What is Chronic Bronchitis, Chronic Bronchitis and Emphysema Treatment

What is Chronic Bronchitis, Chronic Bronchitis and Emphysema Treatment

Of chronic bronchitis in the airway inflammation, cell infiltration in-nu, edema, and air flow obstruction can cause difficulty. The main symptoms of the disease cough and sputum. For the diagnosis of chronic bronchitis, cough and sputum for at least three months of the year and to be present in most of the days of this period and should continue for at least two consecutive years. Chronic bronchitis is an important disease, causing loss of business is located at the top of the diseases, the incidence of about 5%.

Anatomical abnormalities in the lungs emphysema develops, the distal air spaces of the terminal bronchioles and alveolar walls of the destruction of abnormal expansion occurs.

Etiology

Non, infection, air pollution, occupation and age with chronic bronchitis and the major factors in the etiology of amp-GROUND.

Smoking takes place at the forefront of the etiology of chronic bronchitis and emphysema. 15-20 times higher in smokers with chronic bronchitis. When we stop smoking, the incidence of chronic bronchitis and reduced mortality.
Serious childhood infections such as infection, especially measles, whooping cough, pneumonia, viral infections, tuberculosis and upper respiratory tract infections (dental infections, gingivitis, sinusitis), chronic bronchitis etloyoj has a lot of important business.

Air pollution and occupational

Chronic bronchitis than those living in urban areas being a major cause of air pollution. Workers in mines, organic and inorganic dust inhaled in those professions need to increase the incidence of chronic bronchitis.

Climate changes, especially the more moist (fog), and cold weather cough, phlegm, wheezing and dyspnea increase and leads to exacerbation of chronic bronchitis. Those with advanced disease can not go out of their homes in such weather.

Pathology, Pulmonary emphysema Emphysema

Chronic bronchitis is a dark sticky mucus and bronchial gap narrows. Mucus, purulent infection cases is complicated. Ödemlidir mucous. Hiperlazi epithelium and bronchial glands, and hypertrophy occurs. Therefore, bronchial wall, bronchial cloth between the rate increases. This ratio (Reid index) is normally of 0.25 is. Chronic bronchitis 0.36 from the high.

Emphysema irreversible anatomic changes are observed. Abnormal enlargement of the distal air spaces of non-contribution to breathing, there is alveolar destruction. Anatomically there is a homogenous disorder. The main types and panlobülerdir centrilobular emphysema. Centrilobular emphysema and respiratory expansion of air spaces around the capillaries and their destruction in the region has bronchiols. Panlobüler emphysema and enlarged air spaces, and the bronchioles, devastated in the middle of lobules collected. Especially with these two species found in later stages of the disease. Bullous, focal, alveolar-duct, congenital and unilateral (Swyer-James or Macleod syndrome) than emphysema, a rare species.

Clinical Symptoms, Symptoms of Chronic Bronchitis, Emphysema Disease

The main symptoms of chronic bronchitis cough, sputum, and dyspnea. Too many times non-specific cough and sputum is increasingly evident, and patients say dönemediklerini original state. Previously, some times of the day and the patient is monitored at other times of the day coughing wakes up from sleep. Exploring the upper respiratory tract infections, chronic bronchitis in the winter almost everyone is a significant problem for ill. Climate changes, especially the more moist (fog), and cold weather will cause an increase in symptoms of the disease. Chronic bronchitis, hemoptysis is one of the diseases. Approximately 15% of these patients, he-moptizi monitored. Hemoptysis is generally down, with blood staining in the form of mucus. Weaker in later stages of chronic bronchitis patients, the main causes of hypoxemia, infection, dysfunction and other complications likasyonlardır diaphragm. In some patients, the drum Comag deformation (clubbing) husule income.

Emphysema usually begins insidiously, sezilmez symptoms of the disease for many years. The disease has so many times in conjunction with chronic bronchitis and asthma. Dyspnea, cough, sputum, and wheezing in chronic obstructive pulmonary disease is a major respiratory symptoms. The main problem with pure emphysema dyspnea. Usually begins after 50 year of life and gradually progresses. There is a close relationship between the degree of dyspnoea and severity of emphysema. Dyspnea on exertion ago, and later came to permeate simple daily movements. Dyspnea at rest and the patient gradually progresses, havasızlıkdan laments. Shortness of breath, cold, damp weather more pronounced.

Decreased strength of respiratory infections in patients with chronic bronchitis and emphysema.
In some cases of emphysema or chronic bronchitis is not certain. Ventilation in patients with this by making a great effort try to keep arterial blood gases at normal levels. Colors of pink than normal because of normal or polycythemia. These patients, "Pink breathing or emphysema-type (A type) is called. Another type of emphysema, chronic bronchitis is in the foreground "Blue breathing or bronchitis-type (type B)" is called emphysema. Changes of pneumonia in these patients, physiologic abnormalities of movement, right-left shunt, hypoxemia (syanoz - a blue appearance), pulmonary hypertension and cor pulmonale, a type of emphysema is monitored more frequently.

Patients with advanced stages of emphysema, fatigue, malaise, anorexia and weight loss complain. These symptoms are less nutrition, movement difficulties, insidious infections and related hipoksemiyle.

Physics Results

The most important finding in patients with chronic bronchitis, especially the expiration ronflan Railer sibilan and be heard. This is more çokdur Railer lung bases. Auscultation is monitored in some patients decreased breath sounds. Advanced stages of chronic bronchitis and emphysema komplikasyonuyla findings related symptoms develop. In these cases, a well-formite toraksda barrel-shaped, kyphosis (increased thoracic anterior-posterior diameter) and a horizontal rib husule income status. Generally, decreased thoracic movement. Supporting the contribution of the respiratory muscles, breathing is evident. Case that the diaphragm down to the edge of the liver, ribs pushed down a few fingers. Breath sounds may be reduced in patients with bronchitis, but the most important finding to be heard ronflan and sibilan Railer.

Patients with advanced stages of chronic bronchitis weakened. This zayıflamada hypoxemia, infections, and other complications, is the influence of diaphragm dysfunction. In some cases, deformity Comag drum toes (clubbing) husule income. However, such a deformity, primarily cancer or bronchiectasis should consider.

Physical findings are more typical of advanced emphysema. Expands chest anterior-posterior diameter of the barrel takes the shape of the thorax vertebralarında a kyphotic deformity occurs. Respiratory motion is more pronounced in the upper toraksda. Lower ribs are a paradoxical movement (side ribs genişleyeceğine inspiration is drawn inward). This retreat in more air (hyperinflation) have been pushed down and flattened due to contraction of the diaphragm is about inspiration. Patient use of accessory respiratory muscles. Characterized by very fit patients with advanced emphysema: the patient sits upright and shoulders leaning forward, so that the expiratory abdominal muscles Fribord to facilitate the works. Prolonged period of expiratory respiration. The patient's mouth expiratory büzerek make your lips like a whistle öttürür, keeping the air outlet of a higher level of intrathoracic pressure, which works önlemeğe expiratory difficulty. The patient has a particular difficulty in breathing. Sternocleidomastoid, pectoral, intercostal and abdominal muscle contraction is seen clearly. Elasticity decreased, if inspiration had solidified chest (locked) are.

Less enlarged on palpation of the thorax, decreased vibration is monitored. Vurumunun palpation is difficult or can not be palpated heart apex. Hipersonorite or tympanic sound is percussion, and movement of the diaphragm decreased below the normal level. Matitesi decreased liver and heart. Auscultation prolonged expiratory time. Have the right heart hypertrophy in patients with heart failure, hepatomegaly, peripheral edema are.

Radiological Findings

Chronic bronchitis is useful if there is another disease than chest radiography. 40'nda% of cases are normal. Major abnormalities of tubular lines of the shadows and an increase in lung vascular deficiencies. With contrast material filling of the bronchial glands enlarged Bronkogra-seedling of a diverticulum view "bronchial divertikülosis" and more recent-landığı bronchus mucus congestion, can be seen to be amputated. Bronchi is similar to an enlarged cylindrical bronchiectasis.

Radiological abnormalities of emphysema mainly consists of 4 groups:

1 - Hyperinflation (swelling of the lungs with more air) Radiography in a black look more cool, diaphragmatic dome yassılaşması, costophrenic sinuses and ribs to be less significant increase in range is monitored. La-lateral radiograph the retrosternal, retrokardiak increased air space, vertebralannda sternum and thoracic kyphosis is pushed forward.

2 - Cardiovascular abnormalities in lung vascular shadows in the periphery is reduced, is lost (oligemi). In some regions apparent in the shadows of blood vessels occurs. Vascular abnormalities of the lower lobes are seen more. Hilar arteries expand more developed pulmonary hypertension.

3 - The increase in lung bronchial and vascular abnormalities related to the lines of, "an increase in bronchovascular lines" is defined as. Usually associated with chronic bronchitis.

4 - The blistering is more common in cases of emphysema. Air-filled cystic cavities in the local blistering. Capillary walls are thin. Tomography easier to identify with an entire hemithorax sm'den edilir.Büllerin 1-2 diameters can be large enough to cover. Single or multiple.

Laboratory Findings

Köpüklüdür in the early stages of chronic bronchitis and mucoid sputum, is an acute purulent exacerbations. Chronic bronchitis the last period of continuous mucopurulent sputum quality wins. The most common inflammatory cells in sputum polymorphonuclear leucocytes core. Sputum culture and drug sensitivity often (antibiotic) should be examined and appropriate antibiotic therapy. Urea-yen several times in culture the bacteria streptococcus and haemophilus inflüenza'dır pnömonia. When a complication of acute infection in the blood leukocytes increases. Cases, reversible narrowing of the bronchial eosinophilia (wheezing-asthma) are available. These patients benefit from bronchodilator therapy. Increase in hematocrit is indicated for chronic hypoxemia.

If you have emphysema complication of infection consists of mild leukocytosis. Neutrophils increase. Hypoxemia in cases with hematocrit rises. Some patients with emphysema and chronic obstructive lung alpha 1 - antitrypsin material is missing.
Periods of severe emphysema (eg cor pulmonale) consists of abnormalities in ECG P wave and QRS complexes.

Lung Functions

Chronic pulmonary function tests of the first period bronşit'in tracked specific abnormality. The disease progresses, forced vital capacity 1 seconds (ZVK1) drops below 75%, forced expiratory flow-volume curves of reduced flows and increased residual volume. In more serious cases, diffusion capacity, arterial blood pressure of 02 (Pa. 02) is reduced and the C02 pressure (Pa C02) increases.

Emphysema diagnosis and determining the degree of lung function tests-ing (AFT) has an important place. ECG due to coronary disease is important, so important to AFT emphysema. Emphysema and total lung capacity (TAC) has increased and this increase in residual volume usually (RV) related to the increase. Thus, RV / TAC ratio increases. The early stages of the disease is vital capacity (VC) is normal, BMI decreases with increasing process in emphysema.

Forced vital capacity evaluation of obstructive emphysema abnormality 1 Seconds and the flow-volume curves of the most widely used tests in practice. Disease ciddileştikçe diffusion capacity is reduced, and arterial blood gas analysis before the decrease of P02 (hypoxemia), pC02 of further increases in the period of illness (respiratory acidosis) are observed.

Treatment and prognosis

Prevention of chronic bronchitis and emphysema, smoking cessation, will be more effective in the treatment and prognosis is important in terms of being better. Prevansiyonda, air pollution, infections and socio-economic conditions should be considered. In cases of chronic bronchitis with recurrent infection, prolonged antibiotic therapy qualifications are intermittent. For example, antibiotics are given for 5-7 days every month, especially in winter. When the antibiotic treatment of an acute infection begins when the patient returns to its original state (typically 7-10 days) treatment interrupted. Frequent yakalananlarda influenza, those with serious heart and lung disease, diabetes and elderly patients with chronic obstructive pulmonary disease once a year, before entering the winter period (end of October and in November) is a multivalent influenza vaccine protective effect. Furthermore, COPD is a serious complication of pneumonia vaccine is made ​​once a year for prevention of pneumonia.

Respiration in the history of wheezing or asthma attacks in which more patients benefit from bronchodilator therapy. 1 / forced vital capacity after bronchodilator treatment Seconds (ZVK1) and a certain improvement in tests that measure air flow in chronic obstructive pulmonary disease (COPD), asthma, confirms the contribution. This finding helps treatment program. Major beta-adrenergic agents, bronchodilators, theophylline, and anticholinergic agents. Expectorant drugs and reduces the tack of diluting out the removal of mucus easier. The best expectorants (diluent) is water, 8-10 glasses of water a day, it provides a means of. Need oxygen therapy in hypoxemic patients. Under the ideal weight of the patient or the body. The most important respiratory muscle activity of the diaphragm is reduced şişmanlarda. Rehabilitation of the patient's physical activity and increases the overall exercise, cough, sputum and reduces symptoms such as dyspnea and provides a positive effect psychologically.

Upper respiratory tract infections, vegetation, nasal septum deviation, paranasal sinusitis therapy has an important role in the control of chronic obstructive pulmonary disease. Alcohol has the effect of progression of chronic obstructive pulmonary disease, drunk.
The main factor in the prognosis of chronic obstructive pulmonary disease bronchial and lung infections. The disease is an infection or exacerbation of congestive heart failure caused by another reason, if the prognosis is poor in one direction is indicated. Weight loss is a sign of a poor prognosis. Related to insufficiency of oxygen metabolism. Fact that smoking has an important effect and prognosis of the disease.