Chronic bronchitis is a diagnosis featured with constant cough and sputum producing. It may be accompanied by airflow blockage or obstruction taking duration of over two to three months in two years. Testing aids such as pulmonary function may be applied in determining the extent of airflow obstruction reversibility. Great knowledge and understanding of inflammatory mediators has promoted managing inflammation of the airway and bronchospasm relief (May, 1968).
In such cases, inhaled sympathomimetic and bromide ipratropium agents are the key management mainstays. Though theophylline was an excellent therapy, it would be disputed on bases of its narrow interaction and therapeutic ranges with other supporting agents. Steroid oral therapy is used for patients who demonstrate improvement in airflow that is hard to achieve with the inhaled agents. In some cases, antibiotics play a part in acute exacerbations, but in recent research, they have been shown only to improve airflow (Great Britain, 1965). Chronic bronchitis may be managed on long term by strengthening respiratory muscles, provision of supplemental oxygen, nutritional support, and smoking cessation. Chronic bronchitis is a manifest of one fourth of deaths causing disease known as pulmonary chronic obstructive disease. For instance, more than 9 million American citizens are affected while overall it causes 42,000 deaths per year (Haas, 2000).
Airflow block in chronic bronchitis is protected and influenced by extreme production of tracheobronchial mucus. This is distinct from emphysema which is the distention of air space and destruction of septa alveolar. Cigarette smoking act is a leading risk factor to chronic bronchitis progress. Patients infected with this disease have a long history of smoking habits; however, about fifteen per cent of smokers have been diagnosed with the airway obstructive disease (May, 1968).
Haemophilus influenzae, Moraxella catarrhal, and streptococcus pneumonia bacteria are isolated from lower bronchus of patients infected to chronic bronchitis. The organisms that cause this infection include chlamydia, trachoma, and mycoplasma pneumonia. They mainly cause inflammation of the airways to the lungs leading to airway swells, narrowing, and finally, closure of bronchial tubes (Haas, 2000).
Bronchitis can be chronic or acute. Acute bronchitis is presented with coughs, fever, mild wheezing, chills, shortness of breath, and malaise. In other cases, it may lead to sputum production which lasts for three weeks. In such incidents, the patients recover with no damage on the bronchial tree (May, 1968). Acute exacerbation triggered by inflammation in the airways is caused by reaction of these bacteria’s and viruses. This continuous reaction has called for frequent therapy for patients with chronic bronchitis.
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Pulmonary functioning and testing documentation are extremely beneficial in chronic bronchitis diagnosis. The reason is that it offers valuable critical therapeutic evidence about responsiveness of the patient towards inhalation of bronchodilator therapy. This would be achieved by use of a measurement strategy known as force expiratory volume measured in seconds. In cases where a lesser number than seventy per cent is shown, the presence of the airway obstructive disease may be detected (Haas, 2000).In other cases, a forced vital capacity of less than fifty per cent presents the end stages of airway obstructive disease. A decrease of forced expiratory capacity of about 30 millimeters is experienced in adults due to reduction in lung elasticity caused by physiological changes that are age-related. Obstruction of airflow in existence of sputum production indicates and confirms the presence of chronic bronchitis (Haas, 2000).
Though clinically caused by bacterial, it may also be caused and influenced by other supporting factors such as contact to irritants (wood smoke, inhaled solvents, and tobacco). Mucus, produced during coughs, is breeding ground for viruses and bacteria; this leads to discoloring due to the overgrowth of bacteria leading to infections. Mucus swelling and inflammation inhibit the flow of air by obstructing and narrowing the bronchioles and bronchi (May, 1968). The main risk factors of chronic bronchitis are cigarette smoking and secondhand smoking. Another factor is the pollution of air from chemical factories producing coal, sulfur dioxide, and ammonia. Similarly, dust, reflux diseases, and pneumonia may promote attack and infection with chronic bronchitis (May, 1968).
Clinical presentation related with sputum lasts for three months. Sputum may be bloody, yellowish, clear, or greenish. Occasionally, production of sputum reduces as time progress still it is so severe in the morning. This desease may have other infections that include wheezing, breath shortness, fatigue, nasal congestion, headaches, and muscle aches (F. Haas & S. Haas, 1990). Medical history, tests, and physical examinations of the patient should be used in the diagnosis. The daily cough produced is used in examinations and tests. Wheezing is experienced in patients due to obstruction of airways. Lung problems associated with chronic bronchitis may be ruled out through the use of x-rays. These lung problems associated with chronic bronchitis include bronchitis obstruction, TB, and pneumonia (Haas, 2000).
Blood tests such as hypoxemia are the common using methods. Hypoxemia is used in providing findings regarding arterial blood sampling of gas. Mostly, it is done in patients who have advanced states of chronic bronchitis or failure of ventilating system that may cause inflammation or bronchospasm. Mild or moderate cases of polycythemia that result to hypoxia may be indicated by blood tests (Haas, 2000).
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Electrocardiogram that includes disturbances of supra ventricular rhythm may be used in the diagnosis. This includes atrial fibrillation or tachycardia multifocal atrial. Electrocardiogram can also be used in finding and research on biopsy of the airways that may include sub mucosal and mucosal inflammations or cell hyperplasia (Howell, 1951).
Also, sputum culture may be used in the diagnosis. Though, this is not commonly used because sputum culture has been limited for most non-hospitalized patients who show signs of severe exacerbation with chronic bronchitis (May, 1968). This method is not effective since it mainly shows distal levels of bronchial rather than the causative organisms. In most cases, gram staining of sputum is used as a mean of initiating antibiotic therapy (May, 1968).
Though there is no cure for chronic bronchitis, management techniques should be applied to reduce the progression of infection. Treatment aims at relieving signs and symptoms and preventing complication. Management aims at avoiding risk factors, such as smoking, since this may worsen the situation or phase of infection (Haas, 2000). Also, any irritants to the respiratory should be avoided since they may also worsen the health state. That is smoking cessation remains the most efficient, effective, and economical mean of reducing morbidity of chronic bronchitis. Patients may apply various methods to stop or reduce smoking. These may include application of cessation smoking tools such as attending behavior change trainings, use of systems that nicotine, replacement, work in groups to keep self-control and esteem high. Personal physician should do a follow up to make sure that the patients follow all the steps to help reduce smoking. This should be accompanied by the community and family members on the various ways of caring the patient so that he can achieve smoke cessation determinations. Cessation requires a lot of support, care, and massive care of the patient (F. Haas & S. Haas, 1990).
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Other factors that may promote management of chronic bronchitis at both family and community level include elimination and reduction of environments’ exposure to patients with respiratory irritants that may assist in reduction of bronchitis. These irritants include deodorant products, hairs that are aerosolized or noxious gas, or dusts in industries and workplaces. Such sources should be isolated to reduce exposure of these irritants to the environment.
Family members, nurses, patients as well as caregivers have to be educated on the impacts and nature of the chronic bronchitis. Patients should be directed on the hospitalization procedure and supported all through that may involve activities such as compliance of oxygen and management of medication. Nurses and therapists should enlighten the patients on use and utilization of inhalers in order to achieve the reduction of progression of chronic bronchitis (Great Britain, 1965).
Similarly, the use of theophylline may be used in therapy and management of chronic bronchitis. This is due to the facts that it improves ventilation in the airways, improve clearance of mucociliary, and improve functionality of respiratory muscles. Theophylline is the most effective for patients who worsen at night due to the blockage of airways. Intake of theophylline will not disrupt sleep as inhalers do; therefore, the use of theophylline should be recommended (May, 1968).
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Medication to chronic bronchitis includes using of steroids that help in reduction of inflammation in the airways and using of inhalers that dilate airways. In some cases, one may use antibiotics though not insisted on since may lead to resistance. Inhalers reduce wheezing while steroids influence mucus secretion and swell of the bronchial (Lorig, 2006).
In critical cases, other techniques such as oxygen therapy or lung transplant can be applied. Though antibiotics are prescribed to patients, this should be avoided since it may result to antibiotic resistance. Chronic Bronchitis complications may range from acute bronchitis, weakness, and enlargement of heart right side, lung collapse, breath shortness, and other deseases (Lorig, 2006). Pulmonary rehabilitation and use of medicine may be applied in controlling both moderate and mild cases of chronic bronchitis.
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