Mechanisms of Improvement in Bronchopulmonary Disease

Abstract

The four most common of the chronic bronchopulmonary diseases, asthma, bronchitis, pneumonitis and emphysema, show great similarity in symptoms, physical findings, and x-ray picture. Therapy at the onset is similar in all these conditions. Long term therapy should be planned in consideration of the anatomic and pathologic changes which have occurred and be designed to take advantage of the methods and mechanisms by which improvement may occur. This study was done on 64 patients who demonstrated serious dyspnea, wheezing, cough and obvious loss of respiratory reserve. They were studied by x-ray examination, physical findings, electrocardiogram and pulmonary function testing. Treatment programs were instituted and progress evaluated at regular intervals. Asthma is a disease of allergic origin marked by bronchial obstruction caused by edema of the mucosa, spasm of the bronchi and large amounts of viscous secretion. The lung is not involved. Bronchial infection is an almost constant finding in chronic asthma. Improvement depends upon therapy designed to create and maintain a free airway and equalization of ventilation. Bronchitis demonstrates a clinical picture similar to asthma with, however, permanent pathology in the bronchial tree, more resistant to improvement and more likely to recur. Improvement depends upon elimination of infection, maintenance of a clear airway and adequate ventilation to aid in the drainage of bronchial secretion. Since the pathology is permanent, therapy must be continued after all the symptoms have disappeared. Pneumonitis is an inflammatory process involving the interalveolar septa and the interlobular areas of the lung. As a clinical entity it is associated with bronchial infection, frequently chronic bronchitis. Improvement depends upon treatment of the chronic bronchitis and an attempt to improve the expansion of the lung to yield more adequate ventilation. This improvement is limited by the degree of irreversible fibrosis. The pathology is permanent and all treatments must be continued indefinitely. Emphysema is a disease with diffuse bronchiolar obstruction associated with destruction of alveolar components. It is a diffuse disease with so complex a clinical picture that the therapy must be complex likewise. No one mode of treatment is adequate. Both bronchial and pulmonary pathology are permanent and irreversible. Improvement depends upon treatment of complicating bronchial factors, equalization of ventilation as much as is possible and the development of a more efficient type of ventilation correlated with physical activity. In all four types of disease, one mode of therapy was constant: bronchodilatation and maintenance of adequate ventilation. IPPB with a proper bronchodilator was found to meet this need. The bronchodilator must be one that can be continued for long periods of time without undesirable side reactions. Individual treatment and methods of rehabilitation must be determined by the particular pathophysiologic changes in each disease. Cardiac problems are frequently associated with chronic bronchopulmonary disease. These may be arteriosclerotic in origin because of the age of the average patient or cor pulmonale caused by the pulmonary disease. Improvement which occurs in cardiac status is generally due to the increased oxygenation of the blood and therefore of the myocardial muscle as well as to the reduction of pressure in the chest. All therapy must be long term in nature and regulated by the pathophysiologic changes which are occurring in the patient.