Medicine-1

Prepared by Dr.Salman khan

Lecturer at DPT department Abasyn
university Peshawar
 Topic to be covered
• Acute and chronic bronchitis
• Sign symptoms
• Diagnosis
• Treatment
• Bronchiectasis
• Cystic fibrosis
 Acute and chronic bronchitis
• Bronchitis is an inflammation of the lining of
your bronchial tubes, which carry air to and
from your lungs. People who have bronchitis
often cough up thickened mucus, which can
be discolored.
• Bronchitis may be either acute or chronic.
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• Often developing from a cold or other
respiratory infection, acute bronchitis is very
common. Chronic bronchitis, a more serious
condition, is a constant irritation or
inflammation of the lining of the bronchial
tubes, often due to smoking.
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• Acute bronchitis, also called a chest cold,
usually improves within a week to 10 days
without lasting effects, although the cough
may linger for weeks.
• However, if you have repeated bouts of
bronchitis, you may have chronic bronchitis,
which requires medical attention. Chronic
bronchitis is one of the conditions included in
chronic obstructive pulmonary disease (COPD).
 Symptoms
• For either acute bronchitis or chronic bronchitis, signs
and symptoms may include:
• Cough
• Production of mucus (sputum), which can be clear,
white, yellowish-gray or green in color — rarely, it may
be streaked with blood
• Fatigue
• Shortness of breath
• Slight fever and chills
• Chest discomfort
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• If you have acute bronchitis, you might have cold
symptoms, such as a mild headache or body aches. While
these symptoms usually improve in about a week, you
may have a nagging cough that lingers for several weeks.
• Chronic bronchitis is defined as a productive cough that
lasts at least three months, with recurring bouts occurring
for at least two consecutive years.
• If you have chronic bronchitis, you're likely to have periods
when your cough or other symptoms worsen. At those
times, you may have an acute infection on top of chronic
bronchitis.
 When to see a doctor
• See your doctor if your cough:
• Lasts more than three weeks
• Prevents you from sleeping
• Is accompanied by fever higher than 100.4 F (38
C)
• Produces discolored mucus
• Produces blood
• Is associated with wheezing or shortness of
breath
 Causes
• Acute bronchitis is usually caused by viruses,
typically the same viruses that cause colds and
flu (influenza). Antibiotics don't kill viruses, so
this type of medication isn't useful in most
cases of bronchitis.
• The most common cause of chronic bronchitis
is cigarette smoking. Air pollution and dust or
toxic gases in the environment or workplace
also can contribute to the condition.
 Risk factors
• Factors that increase your risk of bronchitis
include:
• Cigarette smoke.
• Low resistance.
• Exposure to irritants on the job.
• Gastric reflux.
 Complications
• 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
(COPD).
 Diagnosis
• Tests:
• Chest X-ray. A chest X-ray can help determine if you have
pneumonia or another condition that may explain your cough.
This is especially important if you ever were or currently are a
smoker.
• Sputum tests. Sputum is the mucus that you cough up from your
lungs. It can be tested to see if you have illnesses that could be
helped by antibiotics. Sputum can also be tested for signs of
allergies.
• Pulmonary function test. During a pulmonary function test, you
blow into a device called a spirometer, which measures how
much air your lungs can hold and how quickly you can get air out
of your lungs. This test checks for signs of asthma or emphysema.
 Treatment
• Most cases of acute bronchitis get better
without treatment, usually within a couple of
weeks.
• Medications
• Because most cases of bronchitis are caused
by viral infections, antibiotics aren't effective.
However, if your doctor suspects that you
have a bacterial infection, he or she may
prescribe an antibiotic.
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• In some circumstances, your doctor may
recommend other medications, including:
• Cough medicine. If your cough keeps you from
sleeping, you might try cough suppressants at
bedtime.
• Other medications. If you have allergies, asthma or
chronic obstructive pulmonary disease (COPD), your
doctor may recommend an inhaler and other
medications to reduce inflammation and open
narrowed passages in your lungs.
 Therapies
• If you have chronic bronchitis, you may benefit
from pulmonary rehabilitation — a breathing
exercise program in which a respiratory
therapist teaches you how to breathe more
easily and increase your ability to exercise.
• Life style changes
 Bronchiectasis
• Bronchiectasis is when the walls of your
bronchi, the tubes that carry air into and out of
your lungs, become thickened and damaged.
• This makes it harder to breathe. You could have
flare-ups of severe breathing problems (your
doctor may call them exacerbations) from time
to time.
• Bronchiectasis is a long-term (or chronic)
disease that gets worse over time. There’s no
cure, but you can live with it for a long time.
 Bronchiectasis Symptoms
• Coughing and shortness of breath are common symptoms
of bronchiectasis. Others include:
• Coughing up phlegm or blood
• Chills or night sweats
• Fatigue
• Weight loss
• Chest pain
• Thicker skin under your fingernails and toenails (clubbing)
• Wheezing or a whistling sound when you breathe
• Frequent respiratory infections
 Bronchiectasis Causes
• Your bronchial walls can slowly get thicker because
of inflammation and infections. Both of these
things keep mucus from draining the way it should.
That extra mucus can trap bacteria, causing more
infections, scarring, and thickening. Over time, your
lungs have to work harder to breathe.
• Acid reflux into your lungs, like with
gastroesophageal reflux disease (GERD), may also
damage them.
 Bronchiectasis Risk Factors
• Younger people don’t usually get
bronchiectasis. Fewer than 1 in 20,000 people
ages 18 to 34 have it. But that number goes up
to about 1 in every 350 people who are 75 or
older.
• Two-thirds of bronchiectasis cases are in
women. But it’s more common in young boys
than in girls.
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• You’re more likely to get it if you have:
• Lung infections that are severe or keep coming back,
like pneumonia, tuberculosis, or whooping cough
(pertussis)
• Allergic bronchopulmonary aspergillosis, a type of lung
inflammation caused by a fungus
• Alpha-1-antitrypsin deficiency, which raises your risk of
lung and liver diseases
• Cystic fibrosis, a disease that’s tied to your genes and
damages your lungs, digestive system, and other organs
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• Conditions that affect the cilia, small hair-like growths that clear mucus
out of your bronchi
• Immunodeficiency diseases such as HIV or AIDS
• Inflammatory bowel diseases, like Crohn’s disease and ulcerative colitis
• Low levels of proteins that fight infections in your blood (humoral
immunodeficiency)
• Rheumatic diseases, like rheumatoid arthritis and Sjogren’s syndrome
• Chronic pulmonary aspiration, when you accidentally inhale things like
food or liquids
• Breathing in things that damage your airways like gases, smoke, or coal
dust
 Bronchiectasis Diagnosis
• See your doctor if you have symptoms of bronchiectasis,
especially if you’ve had them for a while. They’ll probably order
tests including:
• A chest X-ray and CT scan to make images of your lungs
• Blood tests to check for infections
• Pulmonary function tests to measure how well you’re breathing
• Tests of material that you cough up from your lungs, called
sputum, which may have bacteria in it
• A sweat test to look for cystic fibrosis
• Bronchoscopy, in which your doctor uses a thin, flexible tube
called a bronchoscope to look inside your airways
 Bronchiectasis Treatment
• Because bronchiectasis gets worse over time, it’s important to
catch and treat it early. That will prevent infections, slow damage,
and make your symptoms easier to manage.
• Depending on your case, treatment for bronchiectasis can include:
• Medications. You’ll probably get antibiotics to fight infections.
One type, called macrolides (examples are azithromycin and
clarithromycin), eases inflammation. Inhaled corticosteroids can
also treat inflammation in your airways. Your doctor may
prescribe medicine to thin mucus or help you cough it up (called
expectorants). They might also give you an inhaler or a machine
called a nebulizer to breathe in bronchodilators, drugs that open
your airways.
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• Vaccines. Your doctor will probably suggest that you get flu
and pneumonia vaccinations to keep certain infections
avoid.
• Oxygen therapy and chest physical therapy. They may also
suggest oxygen therapy or methods and devices to shake
mucus free. These treatments are known as chest physical
therapy (CPT), chest clapping, or percussion. They can
include physically pounding on your chest to clear your
bronchi and lungs, or wearing an inflatable vest that uses air
waves to force mucus up.
• Surgery. In severe cases, you might need to have surgery or
a lung transplant.
 Bronchiectasis Prevention
• Some steps help prevent the infections and tissue
damage that can lead to bronchiectasis.
• Get treatment for any lung infection as soon as possible.
• Make sure children get recommended vaccinations for
illnesses like whooping cough and measles.
• Keep an eye on small children to keep them from
putting things in their mouth. Get help right away if
someone’s airways are blocked.
• Avoid things that can damage your lungs, like smoke
and chemicals.
 Cystic fibrosis
• Cystic fibrosis (CF) is an inherited disorder that
causes severe damage to the lungs, digestive
system and other organs in the body.
• Cystic fibrosis affects the cells that produce
mucus, sweat and digestive juices. These secreted
fluids are normally thin and slippery. But in people
with CF, a defective gene causes the secretions to
become sticky and thick. Instead of acting as
lubricants, the secretions plug up tubes, ducts and
passageways, especially in the lungs and pancreas.
 Sign and symptoms
• Cystic fibrosis signs and symptoms vary, depending on the
severity of the disease. Even in the same person, symptoms
may worsen or improve as time passes. Some people may
not experience symptoms until their teenage years or
adulthood. People who are not diagnosed until adulthood
usually have milder disease and are more likely to have
atypical symptoms, such as recurring bouts of an inflamed
pancreas (pancreatitis), infertility and recurring pneumonia.
• People with cystic fibrosis have a higher than normal level
of salt in their sweat. Parents often can taste the salt when
they kiss their children. Most of the other signs and
symptoms of CF affect the respiratory system and digestive
system.
 Respiratory signs and symptoms
• The thick and sticky mucus associated with cystic
fibrosis clogs the tubes that carry air in and out of your
lungs. This can cause signs and symptoms such as:
• A persistent cough that produces thick mucus
(sputum)
• Wheezing
• Exercise intolerance
• Repeated lung infections
• Inflamed nasal passages or a stuffy nose
• Recurrent sinusitis
 Digestive signs and symptoms
• The thick mucus can also block tubes that carry digestive
enzymes from your pancreas to your small intestine. Without
these digestive enzymes, your intestines aren't able to
completely absorb the nutrients in the food you eat. The
result is often:
• Foul-smelling, greasy stools
• Poor weight gain and growth
• Intestinal blockage, particularly in newborns (meconium ileus)
• Chronic or severe constipation, which may include frequent
straining while trying to pass stool, eventually causing part of
the rectum to protrude outside the anus (rectal prolapse)
 Causes
• In cystic fibrosis, a defect (mutation) in a gene
— the cystic fibrosis transmembrane
conductance regulator (CFTR) gene — changes
a protein that regulates the movement of salt
in and out of cells. The result is thick, sticky
mucus in the respiratory, digestive and
reproductive systems, as well as increased salt
in sweat.
 Risk factors
• Because cystic fibrosis is an inherited disorder,
it runs in families, so family history is a risk
factor.
 Diagnosis

• Newborn screening and diagnosis

• In one screening test, a blood sample is
checked for higher than normal levels of a
chemical called immunoreactive trypsinogen
(IRT), which is released by the pancreas. A
newborn's IRT levels may be high because of
premature birth or a stressful delivery. For
that reason, other tests may be needed to
confirm a diagnosis of cystic fibrosis.
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• To evaluate if an infant has cystic fibrosis, doctors may
also conduct a sweat test once the infant is at least 2
weeks old. A sweat-producing chemical is applied to a
small area of skin. Then the sweat is collected to test it
and see if it's saltier than normal. Testing done at a care
center accredited by the Cystic Fibrosis Foundation helps
ensure reliable results.
• Doctors may also recommend genetic tests for specific
defects on the gene responsible for cystic fibrosis.
Genetic tests may be used in addition to checking
the IRT levels to confirm the diagnosis.
 Testing of older children and adults
• Cystic fibrosis tests may be recommended for
older children and adults who weren't
screened at birth. Your doctor may suggest
genetic and sweat tests for CF if you have
recurring bouts of an inflamed pancreas, nasal
polyps, chronic sinus or lung infections,
bronchiectasis, or male infertility.
 Treatment
• There is no cure for cystic fibrosis, but treatment
can ease symptoms, reduce complications and
improve quality of life. Close monitoring and early,
aggressive intervention is recommended to slow
the progression of CF, which can lead to a longer
life.
• Managing cystic fibrosis is complex, so consider
getting treatment at a center with a multispecialty
team of doctors and medical professionals trained
in CF to evaluate and treat your condition.
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• The goals of treatment include:
• Preventing and controlling infections that
occur in the lungs
• Removing and loosening mucus from the
lungs
• Treating and preventing intestinal blockage
• Providing adequate nutrition
 Medications
• Options include:
• Medications that target gene mutations,
including a new medication that combines
three drugs to treat the most common genetic
mutation causing CF and is considered a major
achievement in treatment
• Antibiotics to treat and prevent lung infections
• Anti-inflammatory medications to lessen
swelling in the airways in your lungs
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• Mucus-thinning drugs, such as hypertonic saline, to help you
cough up the mucus, which can improve lung function
• Inhaled medications called bronchodilators that can help
keep your airways open by relaxing the muscles around your
bronchial tubes
• Oral pancreatic enzymes to help your digestive tract absorb
nutrients
• Stool softeners to prevent constipation or bowel obstruction
• Acid-reducing medications to help pancreatic enzymes work
better
• Specific drugs for diabetes or liver disease, when appropriate
 Medications that target genes
• For those with cystic fibrosis who have certain
gene mutations, doctors may recommend
cystic fibrosis transmembrane conductance
regulator (CTFR) modulators. These newer
medications help improve the function of the
faulty CFTR protein. They may improve lung
function and weight, and reduce the amount
of salt in sweat.
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• The FDA has approved these medications for treating CF in
people with one or more mutations in the CFTR gene:
• The newest combination medication containing elexacaftor,
ivacaftor and tezacaftor (Trikafta) is approved for people age 12
years and older and considered a breakthrough by many experts.
• The combination medication containing tezacaftor and ivacaftor
(Symdeko) is approved for people age 6 years and older.
• The combination medication containing lumacaftor and ivacaftor
(Orkambi) is approved for people who are age 2 years and older.
• Ivacaftor (Kalydeco) has been approved for people who are 6
months and older