BRONCHITIS

DEFINITION
Acute inflammation of the mucous membranes of the trachea and bronchi (duration < 4 weeks).

ETIOLOGY
1. 2.

Common respiratory tract viruses (80%) Bacteria (in about 20% of cases):
Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae Chlamydia Pertussis

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A fungal infection (eg, Aspergillus tracheobronchitis) Smoking Air pollution Allergy to something in the air such as pollen Lung disease such as asthma or emphysema

PATHOPHYSIOLOGY
Due to etiological factors Viruses penetrate terminal bronchiolar cells--directly damaging and inflaming

Pathologic changes begin 18-24 hours after infection

Bronchiolar cell necrosis, ciliary disruption,

Edema, excessive mucus, sloughed epithelium lead to airway obstruction and atelectasis Signs and symptoms

CLINICAL MANIFESTATIONS
1) 2) 3) 4) 5) 6) 7) 8)

9)

Initially, the patient has a dry, irritating cough and expectorates a scanty amount of mucoid sputum. Nasal congestion, Dyspnea on exertion Dyspnea at rest Hypoxemia & hypercapnea Polycythemia Cyanosis Bluish-red skin color Pulmonary hypertension Cor pulmonale Low-grade fever

9) 10)

11) 12)

Headache and general malaise. As the infection progresses, the patient may be short of breath, have noisy inspiration and expiration (inspiratory stridor and expiratory wheeze) Purulent (pus-filled) sputum With severe trachea-bronchitis, blood-streaked secretions may be expectorated as a result of the irritation of the mucosa of the airways.

DIAGNOSIS
1. 2.

Clinical diagnosis based on history and physical exam Supported by CXR: hyperinflation, flattened diaphragms, air bronchograms, peribronchial cuffing, patchy infiltrates, atelectasis.

MANAGEMENT
a.

b.

In most cases, treatment of trachea-bronchitis is largely symptomatic. Bronchodilators

Beta-adrenergic agonist: Proventil Methylxanthines: Theophylline Anticholinergics: Atrovent

c. d. e. f.

Mucolytics: Mucomyst Expectorants: Guaifenisin The patient is advised to rest. Increasing the vapor pressure (moisture content) in the air will reduce irritation.

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h. i.

j.

Cool vapor therapy or steam inhalations may help relieve laryngeal and tracheal irritation. Moist heat to the chest may relieve the soreness and pain. Mild analgesics or antipyretics may be indicated(e.g. diclovin). Fluid intake is increased to thin the viscous and tenacious secretions.

g.

Copious, purulent secretions that cannot be cleared by coughing place the patient at risk for increasing airway obstruction and the development of a more severe lower respiratory tract infection, such as pneumonia. Suctioning and bronchoscopy may be needed to remove secretions. Rarely, endotracheal intubation may be required in cases of acute tracheobronchitis leading to acute respiratory failure.

g.

NURSING MANAGEMENT
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A primary nursing function is to encourage bronchial hygiene, such as increasing fluid intake and directed coughing to remove secretions. The nurse should encourage and assist the patient to sit up frequently to cough effectively and to prevent retention of mucopurulent sputum. If the patient is treated with antibiotics for an underlying infection, it is important to emphasize the need to complete the full course of antibiotics prescribed.

Nursing Diagnoses
1.

Ineffective airway clearance r/t bronchospasm, ineffective cough, excessive mucus. Anxiety r/t difficulty breathing, fear of suffocation. Ineffective therapeutic regimen management r/t lack of information about asthma.

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