Mr Roger Wilson is a 32-year-old man with a history of asthma who is currently a gym instructor, had seen his GP complaining of shortness of breath, fever, headaches and a productive cough over the past week. The GP has diagnosed Mr Wilson with a respiratory tract infection and has prescribed roxithromycin (Rulide) 150mg twice daily (BD). After taking the antibiotic for two (2) days, Mr Wilson has returned to his GP feeling much worse. A chest x-ray shows bilateral pneumonia and Mr Wilson was administered to hospital via the emergency department (ED).
Discussion of (3) medications related to the Pathophysiology of the patient in the case patient.
Path physiology of the patient
From the diagnostic symptoms stated in the case study, the patient Roger Wilson is indicative of bronchiectasis. It is a lung condition caused by the airway damage which affects the ability to clear the mucous membrane in the body. Bronchiectasis results in enlargement of the airways of the lungs. It results in acquiring infective diseases such as pneumonia, immune system conditions, tuberculosis and other manifestations (Chalmers, Aliberti & Blasi, 2014).
Bronchiectasis refers to the occurrence of permanent and abnormal bronchi dilation. This is exhibited in the manner in which it causes inflammation. Key clinical manifestation is the production of cough.
Bronchiectasis leads to chronic inflammation which is compounded by the inability of the chest to clear off the mucoid secretions. This often results in the inability to clear sputum (King, 2016). This state of inability leads to build up of bacteria leading to recurrent infections. Each infection arising leads to damage to airwaves, with over the time the airwaves loses the ability to breathe out and in the air, leading to prevention of oxygen from reaching the vital organs resulting in shortness of breath as observed in the case study (Lee, Burge & Holland, 2013).
Bronchiectasis is often a lifelong disease which the bronchi become scarred and enlarged permanently (Ho, Byun & Cunningham-Rundles, 2018). In the disease process, the cilia are enlarged so that they are unable to effectively remove the mucus, this results in the mucus accumulating in the lungs thus making the lungs to develop the infections such as pneumonia as observed in the case study.
Causes of Bronchiectasis are the consequences of damaged bronchi, which is caused by a lung infection. This is evident by the x-ray scan of the patient Roger Wilson which indicates pneumonia state. Further, it can be exacerbate by inhalation of foreign matter such as in the case study, whereby the patient Roger Wilson developed flu-like infection due to poorly aerated air in the gym room being refurbished (Chalmers, Aliberti & Blasi, 2015).
Bronchiectasis can result from various infective and acquired diseases which include pneumonia, low immune levels, and genetic disorders. The disease develops a mechanism of action which leads to the breakdown of airways as a result of excessive response on the inflammatory side. The airways involved become enlarged and its ability to clear secretions is limited. The increase in the number of bacteria in the lungs which leads to blockage of the airway (Aksmait et al., 2017).
The underlying bronchiectasis is often associated with the different pathophysiological process such as allergic bronchial pulmonary which is associated with central bronchiectasis. Bronchiectasis is linked to localized action; it is often associated at the lower lobes which indicate retention of secretion infected.
Lung function in Bronchiectasis
Patients having bronchiectasis experience mild to moderate obstruction of the air flow. There is decline lung function after infection among patients signified by the loss of expiratory volume (Corris, 2013). A study on lung function test show that the obstruction in bronchiectasis ranges from small and medium involvement on attenuation features on the smaller constriction airway. The restricted airway constriction is as a result of decreased attenuation and the thickening of small constriction of bronchiectasis. The restricted bronchiolitis is presented with a mosaic pattern as exhibited in expiratory films.
Studies undertaken have explained the obstruction of bronchiectasis. Studies undertaken have shown that large airways finding of airflow obstruction in bronchiectasis. The studies illustrate large airways are dilated while the small and medium airways are obstructed occurring due the bronchial wall thickening (Cottin, Cordier & Richeldi, 2015).
Signs and symptoms
The major symptom of bronchiectasis is the production of mucus. The mucus can be yellow-green in color with a foul smell which indicates the presence of an infection. This is well illustrated by patient Roger Wilson having green and malodorous sputum. Sputum characteristics depict the nature of infection in the chest. Green colored sputum is often an indication of a long-standing infection which has resulted in debris cell changes as observed in acute pneumonia, chronic infections and infected Bronchiectasis (Hassanzad et al., 2019).
Some patients can develop a productive cough with blood stains referred to as hemoptysis in the absence of dry bronchiectasis. Bad breath in this condition is an indicator of bad infection and is often brought about by breathless which depicts as a possible indicator for Bronchiectasis.
Some of the common signs and symptoms of bronchiectasis include;
-Recurrent lung infection
-Breathlessness in acute bronchiectasis
The onset of the symptoms normally occurs slowly. As the disease progresses, coughing worsens and high amounts of mucus are produced in the chest. The coughing is exhibited by bronchiectasis which produces frequent green mucus as patient Roger Wilson above. Further, it can also depict the coughing of blood when there is no observation of sputum. Further, the bad breath is an indicator of an active infection. The frequent occurrence of bronchiectasis infection and breathlessness are the key possible indicators of bronchiectasis.
Normally the damage of bronchiectasis occurs during childhood. The occurrence of signs and symptoms appear later in life after repeated infections. Patient Roger Wilson in the case study has asthma developed from early years which is significant to damage bronchiectasis.
Complications of bronchiectasis
Severe cases of bronchiectasis can cause severe damage and negative health conditions such as failure of the respiratory function and atelectasis (Liu et al., 2019). Respiratory failure occurs when there is not enough oxygen passing through the lungs into the blood system. Also, the condition can happen when the blood cannot remove carbon dioxide from the blood.
Respiratory failure can cause shortness of breath, increased breathing and air hunger a general feeling of feeling, not breath enough air. In severe cases, it causes bluish color on the skin, lips, and feeling of confusion (Polverino et al., 2017).
On the other hand, is a condition in which one or more areas of the lungs has collapsed or cannot inflate properly as expected, this causes a feeling of shortness of breath. This increases the heart rate and rate of breathing eventually rises.
Pharmacology management intervention and their mechanism ion
Bronchiectasis management needs lifelong management, (Lee et al., 2019). Good management of the condition entails prevention of ongoing damage to the lungs and worsening of the condition. The overall goal of the treatment is to prevent further damage to the lungs.
Pharmacological treatment of bronchiectasis entails control of infections and bronchial secretions. It offers to relive to the airway obstructions and removal of affected portions of the lungs such as embolization and preventing complications. Long term effect of antibiotics prevents the harmful effects of infection and decreases the hospitalization among patients with bronchiectasis. This further increases the risks of people becoming infected with drug-resistant bacteria (Rogers et al., 2014).
Bronchiectasis is often treated with three forms of management; medicines, hydration and chest physical therapy (Abbas et al., 2019). The goal of treatment entails treatment of the underlying conditions and lung infections, mucus removal and prevents complications. Early diagnosis and management prevent further damage to the lungs.
The utilization of macrolides has been widely been used for managing bronchiectasis. Trials done have shown remarkable therapeutical management of bronchiectasis. The bronchiectasis and long term Azithromycin which utilized 250 mg daily have shown three exacerbations, the low dose bronchiectasis treatment requiring two exacerbations have shown a remarkable reduction in the exacerbations frequency as compared to the placebo used (Crooks et al., 2014).
Macrolide drug therapy marks an elevated resistance in oropharyngeal and other forms of bacteria. Macrolides drug have anti-inflammatory effects which entail inhibition of anti-inflammatory effects on cell migration (Elborn & Tunney, 2013).
Inhaled antibiotic have significant advantages over another oral therapy process. They reduce the systematic absorption and side effects and reduce the collateral damage through the development of resistance in gastrointestinal microorganisms.
Another line of treatment is the use of expectorants which act as thinning aids. They help to lower the mucus in the lungs. Combined decongestants effect extra relief. The mucus thinners such as acetylcysteine aid in loosening the mucus and smooth coughing (Albert et al., 2011).
Patient Roger Wilson in the case study has been offered antibiotic management for managing the suspected respiratory cough infection, however it does not yield any positive results, as the patient t continues to deteriorate.
Inhalation of corticosteroids and bronchodilators
The inhaled corticosteroids functioning in bronchiectasis is not clear. They have a clearly established role on COPD and asthma which is often used among patients with bronchiectasis. Studies done have shown that high dose inhalation of steroids tend to reduce sputum volume, reduced inflammatory markers and overall improvement in the quality of life. However this has not established any clear role in lung function (Chalmers, Aliberti and Blasi, 2015).
In Cochrane review studies, the absence of high-quality studies on the use of inhaled corticosteroids among people with bronchiectasis needs to take a keen interest in patients with bronchiectasis. There is a need to consider other prescience of other co-existing airway hyperresponsiveness. The risks and effects associated can be noted with an increase in pneumonia among COPD patients (Tordera., 2012).
Further, inhaled steroids can significantly reduce the production of sputum and the decrease the constriction of the airway over some time. In this way, it helps in the progression of bronchiectasis. This is recommended for adults only.
Bronchodilators help in the relaxation of the muscles present in the airways. They help to breathe easier. Most of the bronchodilators are inhalable medicine. An inhaler or nebulizer is used to breath drug inform of mists (Kapur, 2009).
Patient Roger Wilson utilizes the use of Ventolin through a metered dosed inhaler, which is crucial for symptom relief. This is geared towards managing the patient asthma state. Patient Roger Wilson has a long history of asthma from childhood, hence there is a continuous management protocol being undertaken (Murray et al., 2011).
Surgery is rarely an adopted mechanism of treatment in managing bronchiectasis unless in localized bronchiectasis having symptoms which cannot be controlled through the medical therapy regime. There is limited long term data outcome of bronchiectasis after surgery process. The operative complication rate in studies done has indicated 8.9% thoracoscopic lobectomy for bronchiectasis (Vallilo et al., 2014).
Stepwise treatment approach
Bronchiectasis has a high impact on patients, the severity range from patients without daily symptoms and frequented exacerbates to patients requiring urgent medical attention. Treatment can often place a huge burden on patient Roger Wilson in times of time and side effects in relation to antibiotic resistance (Serisier, 2013). With this view, the patients need appropriate treatment on the stage and severity of the disease.
The ultimate goals of therapeutic management is to improve symptoms, reduce associated complications, management of exacerbations and to reduce the associated mortality levels, which include other associated conditions. Antibiotics and physiotherapy are often mainstream management approaches (Parisi et al., 2019. Other avenues can entail the use of bronchodilators, corticosteroid therapy and surgical therapies where appropriate.
Patients may develop complications as the airway is constricted through and shortness of breath characteristics of airway inflammation. Bronchiectasis represents a condition in which there are many etiological factors. Due to the long term duration of the disease, it is often hard to establish the exact role of such pathogenesis; this can be a risk factor on airway infection occurrence.
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