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Current time:0:00Total duration:11:10

Video transcript

so in chronic bronchitis the problem basically is that we have irritants which lead to inflammation which lead to the production of mucus which leads to all the problems in lung function let's write that lung function things like not getting enough oxygen not being able to breathe out so if that's our theme then it makes sense right to think of it one by one at each of these points what can we do to treat it so irritants first obviously to remove the irritant would be the best so first with irritants of course to remove this source of irritation irritation would always be the best first thing there should be thought of and I'm drawing a cigarette here no matter how much I sound like a broken record quitting smoking is hugely important to chronic bronchitis because it's the only thing that stops the source of the disease from getting worse everything else here is just treating symptoms but stopping the smoking actually stops the progression of the disease so I really want to throw that out there as our first thing to think about in treatment and of course other sources of irritants can lead to chronic bronchitis right a major source for chronic bronchitis especially in some parts of the world is pollution and this one is very hard to treat especially for one person whom you can't stop your city from being polluted so aside from moving there's not much that can be done usually sometimes there's occupational exposures like things to call or to asbestos depending on what this person works and of course we can always promote healthier work environments trying to protect themselves with masks or other things but as of right now these are still very high risk jobs for chronic bronchitis and of course we can have allergens so this the person can have some control over if you know what kind of allergens are irritating you can try to stop stay away from that as much as possible so just decreasing all of these and stop irritating the lungs is the first step to treating chronic bronchitis okay so given that this has already happened we're treating the symptoms inflammation is the body's response to irritants and in the lungs part of that response makes the muscles in the walls of the lungs spasm and that's how we get the cough and also the Airways narrow as part of the inflammation so if we draw a cross-section of the airway here we're looking down the tube like this and usually in a non irritated lung the lumen here might be about that wide this is smooth muscle and just different things layers of the wall there's glance there's connective tissue okay this is how along usually it looks like but when it's being irritated it spasms and the lumen gets so small like this it's hard for air to get through so all of these muscles are spasming and the walls are getting thicker like that and in our case there's gonna be some mucus in the luminous wall clogging it up so one important way to treat this is a right this is a bronco dilator so already know that bronco refers to the lungs bronco die later and this basically just makes opens the airway back up so the front collect dilator helps us go from this to this now there are different classes of drugs that all qualify as a bronchodilator because all that means it just opens the airway back up so one important class is a beta-2 agonist an agonist means it activates this receptor and beta receptors are part of the fight and flight response that a body has and their beta receptors all over the body including in our heart and then there are our eyes so during fight and flight our pupils get bigger so we can see a little better and of course and so we're talking about this right now it's also part of the lungs and the lungs it just opens up the airway like we talked about just now another class is the anti cholinergic so instead of agonist these are antagonists cholinergic that just means it goes against where the cholinergic s-- usually do now this is a completely different pathway but it does the same thing of opening up the lumen of the Airways we can get more breath in and the lung can be less inflamed so another completely different kind different class of anti-inflammatory drugs are the steroids and the leukotriene inhibitors leuco trying inhibitors so up here the bronchodilators really just treat the symptom of inflammation let's write that here the symptom but down here we'll bring out the the steroids and the leukotriene inhibitors these are the big guns that actually go to the actual site of the inflammation and stop it there so how inflammation works in our body is that there's a trigger so t4 trigger and it goes through a cascade one leads to another so we have a leading to be getting to see leading to D that all the way the last step is of leuco trying we've reached the end inflammation cascade inflammation has started and it will keep going so of course the local trying inhibitor is here it just gets rid of the last the product of this whole cascade so it tempers down the inflammation the steroids are earlier say in step C the steroids come in and stop the Cascade earlier here now I put a slash here but do not confuse them for being similar to each other or being interchangeable they're completely different but I had them together here because they both target the Cascade of the inflammation and stops it at the root instead of just going for the symptom of it like a bronchodilator okay let's keep going with our process here now for the mucus you might imagine that since they cough so much and that must be very uncomfortable we might give cough suppressants to these people you're probably seen that over-the-counter stops you from coughing and it's important to remember that for chronic bronchitis we do not to do the suppressants because the mucus started there we wanted to come out so again we have our Airways here and it's coated by the there's too much mucus here and we don't want it let me use a blue color because it's kind of a liquid okay here's all the mucus and week off all day long that's uncomfortable yes but imagine if we gave them the suppressant and they no longer cough it up this would just be full of mucus all clogged up this would actually be horrible for the patient the more clock we are the more we can have bacteria behind it we'll have pneumonia other infections so we really don't want that so as much as it's uncomfortable to cough unfortunately most of the time for productive coffers we need to let them keep coughing but we can go through these other treatments to go down in the inflammation maybe there won't make as much mucus to try to solve the problem that way and lastly we have to do with the fact that the lungs are not getting enough oxygen these people are called blue bloaters right because they have lower oxygen in their blood because the airways are so narrow and there's mucus so oxygen doesn't get through as well so we might think okay let's give them oxygen nowadays it's easy enough to do that in the hospital so or at home oxygen but I really want to put that in parenthesis because yes a lot of people get this but in some patients especially very sick patients we have to be very careful about giving them oxygen and here's why and here we have to talk about the issue of the breathing drive I mean you don't have to think about breathing all day long right that's because something in your brain automatically tells us to breathe this is there when you're asleep and it's a very powerful drive and it's important to remember that in most people let's say they're Oh - level is about this high their carbon dioxide level will be about this high it's gonna be lower and that differential is there so remember that oxygen goes in the blood during a breath and when breathe out the co2 comes out so if you're not breathing the co2 goes up and the oxygen comes down if you or I stop breathing it is the fact that our co2 would go up that signals our body in our brain that we're not breathing and the breathing Drive kicks in so in a person with alack bronchitis it is the fact that the co2 is going up that makes us breathe that signals our brain in our body and that ok I want to keep breathing when you get that gas out of there so co2 controls the breathing drive and people who don't have chronic bronchitis okay so this is a healthy H for healthy now let's look at people with chronic bronchitis what happens is that there Oh to level is lower to begin with and their co2 level is higher than normal so like that so the co2 being high no longer makes them breathe drive them to breathe it is the fact that this o - is low that controls their breathing Drive so if we give them oxygen here this can actually take away the breathing drive by giving them too much oxygen the body would think dizzy it's usually relying on the oxygen to breathe so with extra oxygen that drive might go away and this person can actually stop breathing especially when they're having a bad episode of chronic bronchitis so oxygen it is is used but it can be dangerous and it should be used with caution and this person should be monitored to make sure that they're still breathing unless they just want to mention that if a person has an acute episode just when the disease gets really bad we will treat them aggressively with steroids yes but one other thing we want to add are antibiotics because they might have an infection if they have it we've to treat it and they don't we want to prevent it because the extra mucus during an acute exacerbation can keep the bacteria in the lungs so we really want to get on top of that and make sure that we don't develop pneumonia on top of bad chronic bronchitis so here in a nutshell are the most common treatments for chronic bronchitis as you can see most of it is symptomatic means which means we don't get rid of the root of the problem remember to go back to the beginning whatever we can do to reduce the irritation to be with will be the best thing for the patient in the long term