Lower Respiratory Tract Infections

By Miss. Prajakta D. Hingole .
M.S 1st year In Pharmacology and Toxicology department ,
NIPER Kolkata.

1. LOWER RESPIRATORY TRACT INFECTIONS BY MISS.PRAJAKTA D. HINGOLE PHARMACOLOGY AND TOXICOLOGY DEPT , NIPER KOLKATA.

2. TERMINOLOGY INTRODUCTION BRONCHITIS PNEUMONIA PULMONARY TUBERCULOSIS

3. INTRODUCTION DEFINITION lower respiratory tract infection or LRTI is an generic term for an acute infection of trachea (windpipe), airways and lungs, which make up the lower respiratory system. LRTI includes bronchitis , pneumonia , pulmonary TB, haemoptisis , haematemesis .

4. BRONCHITIS Bronchitis is inflammation or swelling of the bronchial tubes (bronchi), the air passages between the nose and the lungs. More specifically, bronchitis is when the lining of the bronchial tubes becomes inflamed or infected . Bronchitis is caused by viruses, bacteria, and other particles that irritate the bronchial tubes.

5. BRONCHITIS Types There are two types of bronchitis Acute bronchitis Chronic bronchitis

6. ACUTE BRONCHITIS Acute bronchitis is a shorter illness that commonly follows a cold or viral infection, such as the flu. Acute bronchitis usually lasts a few days or weeks

7. CHRONIC BRONCHITIS Chronic bronchitis is characterized by a persistent, mucus-producing cough on most days of the month , three months of a year for two successive years in absence of a secondary cause of the cough .

8. CAUSES Viral infection that causes the inner lining of the bronchial tubes to become inflamed and undergo the changes tthat occur with any inflammation in the body. Bacteria can also cause bronchitis such as Mycoplama , Pnneumonia , Klebsiella , haemophilus . Chemical irritants for eg ; tobacco smoke , gastric reflux solvents can cause acute bronchitis.

9. RISK FACTORS Smokers People who are exposed to a lot of second-hand smoke. People with weakened immune systems The elderly and infants People with gastroesophageal reflux disease(GERD) Those who are exposed to irritants at work.

10. Cigarette smoking ,RTI, environmental pollutants Inflammation Bradykinin , histamine , prostaglandin Increases capillary permeability fluid/ cellular exudation Edema of mucous membrane Hypersecreation of mucus Persisitant cough

11. SIGN AND SYMPTOMS Coughing Production of clear white ,yellow, grey,or green mucus(sputum) Shortness of breath Wheezing Fatigue Fever and chills Chest pain or discomfort Blocked or runny nose

12. Diagnostic evaluation History collection Physical examination Chest X-rays Sputum culture Pulmonary function test Spirometer excerises Bronchoscopy

13. MANAGEMENT Antibiotics - these are effective for bacterial infections, but not for viral infections. They may also prevent secondary infections. Cough medicine - one must be careful not to completely suppress the cough, for it is an important way to bring up mucus and remove irritants from the lungs. Bronchodilators - these open the bronchial tubes and clear out mucus .

14. Mucolytics - these thin or loosen mucus in the airways, making it easier to cough up sputum. Anti-inflammatory medicines and glucocorticoid steroids - these are for more persistent symptoms. Pulmonary rehabilitation program - this includes work with a respiratory therapist to help breathing.

15. COMPLICATIONS Asthma Bronchiectasis Tuberculosis Sinusitis

16. PNEUMONIA Pneumonia is an infection in one or both lungs . Pneumonia causes inflammation in the alveoli . The alveoli are filled with fluid or pus, making it difficult to breathe

17. Etiology : Bacteria, viruses, mycoplasmas, fungal agents & protozoa. Aspiration of food, fluids, / vomitus. Inhalation of toxic/caustic chemicals, smoke, dusts/gases . Influenza .

18. Risk Factors : • Advanced age. • History of smoking. • Upper respiratory infection. • Tracheal intubation. • Prolonged immobility. • Immunosuppressive therapy. • Nonfunctional immune system. • Malnutrition. • Dehydration. • Chronic disease state

19. DIAGNOSIS Chest auscultation. Sputum culture analysis & sensitivity/ serologic testing. Fiber optic bronchoscopy/ Transcutaneous needle aspiration/ biopsy. Skin tests. Blood & urine cultures. Transcutaneous oxygen level analysis/ ABG measurements . Chest X-ray examination

20. PULMONARY TUBERCULOSIS Pulmonary Tuberculosis (TB) is an infectious disease that mainly affect the lungs parenchyma . •It is a Chronic specific Inflammatory infectious Disease caused by Mycobacterium Tuberculosis In human . •Usually attacks the lungs but It can also effect any part of The body

21. ETIOLOGY TB is caused by the bacteria M. tuberculosis (most common cause). Other than tuberculosis – includes; M. avium intracellulare M. kansasi M. scrofulaceuru M. ulcerans M. marinum and etc

22. It also caused by breathing in air droplets from a cough or sneeze of an infected person this is called Primary TB. TB spread from person to person by airborne transmission . Infected person release droplet nuclei (1-5 micro meter in diameter) through, Talking Coughing Sneezing Laughing Singing • If not treated properly, TB can be fatal

23. Risk factors Elderly Infants Low socioeconomic status Crowded living conditions Disease that weakens immune system like HIV Alcoholism Recent Tubercular infection ( within last 2 years) and etc.

24. SIGNIFICANT LAB TEST  Tuberculin skin test (PPD test); Injecting a small amount of protein from tuberculosis bacteria between the derived layer of the skin (usually forearm ).  Sputum examination and Cultures; Is examined under a microscope to look for tuberculosis bacteria and used to grow the bacteria in a culture .

25.  Interferon-gamma Blood test ; A simple blood is mixed with synthetic proteins similar to those produced by the tuberculosis bacteria. If people are infected with tuberculosis bacteria, their white blood cells produce certain substances (interferons) in response to the synthetic proteins IMAGING CONSIDERATION  Chest CT Scan  Chest X-ray