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Lungs
Right side has 3 lobes Left side 2 lobes Contains the lower respiratory structures
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Anatomy of bronchi
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44
ACUTE BRONCHITIS
The bronchial tubes swell and produce mucus, which causes a person to cough. 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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Epidemiology:
Cough is the most frequent reason patients seek care outside of a general medical examination. In the UK, acute bronchitis affects 44 out of every 1000 adults over the age of 16 years, with most episodes (82%) occurring in autumn or winter. while in the US it has been estimated that almost 5% of the general population develops acute bronchitis each year
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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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CLINICAL PRESENTATION
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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.
The most important etiologic factor in the development of chronic bronchitis is cigarette smoking.
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Etiology:
CHRONIC BRONCHITIS
PATHOPHYSIOLOGY : Chronic inflammation Hypertrophy & hyperplasia of bronchial glands that secrete mucus Increase number of goblet cells Bronchospasm often occurs End result
Hypoxemia RBCs)
Polycythemia (increase
In early stages
Productive cough
Bronchospasm
rest
Polycythemia Cyanosis
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Goals of Treatment:
Chronic Bronchitis
Improved ventilation Remove secretions Prevent complications Slow progression of signs & symptoms
Decrease vital capacity Prolonged expiratory flow Spirometry peak flow meter Arterial blood gas (ABG) x-ray
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1515
TREATMENT
drugs
Oral
dose 0.25-0.5 .5 .5-75 dose .5
dose schedule(dose/dail y)
schedule(dose/dai ly 1 1616 4
BRONCHIOLITIS
Its an acute viral infection of lower respiratory tract infection affecting nearly 50% of children during 1st 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.
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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.
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SYMPTOMS
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1919
NON-PULMONARY COMPLICATIONS
myositis (rare, > in children, > with type B) cardiac complications liver and CNS
Reye syndrome
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2020
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Although four antiviral agents are commercially available, for treatment of influenza disease in infants and children oseltamivir (Tamiflu), zanamivir (Relenza), amantidine and rimantidine. Oseltamivir is given for the treatment and prophylaxis of influenza for those aged 1 year and older. Zanamivir is labeled for use in ages 7 years for treatment and for ages 5 years for prophylaxis.
Pharmacotherapy of influenza
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PNEUMONIA
DEFINITION : An inflammation of the lung caused by bacteria, viruses, or mycoplasms. Radiographs reveal patchy alveolar infiltrates, or pulmonary densities The alveolar air spaces are filled with fluid or cells If the infection is bacterial, treatment includes antiobiotics
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Community-acquired pneumonia
Epidemiology
Community-acquired pneumonia (CAP) is a serious illness. It is the fourth most common cause of death in the UK, and sixth in the USA. 85% of cases of CAP are caused by the typical bacterial pathogens, namely, Streptococcus pneumoniae,Haemophilus influenzae, and Moraxella catarrhalis.
The remaining 15% are caused by atypical pathogens, namely Mycoplasma pneumoniae, Chlamydia 4/25/12 pneumoniae, andLegionella species.
Clinical features
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Fever or hypothermia Cough with or without sputum, hemoptysis Pleuritic chest pain Myalgia, malaise, fatigue GI symptoms Dyspnea Rales, rhonchi, wheezing Bronchial breath sounds
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Hospital-acquired pneumonia
Hospital-acquired pneumonia, also called nosocomial pneumonia, is a lung infection acquired after hospitalization for another illness or procedure. Hospitalized patients have a variety of risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying cardiac and pulmonary diseases, achlorhydria and immune disorders. These pathogens include resistant aerobic gram-negative rods, such as Pseudomonas , Enterobacter and Serratia, resistant g
Antibiotics used for hospital-acquired pneumonia include aminoglycosides, fluoroquinolones, carbapenems, and 4/25/12 vancomycin.ram positive cocci, such as MRSA.
Pathogenesis
Inhalation, aspiration and hematogenous spread are the 3 main mechanisms by which bacteria reaches the lungs Primary inhalation: when organisms bypass normal respiratory defense mechanisms or when the Pt inhales aerobic GN organisms that colonize the upper respiratory tract or respiratory support equipment.
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Aspiration Pneumonia
This type of pneumonia can occur if you inhale food, drink, vomit, or saliva from your mouth into your lungs. This may happen if something disturbs your normal gag reflex, such as a brain injury, swallowing problem, or excessive use of alcohol or drugs. Aspiration pneumonia can cause pus to form in a cavity in the lung. When this happens, it's called a lung abscess (ABses)
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Atypical Pneumonia
Several types of bacteriaLegionella pneumophila , mycoplasma pneumonia, and Chlamydophila pneumoniaecause atypical pneumonia, a type of CAP. Atypical pneumonia is passed from person to person
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Legionella pneumophila This type of pneumonia sometimes is called Legionnaire's disease. Mycoplasma pneumonia : This is a common type of pneumonia that usually affects people younger than 40 years old. It may be associated with a skin rash and hemolysis (the breakdown of red blood cells).
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A lobar pneumonia is an infection that involves, and is limited to, a single lobe of a lung (generally due to Streptococcus pneumoniae). In contrast, multilobar pneumonia involves more than one lobe. Ventilator-associated pneumonia can be considered a subset of hospital-acquired pneumonia; and in hospitalized or recently discharged patients . Pneumococcal pneumonia is due to S. pneumoniae (around half of all pneumonias). Finally, atypical pneumonia is due to either Mycoplasma, Chlamydia,or Legionella.
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Lobar Pneumonia
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may enter the respiratory tract through inspiration or aspiration of oral secretions; staphylococcus and Gram-negative bacilli may reach the lungs through circulation in the bloodstream. (cough reflex, mucocilliary transport, and pulmonary macrophages) usually protect against infection.
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pathogenesis
The
invading organism multiplies and releases damaging toxins, causing inflammation and edema of the lung parenchyma; results in accumulation of cellular debris and exudates. tissue fills with exudates and fluid, viral pneumonia, the ciliated epithelial cells become damaged.
this
Lung In
of symptoms depends on the extent of pneumonia present (e.g., partial lobe, full lobe [lobar pneumonia], or diffuse [broncho pneumonia]). 4/25/12
Severity
Streptococcus pneumonia
Most common cause of CAP Gram positive diplococci Typical symptoms (e.g. malaise, shaking chills, fever, rusty sputum, pleuritic hest pain, cough) Lobar infiltrate on CXR Suppressed host 25% bacteremic
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Viral Pneumonia
Influenza most important viral cause in adults, especially during winter months Post-influenza pneumonia (secondary bacterial infection)
S. pneumo, Staph aureus
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Treatment
Outpatient: doxycycline, newer macrolide or fluoroquinolone Hospitalized: evidence indicates that early administration (within 8 hrs of presentation) leads to lower mortality rate and hospital stay, therapy should be initiated with 2-3rd generation cephalosporin or PCN plus betalactamase inhibitor, with a macrolide.
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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. 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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OSELTAMIVIR PHOSPHATE
Class: Anti-infective/Antiviral Action Inhibition of influenza virus neuraminidase with possible alteration of virus particle aggregation and release. Indications : Treatment of uncomplicated acute illness caused by influenza infection in patients > 1 yr who have been symptomatic for 2 days; prophylaxis of influenza in patients 13 yr. Prophylaxis
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Diphenhydramine
Trade name: Benadryl One of the oldest anti-histamines Action: Antagonizes the effects of histamine at the H1 receptor sites. Adverse Effects: Significant CNS depressant: drowsiness, dizziness, hypotension, dry mouth.
Peak:
Duration:
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TRIMETHOPRIMSULFAMETHOXAZOLE(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.
Azithromycin
Action : Interferes with microbial protein synthesis. Zithromax Tablets: 250 mg (as dihydrate) Tablets: 500 mg (as dihydrate) Class: Antibiotic, Macrolide Indications ADULTS: Treatment of infections of the respiratory tract, chronic obstructive pulmonary disease (COPD), community-acquired pneumonia, CHILDREN: community-acquired pneumonia Bacterial Infections Adults: PO 500 mg as single dose on first day, then 250 mg/day on days 2 through 5.
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References
edition; Page.no.1945-50.
Bestpractice.bmj.com/bestpractice/monograph/135/.../epidemiology.html
Hueston WJ (March 1997). "Antibiotics: neither cost effective nor 'cough' effective". The Journal of Family Practice 44 (3): 2615. 4545