Bronchial Asthma and Pneumonia PDF

BRONCHIAL ASTHMA  BRONCHIAL ASTHMA Asthma is a condition in which airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, wheezing when breathe out and shortness of breath. For some people, asthma is a minor nuisance. For others,...

BRONCHIAL ASTHMA  BRONCHIAL ASTHMA Asthma is a condition in which airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, wheezing when breathe out and shortness of breath. For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma can't be cured, but its symptoms can be controlled.  SIGNS AND SYMPTOMS Shortness of breath Chest tightness or pain Wheezing when exhaling Trouble sleeping caused by shortness of breath, coughing or wheezing Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu ASTHMA SIGNS AND SYMPTOMS FL ARE UP IN CERTAIN SITUATIONS: Exercise-induced asthma, which may be worse when the air is cold and dry Occupational asthma, triggered by workplace irritants such as chemicals, gases or dust Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, or particles of skin and dried saliva shed by pets (pet dander)  CAUSES Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include: Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste Respiratory infections, such as the common cold Physical activity Cold air Air pollutants and irritants, such as smoke Certain medications, including beta blockers, aspirin and nonsteroidal anti- inflammatory drugs, such as ibuprofen and naproxen sodium.  CAUSES Strong emotions and stress Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into throat  RISK FACTORS Having a blood relative with asthma, such as a parent or sibling Having another allergic condition, such as atopic dermatitis — which causes red, itchy skin — or hay fever — which causes a runny nose, congestion and itchy eyes Being overweight Being a smoker Exposure to secondhand smoke Exposure to exhaust fumes or other types of pollution Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing  ASTHMA DIAGNOSIS TESTS Spirometry. Spirometry with bronchodilator tests. Bronchoprovocation tests. Peak expiratory flow (PEF) tests. Fractional exhaled nitric oxide (FeNO) tests. Allergy skin or blood tests.  COMPLICATIONS Signs and symptoms that interfere with sleep, work and other activities A permanent narrowing of the bronchial tubes Emergency room visits and hospitalizations for severe asthma attacks Side effects from long-term use of some medications used to stabilize severe asthma  PREVENTION Asthma action plan. Asthma is an ongoing condition that needs regular monitoring and treatment. Vaccination for influenza and pneumonia. Vaccinations can prevent flu and pneumonia from triggering asthma flare- ups. Identificaion and avoidance of asthma triggers. Monitoring of breathing. Pacient may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. Identification and treatment attacks early. Taking medication as prescribed.  PNEUMONIA Pneumonia is inflammation of the lungs, usually caused by an infection. Most people get better in 2 to 4 weeks, but babies, older people and people with heart or lung conditions are at risk of getting seriously ill and may need treatment in hospital.  SYMPTOMS Cough, which may produce greenish, yellow or even bloody mucus Fever, sweating and shaking chills Shortness of breath Rapid, shallow breathing Sharp or stabbing chest pain that gets worse when you breathe deeply or cough Loss of appetite, low energy and fatigue Nausea and vomiting, especially in small children Confusion, especially in older people  TYPES OF PNEUMONIA There are more than 30 different causes of pneumonia, and they’re grouped by the cause. The main types of pneumonia are bacterial, viral, and mycoplasma pneumonia. Bacterial (pneumococcal) pneumonia is the most common form. Bacterial pneumonia can be more serious than other types of pneumonia, with symptoms that require medical care. The symptoms of bacterial pneumonia can develop gradually or suddenly. Fever may rise very high, with profuse sweating and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious. Pneumococcal pneumonia is a potentially serious bacterial lung disease. Pneumococcal vaccines are available to help prevent the disease.  TYPES OF PNEUMONIA Viral pneumonia usually develop over a period of several days. Early symptoms are similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain. There may be a high fever and there may be blueness of the lips. Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy. Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness. For individuals that already have a chronic lung disease, those symptoms may worsen.  FUNGAL PNEUMONIA Fungal pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who are exposed to large doses of certain fungi from contaminated soil or bird droppings.  C L AS S IF IC AT ION AC C OR D IN G T O W H E R E OR H OW P N E U M ON I A WA S AC QU I R E D : Hospital-acquired pneumonia (HAP). This type of bacterial pneumonia is acquired during a hospital stay. It can be more serious than other types, as the bacteria involved may be more resistant to antibiotics. Community-acquired pneumonia (CAP). This refers to pneumonia that’s acquired outside of a medical or institutional setting. Ventilator-associated pneumonia (VAP). When people who are using a ventilator get pneumonia. Aspiration pneumonia. Inhaling bacteria into lungs from food, drink, or saliva can cause aspiration pneumonia. It’s more likely to occur if pacient have a swallowing problem, or if too sedated from the use of medications, alcohol, or other drugs.  WALKING PNEUMONIA Walking pneumonia is a milder case of pneumonia. People with walking pneumonia may not even know they have pneumonia. Their symptoms may feel more like a mild respiratory infection than pneumonia. However, walking pneumonia may require a longer recovery period. The symptoms of walking pneumonia can include things like: mild fever dry cough lasting longer than a week chills shortness of breath chest pain reduced appetite  PNEUMONIA DIAGNOSIS TESTS Medical history - any recent travel, occupation, contact with animals, exposure to other sick people at home, work or school, another illness. Physical exam (lung auscultation). Diagnostic Tests: - Blood tests to confirm the infection and to try to identify the germ that is causing illness. - Chest X-ray to look for the location and extent of inflammation in lungs. - Pulse oximetry to measure the oxygen level in blood. Pneumonia can prevent lungs from moving enough oxygen into bloodstream. - Sputum test on a sample of mucus (sputum) taken after a deep cough, to look for the source of the infection.  PNEUMONIA DIAGNOSIS TESTS CT scan of the chest to get a better view of the lungs and look for abscesses or other complications. Arterial blood gas test, to measure the amount of oxygen in a blood sample taken from an artery. This is more accurate than the simpler pulse oximetry. Pleural fluid culture, which removes a small amount of fluid from around tissues that surround the lung, to analyze and identify bacteria causing the pneumonia. Bronchoscopy, a procedure used to look into the lungs' airways.  RISK FACTORS Anyone can get pneumonia, but certain groups do have a higher risk. These groups include: 1. infants from birth to 2 years old 2. people ages 65 and older 3. people with weakened immune systems due to: pregnancy HIV the use of certain medications, such as steroids or certain cancer drugs 4. people with certain chronic medical conditions, such as asthma  RISK FACTORS diabetes COPD heart failure liver disease kidney disease  TREATMENT Oral antibiotics can treat most cases of bacterial pneumonia. Antibiotic medications don’t work on viruses. In some cases, doctor may prescribe an antiviral. However, many cases of viral pneumonia clear on their own with at-home care. Antifungal medications are used to treat fungal pneumonia. Hospitalization.  COMPLICATIONS Pneumonia may cause complications, especially in people with weakened immune systems or chronic conditions, such as diabetes. Worsened chronic conditions. If patient have certain preexisting health conditions, pneumonia could make them worse. These conditions include congestive heart failure and emphysema. For certain people, pneumonia increases their risk of having a heart attack. Bacteremia. Bacteria from the pneumonia infection may spread to bloodstream. This can lead to dangerously low blood pressure, septic shock, and, in some cases, organ failure. Lung abscesses. These are cavities in the lungs that contain pus. Antibiotics can treat them. Sometimes they may require drainage or surgery to remove the pus. Impaired breathing. Acute respiratory distress syndrome. This is a severe form of respiratory failure. It’s a medical emergency.  COMPLICATIONS Pleural effusion. If pneumonia isn’t treated, may develop pleural effusion. The fluid may become infected and need to be drained. Kidney, heart and liver damage. These organs may be damaged if they don’t receive enough oxygen, or if there’s an overreaction of the immune system to the infection. Death. In some cases, pneumonia can be fatal.  PREVENTION Vaccination Healthy lifestyle Hand hygiene Face mask  PULMONARY ABSCESS AND PULMONARY GANGRENE Pulmonary abscess is caused by pyogenic organisms, usually by staphylococci, reaching the lung by aspiration from the oral cavity or through the blood stream from a distant focus of suppuration. Pulmonary abscess occurs more frequently in children than in adults, and in cases uncomplicated by septicemia the prognosis is fair. Pulmonary gangrene, comparatively, is a much more severe disease caused by a group of organisms, notably spirochetes, fusiform bacilli and vibrios aspirated from the oral cavity. It occurs much more frequently in adults than in children,  PULMONARY ABSCESS Pulmonary abscess is in the group of lung infections such as lung gangrene and necrotizing pneumonia which is characterized with multiple abscesses. Pulmonary abscess is defined as a circumscribed area of pus or necrotic debris in lung parenchima, which leads to a cavity, and after formation of bronchopulmonary fistula, an air-fluid level inside the cavity. The clinical signs and therapy of lung abscess was described for the first time by Hippocrates. In pre-antibiotic era, one third of patients with lung abscess would die, the other third of patients would recover fully, and the rest of them would survive with sequels such as chronic lung abscess, pleural empyema or bronchiectasis. In that time, surgery was considered as the only effective therapy, and today most of the patients will be fully recovered only with antibiotic therapy.  DIVISION OF LUNG ABSCESSES According to the duration: Acute (less than 6 weeks); Chronic (more than 6 weeks); By etiology: Primary (aspiration of oropharyngeal secretions, necrotizing pneumonia, immunodeficiency); Secondary (bronchial obstructions, haematogenic dissemination, direct spreading from mediastinal infection, from subphrenium, coexisting lung diseases); Way of spreading: Bronchogenic (aspiration of oropharyngeal secretions, bronchial obstruction by tumor, foreign body, enlarged lymph nodes, congenital malformation); Haematogenic (abdominal sepsis, infective endocarditis, septic thromboembolisms).  CAUSES Aspiration of oropharyngeal secretions: Dental/peridental infection; Paranasal sinusitis; Swelling disorders; Gastro-oesophageal reflux disease; Frequent vomiting; Intubated patients; Patients with tracheostomy; Nervous recurrent paralysis; Alcoholism.  CAUSES Haematogenic dissemination: Abdominal sepsis; Infective endocarditis; Intravenous drug abuse; Infected cannula or central venous catheter; Septic thromboembolisms.  CAUSES Coexisting lung diseases: Bronchiectasis; Cystic fibrosis; Bullous emphysema; Bronchial obstruction by tumor, foreign body or enlarged lymph nodes; Congenital malformations (pulmonary sequestration, vasculitis, cystitis); Infected pulmonary infarcts; Pulmonary contusion; Broncho-oesophageal fistula  SIGNS AND SYMPTOMS fever with shivering cough, night sweats dispnea weight loss and fatigue chest pain anemia  THERAPY Antibiotics Abscess greater than 6 cm in diameter or if symptoms lasts more than 12 weeks with appropriate therapy, have little chances for only conservative healing and surgical therapy should be considered  PLEURITIS Pleurisy, also known as pleuritis, is inflammation of the pleura. Pleurisy describes the chest pain syndrome characterized by a sharp chest cavity pain that worsens with breathing.  CAUSES Infections: bacterial (including those that cause tuberculosis), fungi, parasites, or viruses Inhaled chemicals or toxic substances: exposure to some cleaning agents like ammonia Collagen vascular diseases: lupus, rheumatoid arthritis Cancers: the spread of lung cancer or breast cancer to the pleura Tumors of the pleura: mesothelioma or sarcoma Congestion: heart failure Pulmonary embolism Obstruction of lymph channels Trauma Drugs Abdominal processes: such as pancreatitis, cirrhosis of the liver, gallbladder disease, and damage to the spleen. Pneumothorax  SYMPTOMS Pain Shortness of breath Dry cough Extreme weakness Chills and fever Shortness of breath or respiratory distress due to pleural effusion (large amounts of fluid in the pleural space) making it difficult for the lungs to expand  TYPES OF PLEURITIS Dry pleurits: Little to no fluid accumulates around the lungs. The inflamed pleura rub against each other and produces a sound called “pleural friction rub” as you breathe, which sounds like a raspy breath. Exudatve pleuritis: Involves a fluid buildup around the lungs from the inflamed tissue. The excess fluid can make breathing difficult and cause shortness of breath.  DIAGNOSIS Blood tests Chest X-ray CT scan Ultrasound ECG  DIAGNOSTIC PROCEDURES Thoracentesis. Anesthetic is injected between ribs to the area where fluid was seen on your imaging studies. Next a needle is inserted through chest wall between ribs to remove fluid for lab analysis and for medical purpuses (removing fluid can help breathe better). The needle is usually inserted with the help of ultrasound guidance. Thoracoscopy. If TB or cancer is suspected, a thoracoscopy — also called a pleuroscopy — may be performed. During this procedure, a tiny camera (thoracoscope) is inserted through a small cut in chest wall. This procedure allows for a direct view inside chest to look for any problems or for biopsy.  TREATMENT Treatment for pleuritis focuses primarily on the underlying cause. For example, if bacterial pneumonia is the cause, an antibiotic can be prescribed. In the case of viral infection, pleuritis may go away on its own. The pain and inflammation associated with pleuritis is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Steroid medication. THANK YOU.