Medical Management of Bronchiectasis Assignment

Case Study Analysis

Case Overview

A 50 year old presents to the emergency department with chest congestion with purulent sputum production for the last 3 days. She also has dyspnea which is not relieved by albuterol inhaler. She has a positive history tobacco use for 10 years and COPD. The vital signs are unremarkable except pulse rate of 108b/minute and respiration of 22breaths/minute. Chest x-ray reveals hyperinflation with a flattened diaphragm. The paper will explain the pulmonary pathophysiologic processes that causes the symptoms, the racial/ethnic variables that impact physiologic functioning and how these processes affect the patient. Medical Management of Bronchiectasis Assignment

Introduction

Bronchiectasis is a chronic lung disease that is defined by abnormal and permanent dilatation of the bronchial airways and weakening of the mucocilliary transport mechanism function resulting in recurrent infections owing to mucus pooling and bacterial invasion throughout the bronchial tree. The disease may be limited to a single lung segment/ lobe or it may affect one or both lungs more diffusely. According to O’Donnell, (2018), factors such as smoking, extreme of ages and chronic obstructive pulmonary disease are important considerations.

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Pulmonary Pathophysiologic Processes

Conditions such as chronic obstructive airway disease, severe asthma, alpha-1 antitrypsin deficiency, tuberculosis and others have common features that lead to dilatation and remodeling of the airways. The conditions result in inflammation that damages the bronchial walls stimulating the formation of excess thick mucus. The moist and warm environment causes further inflammation, impaired mucociliary clearance and airway secretions retention that interfere with the host immunity therefore rendering the airways more vulnerable to chronic infections (Keir & Chalmers, 2021). The thick mucus causes damage of the cilia and stimulates the immune response to release toxic inflammatory chemicals such as neutrophils that results in bronchospasm and fibrosis if persistent. Medical Management of Bronchiectasis Assignment

The recurrent bacterial infections triggers an inflammatory response that causes injury and abnormal remodeling of the airways resulting in bronchiectasis. These mechanisms leads to the clinical presentation that includes; long-standing purulent cough, pleuritic chest pain, dyspnea, intermittent wheezing, weight loss and hemoptysis.

Racial/Ethnic Variables That May Impact Physiologic Functioning

Research studies suggest that bronchiectasis was described in a population of mainly white ethnic group of patients (Assari et al., 2020). However, there is a change in the demographics to African Americans having the disease due to the risk factors. COPD is increasingly being recognized as a major health problem among African Americans. COPD which often complicates to bronchiectasis is common in African Americans develop the disease due to biological, socioeconomic and cultural factors.

How the Processes Interact

African Americans are more susceptible to risk factors such as tobacco smoking and exposure to secondhand smoke which is associated with an increased risk of COPD hence bronchiectasis (Mamary et al., 2018). Studies suggest that may be explained by poor health seeking behaviors, barriers to access of healthcare services, low socioeconomic status and increased cases of medication non-adherence. Medical Management of Bronchiectasis Assignment

Conclusion

Bronchiectasis is a debilitating disease and is responsible for notable loss of lung function and can lead to increased morbidity and early mortality (O’Donnell, 2018). Patients with bronchiectasis should have a personalized approach that is needed to formulate an optimal management plan to prevent disease progression.

References

Assari, S., Chalian, H., & Bazargan, M. (2020). Race, Ethnicity, Socioeconomic Status, and Chronic Lung Disease in the U.S. Research in Health Science, 5(1), p48. https://doi.org/10.22158/rhs.v5n1p48

Keir, H. R., & Chalmers, J. D. (2021). Pathophysiology of Bronchiectasis. Seminars in Respiratory and Critical Care Medicine, 42(04), 499–512. https://doi.org/10.1055/s-0041-1730891

Mamary, A. J., Stewart, J. I., Kinney, G. L., Hokanson, J. E., Shenoy, K., Dransfield, M. T., Foreman, M. G., Vance, G. B., & Criner, G. J. (2018). Race and gender disparities are evident in COPD underdiagnoses across all severities of measured airflow obstruction. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 5(3), 177–184. https://doi.org/10.15326/jcopdf.5.3.2017.0145

O’Donnell, A. E. (2018). Medical management of bronchiectasis. Journal of Thoracic Disease, 10(S28), S3428–S3435. https://doi.org/10.21037/jtd.2018.09.39

Case Scenario:
A 50-year-old white female presents to the emergency room with complaints of increased chest congestion with purulent sputum production for the last 3 days. The patient reports she has had some increased dyspnea and is using her albuterol inhaler which isn’t helping her symptoms. The patient reports a history of tobacco use for last 10 years and a history of COPD which was diagnosed last year. The patient reports that her primary care provider ordered another medication for the COPD but she couldn’t afford it. The patient denies fever. The patient’s vital signs: BP 148/90, pulse 108, respirations 22, O2 sat 92%, and temp 98.1F. Chest x-ray reveals hyperinflation with flattened diaphragm but is without effusions or infiltrates. Medical Management of Bronchiectasis Assignment

The Assignment
In your Case Study Analysis related to the scenario provided, explain the following
• The pulmonary pathophysiologic processes that result in the patient presenting these symptoms.
• Any racial/ethnic variables that may impact physiological functioning.
• How these processes interact to affect the patient.
Rubric

This criterion is linked to a Learning Outcome Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following: Explain pulmonary pathophysiologic processes of why the patient presents these symptoms.

This criterion is linked to a Learning OutcomeExplain how the pulmonary pathophysiologic processes interact to affect the patient.

Explain any racial/ethnic variables that may impact physiological functioning. Medical Management of Bronchiectasis Assignment