify hallmark signs identified from the physical exam and symptoms.
The hallmark sign and symptoms are duration of cough less than 30 days, productive cough, no history of chronic respiratory illness, and fever. Production of mucus (sputum), which can be clear, white, and yellowish-gray or green in color can occur in acute bronchitis. Acute bronchitis is caused by a virus. Cough from the irritated and inflamed bronchial epithelium and increased mucus production (McCance, Huether, Brashers and Rote, 2013).
Describe the pathophysiology of complications of bronchitis.
As with most diseases, complications can arise from bronchitis. Around one person in 20 with bronchitis may develop a secondary infection in the lungs leading to pneumonia. The infection is commonly bacterial although the initial infection that caused the bronchitis may be viral. The infection affects the tiny air sacs known as alveoli in the lungs (National Heart, Lung, and Blood Institute, 2018). Although a single episode of bronchitis usually isn’t cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may mean that you have chronic obstructive pulmonary disease, or COPD. Chronic bronchitis can lead to long term COPD with progressively diminishing lung reserves and breathing difficulties. COPD further raises the risk of occasional flare ups and increased risk of recurrent and frequent chest infections. When you breathe, air moves in your trachea through two tubes called bronchi. The bronchi branch out into smaller tubes called bronchioles. At the ends of the bronchioles are little air sacs called alveoli. And at the end of alveoli are capillaries, which are tiny blood vessels. Oxygen moves around in the lungs to the bloodstream through the capillaries. Carbon dioxide moves from the blood into the capillaries and then into the lungs and exhaled. The fibers in the walls of the lungs can become damage (Kim et al, 2015). They are not able to expand and make them less elastic when you exhale.
What teaching related to her diagnosis would you provide?
I would educate Tammy about second-hand exposure to smoke. This could make her bronchitis even worse if exposed. Tammy would most likely be prescribed an inhaler that would open up her bronchioles, helping her breath better. Most people should drink at least 8 eight-ounce cups of water a day. You may need to drink more liquids when you have acute bronchitis. Liquids help keep your air passages moist and help you cough up mucus. I would encourage Tammy to get plenty of rest to help fight the infection. Tammy could use a cool mist humidifier to decrease her cough and make it easier for her to breath (National Heart, Lung, and Blood Institute, 2018).
References
Kim, V., Oros, M., Durra, H., Kelsen, S., Aksoy, M., Cornwell, WD., et al. (2015) Chronic Bronchitis and Current Smoking Are Associated with More Goblet Cells in Moderate to Severe COPD and Smokers without Airflow Obstruction. PLoS ONE 10(2). Doi: https://doi.org/10.1371/journal.pone.0116108
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.
National Heart, Lung, and Blood Institute. (2018). Bronchitis. National Institute of Health. Retrieved from https://www.nhlbi.nih.gov/health-topics/bronchitis
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You really identified the pathological hallmark, the pathological complication of bronchitis. Acute bronchitis is a transient inflammation of the trachea and major bronchi (Wark, 2011). Clinically, it is diagnosed on the basis of a cough and occasionally sputum, dyspnoea, and wheeze. Pathogens and allergen expose are factors that trigger acute bronchitis. Bronchitis is a self-limiting illness, but times the illness do not go away and can lead to complication such as a chronic cough, chronic bronchitis, and pneumonia
As nurse practitioners (NPs) it is very important that we are quick in diagnosing acute bronchitis on time by paying attention to the hallmark signs of the disease to prevent the complication of the disease such as pneumonia and chronic bronchitis, which has been linked to impaired lung function and decrease in oxygenation to tissues and organs. These complications if not well managed can lead to death. NPs must treat patient with the right medication mucolytic drugs and antibiotics for those that develop an infection. It is also important to educate the patient on the importance of life style changes such quitting tobacco use and smoking cessation as well as teaching patients the importance of proper hand hygiene to prevent reoccurrence
Wark, P. (2011). Bronchitis (acute). BMJ Clinical Evidence, 2011, 1508. Retrieved from,
I read enjoyed reading your informative post and especially like your educational area. I think too many people do not realize the value of water and hydration. You covered this area very well. Having had bronchitis, I remember being exhausted and the cure all was homemade chicken noodle soup. The old wise tales were very interesting and perhaps there was truth. And of course, there was guaifenesin, a mucoactive drug, to which the doctor stated that it would loosen the mucus to make the cough more productive. Albrecht, Dicpinigaitis & Guenin (2017) stated that the dosing range is 200 to 400 mg every 4 hours and can be taken to six times daily. There are both immediate release formulas as well as those that are extended release and is tolerable for most pediatric and adult patients. Teaching would also include to make sure that if this patient had any children or grandchildren. Again, I really enjoyed your post.
I found an interesting research article that I wanted to share about the use of bronchodilators. After thinking about the topic, for those with asthma, there has to be mention about bronchodilator drugs, Sarioglu, Bilen, Sackes & Gencer (2015) discussed bronchodilator drugs and antibiotics and went into detail about carbonic anhydrase (CA). Carbonic anhydrase (CA) is an enzyme controlling the acid-base balance and Sarioglu, Bilen Sacke & Gencer (2015) added that this enzyme also has a role in electrolyte secretion in tissues. In a study that looked at CA I and II activities, Sarioglu, Bilen Sacke & Gencer (2015) acknowledged that there is strong evidence that there are adverse effects when utilizing antibiotics and bronchodilator drugs because of the carbonic anhydrase inhibition. Again, this has captured my attention because we as clinicians have to look at the patient medications with a fine tooth comb in the prevention of adverse reactions.
Reference:
Albrecht, H. H., Dicpinigaitis, P. V., & Guenin, E. P. (2017). Role of
guaifenesin in the management of chronic bronchitis and upper
respiratory tract infections. Multidisciplinary Respiratory Medicine, 121.
doi:10.1186/s40248-017-0113-4
Sarioglu, N., Bilen, C., Sackes, Z., & Gencer, N. (2015). The effects of
bronchodilator drugs and antibiotics used for respiratory infection on
human erythrocyte carbonic anhydrase I and II isozymes. Archives Of
Physiology & Biochemistry, 121(2), 56-61.
doi:10.3109/13813455.2015.1011068
What is the etiology of bronchitis?
There are two kinds of Bronchitis: Acute Bronchitis, that is caused by “Infections or lung irritants,” and Chronic Bronchitis, that is caused by “repeatedly breathing in fumes that irritate and damage lung and airway tissues” (National Heart, Lung, and Blood Institute, 2018). This could be like smoking or inhaling second-hand smoke. The etiology of bronchitis is the same that causes upper respiratory infections. The names of the viruses that cause bronchitis are coronavirus, rhinovirus, respiratory syncytial virus, and adenovirus. Most cases of bronchitis come from a virus instead of bacteria. Current smoking is associated with a more goblet cell hyperplasia and number, and chronic bronchitis is associated with more goblet cells, independent of the presence of airflow obstruction. This provides clinical and pathologic correlation for smokers with and without COPD (Kim et al., 2015).
Nice job!
Describe in detail the pathophysiological process of bronchitis.
The pathophysiological process of bronchitis is very simple. The symptoms of acute bronchitis are due to acute inflammation of the bronchial wall, which causes increased mucus production along with edema of the bronchus (National Heart, Lung, and Blood Institute, 2018). This leads to the productive cough that is the hallmark of a lower respiratory tract infection. While the infection may clear in several days, repair of the bronchial wall may take several weeks. During the period of repair, patients will continue to cough. Pulmonary function studies of patients with acute bronchitis demonstrate bronchial obstruction similar to that in asthma. As the symptoms of acute bronchitis subside, pulmonary function returns to normal. Most patients will cough for less than 2 weeks with the illness. If a patient coughs longer than 1 month then the term is post bronchitis syndrome (National Heart, Lung, and Blood Institute, 2018). The bronchial walls are trying to repair after the clearance of the infection.
That was very thorough.
Identify hallmark signs identified from the physical exam and symptoms.
The hallmark sign and symptoms are duration of cough less than 30 days, productive cough, no history of chronic respiratory illness, and fever. Production of mucus (sputum), which can be clear, white, and yellowish-gray or green in color can occur in acute bronchitis. Acute bronchitis is caused by a virus. Cough from the irritated and inflamed bronchial epithelium and increased mucus production (McCance, Huether, Brashers and Rote, 2013).
That’s correct.
Describe the pathophysiology of complications of bronchitis.
As with most diseases, complications can arise from bronchitis. Around one person in 20 with bronchitis may develop a secondary infection in the lungs leading to pneumonia. The infection is commonly bacterial although the initial infection that caused the bronchitis may be viral. The infection affects the tiny air sacs known as alveoli in the lungs (National Heart, Lung, and Blood Institute, 2018). Although a single episode of bronchitis usually isn’t cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may mean that you have chronic obstructive pulmonary disease, or COPD. Chronic bronchitis can lead to long term COPD with progressively diminishing lung reserves and breathing difficulties. COPD further raises the risk of occasional flare ups and increased risk of recurrent and frequent chest infections. When you breathe, air moves in your trachea through two tubes called bronchi. The bronchi branch out into smaller tubes called bronchioles. At the ends of the bronchioles are little air sacs called alveoli. And at the end of alveoli are capillaries, which are tiny blood vessels. Oxygen moves around in the lungs to the bloodstream through the capillaries. Carbon dioxide moves from the blood into the capillaries and then into the lungs and exhaled. The fibers in the walls of the lungs can become damage (Kim et al, 2015). They are not able to expand and make them less elastic when you exhale.
Excellent work here!
What teaching related to her diagnosis would you provide?
I would educate Tammy about second-hand exposure to smoke. This could make her bronchitis even worse if exposed. Tammy would most likely be prescribed an inhaler that would open up her bronchioles, helping her breath better. Most people should drink at least 8 eight-ounce cups of water a day. You may need to drink more liquids when you have acute bronchitis. Liquids help keep your air passages moist and help you cough up mucus. I would encourage Tammy to get plenty of rest to help fight the infection. Tammy could use a cool mist humidifier to decrease her cough and make it easier for her to breath (National Heart, Lung, and Blood Institute, 2018).
Very informative post and thank you for sharing. Acute bronchitis and cough is one of the most commonly seen illnesses in ambulatory care and primary care centers. It is characterized by a persistent cough, which may or may not be productive in nature, and lower respiratory tract infection without complication of chronic airway or respiratory disease. Typically upper respiratory tract symptoms and postnasal drainage precede acute bronchitis, causing inflammation of trachea and bronchus (Kinkade & Long, 2016). Acute bronchitis originates from a viral infection 90% of the time and persistent, bothersome cough, lasting more than 2 weeks, is typically the symptom that causes patients to seek treatment. Intermittent wheezing and rhonchi may be auscultated in the lungs, which should clear with cough.
Finally, while fever may be present, it is not a common or required presentation for the diagnosis of acute bronchitis (Kinkade & Long, 2016). Acute bronchitis is the most accurate fitting diagnosis for Tammy’s initial presentation. She has cold like symptoms that worsen into persistent cough. Symptoms are present for 3 weeks, which is a reasonable time frame for the presence of acute bronchitis. The complaints of scratchy throat may be a result of postnasal drainage, leading to the cough, which is also described as a contributing factor of acute bronchitis.
Chronic obstructive pulmonary disease can be classified as either chronic bronchitis, chronic inflammation of the airways with thick mucus production, or emphysema, loss of the elasticity of the alveoli. Deterioration of the alveoli results from the breakdown of elastin, causing air to become trapped. Inflammation and thick secretions noted in chronic bronchitis result from chronic exposure to irritants, decreased ciliary function, and over active goblet cells (McCance et al., 2013). Both versions of COPD lead to obstruction of the airway and increased RV, FRC. However, FVC and ERV and the amount of air exhaled in the first second of forced exhalation (FEV1) are decreased with the disease. Decline in FEV1 over the course of the disease is utilized to measure the severity of COPD and the progression of the disease process (Cerveri et al., 2012).
References
Cerveri, I., Corsico, A. G., Grosso, A., Albicini, F., Ronzoni, V., Tripon, B., Imberti, F., Galasson, T., Klersy, C., Luisetti, M., Pistolesi, M. (2012). The Rapid FEV1 decline in chronic obstructive pulmonary disease is associated with predominant emphysema: A longitudinal study. COPD: Journal of Chronic Obstructive Pulmonary Disease, 10(1), 55-61. doi:10.3109/15412555.2012.727920
Colom, A. J., Maffey, A., Garcia Bournissen, F., & Teper, A. (2014). Pulmonary function of a paediatric cohort of patients with postinfectious bronchiolitis obliterans. A long term follow-up. Thorax, 70(2), 169-174. doi:10.1136/thoraxjnl-2014-205328
McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby
Perez, T., Chanez, P., Dusser, D., & Devillier, P. (2015). Prevalence and reversibility of lung hyperinflation in adult asthmatics with poorly controlled disease or significant dyspnea. Allergy, 71(1), 108-114. doi:10.1111/all.12789
Thank you for your very thorough and informative post. I have a family member that has chronic bronchitis. He usually presents with a very dry barking cough and it lasts for weeks. He usually gets it every year. He does not smoke but worked in an automobile factory while going to college many years ago. It usually starts with a cold. Exposure to second-hand smoke and many other irritants in and around the factory is more than likely the cause. He was prescribed antibiotics a few years ago but they did nothing for him.
Kinkade and Long (2016) explain how the use of antibiotics for bronchitis is not appropriate in most cases. It is important to rule out pneumonia or other bacterial infections first. Bronchitis is usually caused by viral infections in 90% of all cases. A study, between 1996-2010, of antibiotic use found that antibiotics were prescribed in 71% of visits relating to acute bronchitis. Overuse of antibiotics causes antimicrobial resistance and extensive health care costs. Antibiotic use can also cause severe diarrhea, allergic reactions, nausea, headache, and vaginitis.
Biomarkers may help practitioners determine if there is a bacterial infection. C-Reactive protein levels above 50 mcg/ml can help in identifying pneumonia. A chest x-ray can also help to rule out pneumonia. Symptoms of bronchitis can be treated with over-the-counter medications, and some prescribed medications, such as cough medication or inhalers. It is important to differentiate between viral and bacterial infections to avoid unecessary use of antibiotics.
Reference
Kinkade, S., & Long, N. (2016, October 1). Acute bronchitis. American Family Physician, 94(7), 560-565. www.aafp.org/afp
You are right in pointing out that the case was about acute bronchitis. The key symptom to notice is the patient exhibited a productive cough that is persistent for three weeks. Also, the presence of an allergen that triggers an inflammatory response that affected the bronchial walls and the response by scratchy throat due to mucus formation indicating that the bronchial wall is been irritated.
It is also what knowing that the color of the sputum should not be used in deter terming whether the origin of the infection is of viral or bacterial in origin. In other to determine the infective organism further laboratory is necessary for eliminating the causative organism.
The need to address acute bronchitis on time is to prevent patients from making sure that patient due not develop a complication of the disease such as pneumonia, chronic bronchitis. These complications if not addressed in a timely manner will contribute to poor oxygenation, causing damage to lungs and poor perfusion to body tissue and organs resulting in death.
The patients should be educated on the importance of encouraging patients to drink a lot of fluid and use mucolytic to remove mucus from the lung to make it easier for carbondixde to be expelled from tissue and organs to the to avoid cyanosis and hypercapnia and hyperemia and cor pulmonale
Very informative post ladies it seems like antibiotics are thrown around like candy at a parade nowadays. The concern that the overuse of antibiotics can cause resistance to drugs and potentiate a drug-resistant organism is a reality (Dempsey at al., 2014). The need for follow up after the use of antibiotics and this disease process is important to ascertain that the patient did indeed take all the medicine and has resolved all her respiratory issues. We must also be concerned with any side effects from the antibiotic such as diarrhea, rash, nausea, vomiting or any number of reactions what could hinder the resolution of this disease process. The need for education prior to the patient leaving the office setting is important that they understand when to call if there are complications and the importance of following up afterwards.
A sputum culture would also be a possibility since she is coughing up copious amounts of foul smelling green sputum so we can be assured the antibiotic prescribed will be effective. Treating the cause of this infection will aid in preventing lung scaring and prevent continued damage to the lungs from recurrent infections. Education on potential smoking cessation of tobacco should she smoke is appropriate. Finding out what her living conditions are can have a direct impact on her health, for instance cockroach allergens are similar to dust mites as their fecal material leaves behind fragments of their body and becomes airborne (American Lung Association, 2016). These allergens can trigger asthma, which is especially seen in preschool children. Although Tammy is an adult we did not get a history of her health in this scenario. So the goal would be to do the investigative work and discover if there are any pre-existing conditions. Setting health related goals for this patient with her input would be of benefit to help her reach her maximum health status and possibly eliminate any potential hazards in the future.
Reference:
American Lung Association.(2016). Cockroaches. Retrieved from http://www.lung.org/our-initiatives/healthy-air/indoor/indoor-air-pollutants/cockroaches.html?referrer=https://www.google.com/