ACUTE BRONCHOPNEUMONIA
SYNONYMS OR OTHER NAMES:-
Lobular pneumonia, broncho pneumonia, ensular pneumonia, catarrhal pneumonia.
DEFINITION:-
An acute catarrhal inflammation of the terminal bronchioles and air vesicles of the lung, the inflammation forming scattered points of consolidation throughout the lung. Catarrhal pneumonia may be acute or chronic but is generally a secondary disease.
AETIOLOGY:-
- Common organisms producing bronchopneumonia are bacteria’s like pneumococcus, streptococcus, staphylococcus and H. influenza.
- Most commonly occurs in children, may also occur in elderly persons.
- In children it may occur as a primary condition but more often it follows an attack of measles, whooping cough or acute bronchitis.
- In elderly peoples always secondary to acute or chronic bronchitis, emphysema or an attack of influenza.
PATHOLOGY:-
The process begins with acute inflammation of the terminal bronchioles. There is collection of exudates into the affected groups of alveoli followed by solidification or consolidation. Interstitial oedema and proliferation of cells may occur in the alveolar walls. Compensatory emphysema develops around non functioning or collapsed alveoli. Resolution may not be always complete as in case of lobar pneumonia. Pulmonary fibrosis and bronchiectatic changes are, therefore, likely to develop in the affected areas, more so in elderly patients.
SYMPTOMS:-
- The three cardinal symptoms are COUGH, DYSPNOEA AND FEVER.
- Initially the cough is dry and harassing but later becomes productive with purulent expectoration.
- Dyspnoea is prominent and particularly severe in children in whom it is often associated with central cyanosis.
- Fever runs high and is often associated with convulsions in children and rigors in adults.
EXAMINATION:-
The breath sounds are vesicular in character with prolonged expiration.Rhonchi (both sonorous and sibilant) are heard all over the chest bilaterally and symmetrically.Crepitations are present all over the chest. Presence of unusually coarse crepitations at one of the lung bases, signifies develops of bronchiectatic changes.
INVESTIGATIONS:-
- There is marked polymorpho nuclear leucocytosis.
- X-RAY – chest shows multiple patchy opacities with irregular outlines throughout both the lungs, more so in the lower zones.
- SPUTUM TEST – culture of sputum reveals a mixed bacteria flora.
COMPLICATIONS:-
- Capillary bronchitis.
- Phthisis.
- Pleuritis.
- Emphysema.
- Peripheral circulatory failure may occur in course of severe illness.
- Pulmonary fibrosis, bronchiectasis or lung abscess.
TREATMENT:-
- Confine the patient in bed, and frequently change is position.
- Keep the room at an even temperature and the atmosphere moistened with steam.
- The diet should be nutritious and liquid is more.
- Treatment may be started with co-trimoxazole or ampicillin orally or gentamicin intra-muscularly.
- In a severe case, corticosteroid given parenterally is life saving.
- Oxygen therapy is indicated if the patient is cyanosed.
HOMEOPATHIC TREATMENT:-
1. ACONITE:-
Acute, sudden, and violent invasion, with fever, call for it. First remedy for inflammations, inflammatory fevers. Hoarse, dry, croupy cough; loud, labored breathing. Child grasps at throat every time he coughs. Cough, dry, short, hacking; worse at night and after midnight. Cold sweat and icy coldness of face during fever. Thirst and restlessness always present.
2. ANTIMONIUM TARTARICUM:-
Great rattling of mucus, but very little is expectorated. Rapid, short, difficult breathing; seems as if he would suffocate; must sit up. Coughing and gaping consecutively. Bronchial tubes overloaded with mucus. Cough excited by eating, with pain in chest and larynx. Pulse rapid, weak, trembling. Dyspnoea relieved by eructation. Cough and dyspnoea better lying on right side - (opposite Badiaga). Coldness, trembling, and chilliness in fever. Intermittent fever with lethargic condition.
3. ARSENICUM ALBUM:-
For any dryness, when due to some organic trouble, particularly of the heart, or with emphysema, the cough is violent and dry, with shortness of the breath and suffocative spells, worse at night.raipid emaciation and debility, restlessness, anguish and fear of death.
4. BRYONIA ALBA;-
Dry, hacking cough from irritation in upper trachea. Cough, dry, at night; must sit up; worse after eating or drinking, with vomiting, with stitches in chest, and expectoration of rust-colored
sputa. Difficult, quick respiration; worse every movement; caused by stitches in chest. Expectoration brick shade, tough, and falls like lumps of jelly. Coming into warm room excites cough. [Nat. carb.]. Chill with external coldness, dry cough, stitches in fever.
5. CHELIDONIUM:-
Very quick and short inspirations; pain on deep inspiration. Dyspnoea. Short, exhausting cough; sensation of dust not relieved by cough. Whooping-cough; spasmodic cough; loose, rattling; expectoration difficult. Small lumps of mucus fly from mouth when coughing. Constriction of chest.
6. FERRUM PHOS:-
Bronchitis of young children. First stage of all inflammatory affections. Congestions of lungs. Short, painful tickling cough. Hard, dry cough, with sore chest. Expectoration of pure blood in pneumonia. [Millefol.]. Cough better at night. During fever Chill daily at 1 pm. All catarrhal and inflammatory fevers; first stage.
7. IPECAC:-
Dyspnoea; constant constriction in chest. Yearly attacks of difficult shortness of breathing. Cough incessant and violent, with every breath. Chest seems full of phlegm, but does not yield to coughing. Suffocative cough; child becomes stiff, and blue in the face. Bleeding from lungs, with nausea; feeling of constriction; rattling cough. Intermittent fever, irregular cases, after Quinine. Slightest chill with much heat, nausea, vomiting, and dyspnoea in fever.
8. PHOSPHOROUS:-
Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air. Sweetish taste while coughing. Hard, dry, tight, racking cough. Congestion of lungs. Pneumonia, with oppression; worse, lying on left side. Sputum rusty, blood-colored, or purulent. Nervous coughs provoked by strong odors, entrance of a stranger; worse in the presence of strangers; worse lying upon left side; in cold room.
9. PULSATILLA:-
Dry cough in evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucus expectoration. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation when lying on left side. [Phos.]. Smothering sensation on lying down. Chilliness, even in warm room, without thirst in fever. Chill about 4 pm.
10. TUBERCULINUM:-
Hard, dry cough during sleep. Expectoration thick, easy; profuse bronchorrhoea. Sensation of suffocation, even with plenty of fresh air. Hard, hacking cough, profuse sweating and loss of weight, rales all over chest. Deposits begin in apex of lung. (Repeated doses). Shortness of breath. Post-critical temperature of a remittent type. Here repeat dose every two hours. (Macfarlan).
Some of other drugs are ammonium iod, ammonium mur, antimonium ars, belladonna, iodum and kali carb.
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