Chronic bronchitis treatment | Respiratory system diseases | NCLEX-RN | Khan Academy
22
August

By Adem Lewis / in , , , , /


-[Voiceover] In chronic bronchitis, the problem basically is
that we have irritants which lead to inflammation, which lead to the production of mucus, which leads to all the
problems in lung function. Actually let’s write that lung function. Things like not getting enough oxygen, not being able to breathe out. If that’s our theme then it makes sense to think of it one by one. At each of this point,
what can we do to treat it? Irritants first obviously
to remove the irritant would be the best. First with irritants of course to remove the source of irritation would always be the best and first thing that should be thought of and I’m drawing a cigarette here. No matter how much I sound
like a broken record, quitting smoking is hugely
important to chronic bronchitis because it’s the only
thing that stops the source of the disease from getting worse. Everything else here is
just treating symptoms but stopping the smoking actually stops the
progression of the disease. I really want to throw that out there as our first thing to
think about in treatment and of course other sources of irritants can lead to chronic bronchitis, right. A major source for chronic bronchitis especially in some parts
of the world is pollution and this one is very hard to treat especially for one person
and you can’t stop your city from being polluted. Aside from moving, there’s not much that can be done usually. Sometimes there is occupational exposures like things to coal or to asbestos depending on where this person works. Of course we can always promote
healthier work environments trying to protect themselves
with masks or other things but as of right now these
are still very high risk jobs for chronic bronchitis. Of course we can have allergens. The person can have some control over if you know what kind of
allergens are irritating, you can try to stop, stay away from that as much as possible. Just decreasing all of these and stop irritating the
lungs is the first step to treating chronic bronchitis. Okay, so given that this
has already happened, we’re treating the symptoms. Inflammation is the body’s
response to irritants. Then the lungs part of that response makes the muscles in the
walls of the lungs spasm and that’s how we get the cough and also the airways narrow as part of the inflammation. If we draw a cross section
of the airway here, we’re looking down the tube like this and usually in a non irritated lung the lumen here, might be about that wide. This is smooth muscle and
just different things, layers of the wall, there’s glands, there’s connective tissue. This is how along usually it looks like but when it’s being irritated, its spasms and the lumen
get so small like this, it’s hard for air to get through. All of these muscles are spasming and the walls are getting
thicker like that. In our case, there’s
going to be some mucus in the lumen’s wall clogging it up. One important way to treat this is a … Write this as a bronchodilator. We already know that
broncho first at the lungs, bronchodilator. This basically just
opens the airway back up. The bronchodilator helps
us go from this to this. Now, there are different classes of drugs that all qualify as a bronchodilator because all that means is it just opens the airway back up. One important class is a beta-2 agonist. An agonist means it
activates this receptor. Beta receptors are part of
the fight and flight response that our body has and
there are beta receptors all over the body including in our hearts and then there are our eyes. During fight and flight,
our pupils get bigger so we can see a little better. Of course since we’re
talking about this right now is also part of the lungs. The lungs, it just opens up the airway like we talked about just now. Another class is the anticholinergics. Instead of agonist, these are antagonists. That just means it goes against what the cholinergics usually do. Now, this is a completely
different pathway but it does the same thing of opening up the lumen of the airways, so we can get more breath in and the lung can be less inflamed. Another completely different
kind, different class of anti-inflammatory
drugs are the steroids and the leukotriene inhibitors. Leukotriene inhibitors. Up here the bronchodilators
really just treat the symptom of inflammations. Write that here. The symptom but down here
when we bring out the steroids and the leukotriene inhibitors, these are the big guns that actually go to the actual site of the
inflammation and stop it there. How inflammation works in our body is that there’s a
trigger, so T for trigger. It goes to a cascade one leads to another. We have A leading to B, leading to C, leading to D, dot, dot, dot. All the way, the last
step is a leukotriene. We’ve reached the end,
inflammation cascade. Inflammation has started
and then we keep going. Of course the leukotriene
inhibitor is here. Just gets right at the last step, the product of this whole cascade so it tempers down the inflammation. The steroids are earlier, say in step C. The steroids come in and stop
the cascade earlier here. Now I put a slash here
but do not confuse them for being similar to each
other or being interchanged well they’re completely different but I had them together here because they both target the
cascade of the inflammation and stops it at the route instead of just going
for the symptom of it like a bronchodilator. Okay let’s keep going
with our process here. Now for the mucus, you might imagine that since they cough so much and that must be very uncomfortable. We might give cough
suppressants to these people. You probably seen it over the counter, stops you from coughing. It’s important to remember
that for chronic bronchitis, we do not do the suppressants because that mucus is already there. We want it to come out. Again, we have our airways
here and it’s coated by, there’s too much mucus
here and we don’t want it. Let me use a blue color
because it’s kind of a liquid. Okay here’s all the mucus and we cough all day long. That’s uncomfortable, yes. Imagine if we gave them the suppressant and they no longer cough it up, this would just be full
of mucus all clogged up. This would actually be
horrible for the patient because the more clogged we are, the more we can have bacteria behind it, we’ll have pneumonia, other infections so we really don’t want that. As much as it’s uncomfortable to cough, unfortunately most of the
time for productive coughers, we need to let them keep coughing but we can go through
these other treatments to go down on the inflammation. Maybe they won’t make as much mucus to try to solve the problem that way. Lastly, we have to deal with the fact that the lungs are not
getting enough oxygen, these people are called blue bloaters because they have lower
oxygen in their blood because the airways are so narrow and there’s mucus so oxygen
doesn’t get through as well. We might think, okay,
let’s give them oxygen. Nowadays it’s easy enough
to do that in the hospital or at home oxygen but I really want to
put that in parenthesis because yes, a lot of people get this but in some patients
especially very sick patients. We have to be very careful
about giving them oxygen and here’s why, and here we
have to talk about the issue of the breathing drive. I mean you don’t have
to think about breathing all day long, right? Just because something in your brain automatically tells us to breath. This is there when you’re asleep. It’s a very powerful drive and it’s important to
remember that in most people, let’s say their O2 level
is about this high. Their carbon dioxide level
will be about this high, it’s going to be lower and that differential is there. Remember the oxygen goes in the blood during a breath and when you breathe out, the CO2 comes out. If you’re not breathing, the CO2 goes up and oxygen comes down. If you or I stop breathing, it is the fact that our CO2 would go up. That signals our body in our brain that “Uh-oh we’re not breathing” and the breathing drive kicks in. In a person without bronchitis, it is this fact that the CO2 is going up that makes us breathe,
that signals our brain, our body that okay we
need to keep breathing, once you get that gas out of there. CO2 controls the breathing drive in people who don’t have chronic bronchitis. Okay, this is healthy, H for healthy. Let’s look at people
with chronic bronchitis. What happens is that their O2
level is lower to begin with and their CO2 level is
higher than normal like that. The CO2 being high no
longer makes them breath, drive them to breath. Is the fact that this O2 is low, that controls our breathing drive. If we give them oxygen here, this can actually take
away the breathing drive like giving them too much oxygen. The body will think because it’s usually relying
on the oxygen to breath. With extra oxygen, that
drive might go away and this person going to
actually stop breathing especially when they’re
having a bad episode of chronic bronchitis. Oxygen is used but it can be dangerous and they should be used with caution and this person should be monitored to make sure that they’re still breathing. Lastly I just want to
mention that if a person has an acute episode just when the disease gets really bad, we will treat them
aggressively with steroids, yes but one other we want
to add are antibiotics because they might have an infection. If they have it, we have to treat it and they don’t, we want to prevent it because the extra mucus
during an acute exacerbation can keep the bacteria in the lungs. You really want to get on top of that and make sure that we
don’t develop pneumonia on top of bad chronic bronchitis. Here in a nutshell are
the most common treatments for chronic bronchitis. As you can see most of it is symptomatic which means we don’t get rid
of the root of the problem. Remember to go back to the beginning. Whatever we can do to
reduce the irritation to begin with, would be the
best thing for the patient in the long term.


14 thoughts on “Chronic bronchitis treatment | Respiratory system diseases | NCLEX-RN | Khan Academy

  1. Sooooo…. I cough a lot, mainly during seasonal changes. I have been coughing for 12 years and it gets old! I have never smoked, no shortness of breath, if anything its the opposite. When I am stationary is when I cough… Confusing as heck! I play sports, hike 14ers, free dive, all with no problem. The allergy test is negative, and I still cough. What is my problem? Bronchial scaring maybe from coughing so long?  Post Nasal Drip? I would think that's it due to it being seasonal, so allergies would be the irritant, but what am I allergic to? been tested for 150 different things. Thoughts?

  2. I have a question: If you have chronic bronchitis, do the symptoms show up when you get sick again, or are they always there? When treated, I mean. I'm a little confused. 😀

  3. I have all does symptoms when I go see the doc he gives me a treatment for me to breath then some shots but after a few days I'm back with the asthma bronkitis and short of breath I usually use two inhalers a month or if I'm lucky 6 months do you think I should see a pulmonary Doctor ???

  4. WONDERFUL PRESENTATION … but why don't metion Physiotherapy as treatment, as a physiotherapist I tell you there's so many techniques to help chronic bronchitis patients through all phases of illness.

  5. I DONT DO DRUGS SMOKE, IM LIVING IN THE SAME PLACE. I WAS FINE AND NOW I HAVE BRONCHITIS. OR AL ANTIBIOTICS DONT WORK. CONVENTIONAL MEDICINE SIGH.

  6. I was diagnosed with acute bronchitis and was given benzonate and Claritin for it. She told me that the second stage would be steroids. Should she had given me antibiotics instead?

Leave a Reply

Your email address will not be published. Required fields are marked *