ASTHMA & BRONCHIECTASIS

Muthuukaruppan M.

Introduction 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.

 Asthma before the age of 35 is allergic or extrinsic. Exercise induced asthma is prevaent in school children, 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 intrinsic cause. Usually associated with chronic bronchitis.

Pathophysiology:
Mucosa inflammed, edematous and basement membrane thickened. Mucous glands are enlarged, goblet cell hyperplasia. 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.

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.

Subjective & objective findings:

Hyperinflation with sputum retention in X-ray. ABG hypoxemia with reduced PaCO2 in the early phases, later reduced PaO2, raised PaCO2 and pH below 7.30. Tachypnea, hyperinflation, accessory muscle use and pulses paradoxus. Status asthmaticus is a state of emergency unresponsive to medical management and persists for hours.

Introduction 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 common too. Upper lobe is involved during tuberculosis or aspergillosis.

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 and distorted.

Subjective & objective findings:

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-perfusion mismatching.

Haemoptysis occurs in 50% of patients. Dyspnea Wheeze Pleuritic chest pain Reduced FEV1 and increased Residual volume

Problem list 1.

Contributing factors

Treatment

2.

Short term goals:

Long term goals:

Management:

Mini questionnaire:

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 cardiac problems, (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.

ANY QUESTIONS ???