asthma & bronchiectasis

8/13/2019 Asthma & Bronchiectasis

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ASTHMA & BRONCHIECTASIS

Muthuukaruppan M.


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I ntroduction to Asthma:

Chronic inflammatory condition of the airways

characterized by an increased responsiveness of

the airway smooth muscle to various stimuli. Reverses either spontaneously or as a result of

treatment.

Lumens of the airways narrow by bronchial

smooth muscle spasm, inflammation of mucosa

and overproduction of viscous mucus.

80% of children with asthma do not have after 10

years.


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Asthma before the age of 35 is allergic or

extrinsic.

Exercise induced asthma is prevaent in schoolchildren, resulting from hyperosmolar changes or

exposure to temperature changes in airways.

Subjects older than 35years presenting with

asthma usually as a evidence of COPD or intrinsiccause.

Usually associated with chronic bronchitis.


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Pathophysiology:

Mucosa inflammed, edematous and basement

membrane thickened.

Mucous glands are enlarged, goblet cellhyperplasia.

Bronchospasm is due to airway smooth muscle

hypertrophy.

Lumens of the bronchioles are filled with

viscous, sticky mucus.

Secretions are from mucus glands and

cappilaries.


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Signs & Symptoms:

Awakened at night or early morning with either

cough, dyspnea, wheezing and chest tightness.

Increased RR and use of accessory muscles. Prolonged expiratory phase with audible wheeze

Hyper inflated lungs with reduced breath sounds.

Unproductive cough.


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Subjective & objective f indings:

Hyperinflation with sputum retention in X-ray.

ABGhypoxemia with reduced PaCO2in the

early phases, later reduced PaO2, raised PaCO2and pH below 7.30.

Tachypnea, hyperinflation, accessory muscle use

and pulses paradoxus.

Status asthmaticus is a state of emergencyunresponsive to medical management and

persists for hours.


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I ntroduction to Bronchiectasis:

Abnormal dilatation of medium sized bronchi and

bronchioles, associated with a previous

necrotizing infection within these airways.

Cylindrical and Sacular bronchiectasis

Localized to few segments or an entire lobe and

more predilection to basal segments.

Left lingula and right middle lobe are commontoo.

Upper lobe is involved during tuberculosis or

aspergillosis.


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Pathology:

Edematous mucosa and ulcerated.

Destruction of elastic and muscular structures of

the airways which result in dilation and fibrosis.

Airway epithelium is replaced with non ciliated

and mucus secreting cells.

Causes pooling of infected secretions and irritates

the walls. Collapse of lung tissue distal to obstruction.

Collapsed airways increases traction on the

adjacent airways and make them expand anddistorted.


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Subjective & objective f indings:

Mild bronchiectasis concluded with < 10ml of

sputum, moderate 10-150ml and severe considered

to produce more than 150ml.

Finger clubbing in 25%

Chronic cough with expectoration, unpleasant

tasting, purulent sputum.

Changes in body position trigger cough. Right heart failure due to fibrosis extening upto

pulmonary capillaries.

Hypoxemic, hypercapnic and ventilation-perfusionmismatchin .


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Haemoptysis occurs in 50% of patients.

Dyspnea

Wheeze

Pleuritic chest pain

Reduced FEV1and increased Residual volume


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Problem list Contributing factors Treatment

1.

2.

Short term goals:

Long term goals:

Management:


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Mini questionnaire:


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References:

1. Elizabeth Dean(2005), Donna Frownfelter,

Cardiovascular & pulmonary physical therapy,

(4th ed.), Mosby

2. Jennifer Pryor, Barbara A. Webber (2005),

Physiotherapy for respiratory and cardiacproblems, (2nd ed.), Churchill Livingstone

3. Stuart B. porter (2003), Tidys Physiotherapy,

(14th ed.), Churchill Livingstone.

4. Alexandra Hough (2001), Physiotherapy in

respiratory care, (3rd ed.), Nelson Thornes.


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asthma & bronchiectasis

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