Pharmacotherapy of Bronchitis

PST 06106

Basic Pharmacotherapy

Session 9: Pharmacotherapy of Bronchitis

12/3/2020

Pharmacotherapy of Leprosy

Learning objectives

By the end of this session, you are expected to be able to:

Define bronchitis

Explain pathophysiology of bronchitis

Explain the clinical presentation of bronchitis

Outline diagnosis of bronchitis

Describe pharmacological treatment of bronchitis

Describe the monitoring of bronchitis

therapy

Activity: Buzzing

•What

is Chronic Bronchitis??

Definition of Bronchitis

Bronchitis is an infection resulting from the inflammation of the lining of the lungs/bronchioles

It is subdivided into two types

Acute

Bronchitis

Chronic Bronchitis

Acute bronchitis

is one of the most common conditions associated with antibiotic misuse.

Respiratory viruses are by far the most common infectious agents associated with acute

bronchitis

Chronic bronchitis

It defined by a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded.

Chronic Bronchitis

It defined by a chronic productive cough for three months in each of two successive years in a patient in whom other causes of chronic cough have been excluded.

Patients may get secondary bacterial infection with development of fever and production of thick smelly sputum.

The disease is a result of several contributing factors; the most prominent include;

cigarette smoking,

exposure to occupational dusts, fumes, and environmental pollution; and

Host factors [e.g., genetic factors and bacterial (and possibly viral) infections

].

Pathophysiology of Chronic Bronchitis

Microorganisms gain access to the lower respiratory tract by three routes.

Through inhalation as aerosolized particles, or

via the bloodstream from an

extra pulmonary

site of infection;

Aspiration of oropharyngeal contents which is a common occurrence in both healthy and ill persons during sleep is the major mechanism by which pulmonary pathogens gain access to the normally sterile lower airways and alveoli.

When pulmonary defense mechanisms are functioning optimally, aspirated microorganisms are cleared from the region before infection can become established;

However, aspiration of potential pathogens from the oropharynx can result in pneumonia if lung defenses are impaired

Pathophysiology of Chronic

Bronchitis Cont..

Factors that promote aspiration, such as altered sensorium and neuromuscular disease, may result in an increase in the size of the inoculum delivered to the lower respiratory tract, thereby overwhelming local defense mechanisms.

Lung infections with viruses suppress the antibacterial activity of the lung by impairing alveolar macrophage function and mucociliary clearance, thus setting the stage for secondary bacterial pneumonia.

Mucociliary transport is also depressed by ethanol and narcotics and by obstruction of a bronchus by mucus, tumor, or extrinsic compression.

All these factors can severely impair pulmonary clearance of aspirated bacteria hence causing infection in the lung

Clinical Presentation And Diagnosis Of Chronic Bronchitis

Signs and symptoms

Excessive sputum expectoration

Cyanosis (advanced disease)

Obesity

Clinical Presentation And Diagnosis Of Chronic

Bronchitis

Cont

….

Physical examination

Chest auscultation usually reveals inspiratory and expiratory rates,

Rhonchi(Sound generated by the movement of air through the respiratory system), and mild wheezing with an expiratory phase that is frequently prolonged;

H

yper resonance

on percussion(Too much air present within the lung) with obliteration of the area of cardiac dullness(dense tissue)

Normal vesicular breathing sounds are diminished

Clubbing of digits (advanced disease)—- enlargement of the tip of the lung and change in angle, present in bronchitis but not in asthma and pneumonia

Clinical Presentation And Diagnosis Of Chronic Bronchitis

Cont

….

Chest radiograph

Increase in anteroposterior diameter of the thoracic cage (observed as a barrel chest

)—rib cage broadened as in the middle of deep breath, person find hard to breath

Depressed diaphragm with limited

mobility

Laboratory tests

Erythrocytosis

(advanced disease

)—-Too many red blood cells to carry oxygen to your organ and tissue.

Pulmonary function tests

Decreased vital capacity

Prolonged expiratory

flow (person’s maximum speed of expiration as measured with a peak flow meter)

Activity: Small Group Discussion

•

What

is the first line treatment

of

Pneumonia?

Treatment of chronic Bronchitis

The goals of therapy for chronic bronchitis are:

T

o

reduce the severity of chronic symptoms and

T

o

ameliorate acute exacerbations and achieve prolonged infection-free

intervals

Treatment of chronic

Bronchitis

Cont

…

Non-Pharmacological Treatment

Stop smoking and/or remove from hazardous environment

Prompt treatment of infective exacerbations

Antibiotics as above in case of secondary bacterial infection

Controlled oxygen therapy

Physiotherapy

Treatment of chronic

Bronchitis

Cont

……

Pharmacological Treatment

Inhaler

Salbutamol (PO) 100

μg

two puff 6 hourly

OR

Salbutamol (PO) 4mg 8 hourly

OR

Ipratropium bromide aerosol 20–80mg, 6–8 hourly

Trial of steroids if there is possibility of reversible airways obstructions

Prednisolone (PO) 20mg once daily for 5 days

Treatment of chronic Bronchitis

Cont

……

Pharmacological

Treatment..

Antibiotics

are probably helpful only in acute exacerbations of chronic bronchitis

Common current clinical practice is to promptly use antibiotics empirically in patients who demonstrate a fever or a change in sputum character.

Such therapy should be directed against streptococcal species, Haemophilus species and

Moraxella

catarrhalis

.

Treatment of chronic Bronchitis

Cont

……

Monitoring of Chronic Bronchitis Therapy

After therapy has been instituted, appropriate clinical parameters such as signs and symptoms and other laboratory markers such as lung function tests should be monitored to ensure the efficacy and safety of the therapeutic regimen.

Key Points

Pneumonia

is an infection of the lung tissue whereby the air sacs in the lungs become infected with microorganisms, fluid and inflammatory cells and hence they lungs fail to work properly.

Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest X-ray showing new shadowing that is not due to any other cause

Penicillins as well as other antibiotics can be used for treatment of Pneumonia as indicated

Evaluation

What

is Chronic Bronchitis?

What are the signs and symptoms of Chronic Bronchitis?

How is Chronic Bronchitis diagnosed?

How is the treatment of Chronic Bronchitis?

REFER Students to Handout 9.1: Pharmacotherapy of Acute Bronchitis

References

Wells

BG,

DiPiro

J,

Schwinghammer

T (2013),

Pharmacotherapy Handbook

(6

th

Ed). New York, NY: McGraw-Hill.

DiPiro

JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):

Pharmacotherapy: A Pathophysiologic Approach

(7

th

ed

): New York, NY: McGraw-Hill.

Katz M D.,

Matthias KR.,

Chisholm-Burns M A.,

Pharmacotherapy(2011)

Principles & Practice Study Guide: A Case-Based Care Plan Approach

:

New York, NY: McGraw-Hill.

Schwinghammer

TL, Koehler JM (2009)

Pharmacotherapy Casebook: A Patient-Focused Approach

(7

th

ed

): New York, NY: McGraw-Hill.

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