NURS2003 Pathophysiology: Analyzing Roger Wilson's Bronchiectasis Case

This case study analyzes the pathophysiology and pharmacological management of Roger Wilson, a 32-year-old male with a history of asthma who presents with symptoms indicative of bronchiectasis and pneumonia. The analysis covers the underlying mechanisms of bronchiectasis, including airway damage, mucus accumulation, and recurrent infections, linking these to the patient's symptoms such as shortness of breath, fever, and productive cough. It also discusses the role of lung function tests in diagnosing bronchiectasis, highlighting airflow obstruction and bronchial wall thickening. Furthermore, the study explores pharmacological interventions, including antibiotic management with macrolides, inhaled corticosteroids, and bronchodilators like Ventolin, assessing their mechanisms of action and effectiveness in managing bronchiectasis and related conditions like asthma. Surgical options are also briefly discussed, and the importance of a stepwise treatment approach tailored to the severity of the disease is emphasized. The case study also highlights the long-term impact of bronchiectasis and the challenges in establishing the exact pathogenesis due to the chronic nature of the disease.

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UNIVERSITY
NAME
Case study assessment task

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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).

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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;
- Bad Odor
- Chest wheezing
- Recurrent lung infection
- Breathlessness in acute bronchiectasis
The onset of the symptoms normally occurs slowly. As the disease progresses,

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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 ions
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).

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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.
Antibiotic management
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

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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
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

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often hard to establish the exact role of such pathogenesis; this can be a risk factor on airway
infection occurrence.

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