What Is Bronchopneumonia: Symptoms, Causes, And Treatment

Bronchopneumonia classically causes: high fever , cough with phlegm , dyspnea , chest pain , rapid breathing and sweating .
Among the possible complications, the most feared is certainly sepsis .
Treatment depends on the underlying causes. In fact, bacterial bronchopneumonia requires a different therapy than viral bronchopneumonia.

Brief Anatomical Reminder

Lower Airways And Pulmonary Alveoli

The lower airways constitute that section of the respiratory system that begins at the level of the trachea and subsequently includes the bronchial tree – made up of bronchi and bronchioles – and the lungs .
Inside the lungs, there are small elastic sacs, called alveoli , in which the blood that reaches them is “loaded” with oxygen and “frees” itself of carbon dioxide (a waste product of the tissues).
A set of alveoli forms the so-called pulmonary acinus; a pulmonary acinus (or simply acinus) resides at the end of a pulmonary bronchiole. The pulmonary bronchioles are the final branches of the bronchial tree.
A group of multiple pulmonary acini, with their respective terminal bronchioles, constitutes the smallest structure of the lungs visible to the naked eye: the pulmonary lobule (or lobule).

What Is Bronchopneumonia?

Bronchopneumonia is a type of pneumonia almost always of infectious origin, characterized by inflammation of the bronchi, bronchioles and alveoli .
In various medical texts, it is also called lobular pneumonia , due to the fact that the inflammatory state affects one or more lung lobules.

BRONCHOPNEUMONIA AND LOBAR PNEUMONIA

In addition to bronchopneumonia, there are other types of infectious pneumonia.
A very common type, not to be confused with lobular pneumonia, is lobar pneumonia .
Lobar pneumonia generally affects one or more pulmonary lobes, i.e. the various portions that make up the lungs.

Causes

Bronchopneumonia is generally the result of a bacterial infection or a viral infection .
The main bacteria that can cause bronchopneumonia are:

• Staphylococcus aureus
• Streptococcus pneumoniae (or pneumococcus)
• Haemophilus influenzae
• Klebsiella pneumoniae
• Pseudomonas aeruginosa

As regards viruses, the viral agents that can cause bronchopneumonia are:

• Human respiratory syncytial virus
• The influenza A virus (or influenza type A virus ) and the influenza B virus (or influenza type B virus)
• The measles virus . In this case, bronchopneumonia is a complication of measles , the triggering virus of which is a morbillivirus .

OTHER CAUSES

Rarer forms of bronchopneumonia can arise as a result of:

• Ingestion of foreign material or food into the bronchial tree. In these cases, bronchopneumonia is also called ab ingestis bronchopneumonia .
• Inhalation of poisonous gases.
• Malnutrition .
• Serious chronic diseases, such as tuberculosis .
• Surgical interventions at the lower airway level.

RISK FACTORS

Bronchopneumonia affects certain categories of people more frequently.
For example, people such as:

• Children under the age of 2 years. Children are particularly at risk of viral bronchopneumonia
• People aged 65 and over
• Those who suffer from lung diseases , such as cystic fibrosis , asthma , or chronic obstructive pulmonary disease (COPD)
• Patients with AIDS (or HIV )
• Those who, as a result of taking chemotherapy or immunosuppressive drugs, have a weakened immune system
• Smokers _
• Those who have a history of severe alcoholism
• Those who have severe difficulty swallowing
• Malnourished people

• Fever between 39 and 40°C
• Cough with large production of phlegm
• Shortness of breath (dyspnea)
• Chest pain
• Rapid breathing
• Sweating
• Chills
• Heachache
• Muscle pain
• Recurring sense of fatigue
• Confusion or delirium (especially in older people)
• Loss of appetite

MACROSCOPIC APPEARANCE

The typical macroscopic characteristic of bronchopneumonia consists of the presence of multiple inflammatory foci, dispersed in one or both lungs (most frequent case).

HISTOLOGICAL APPEARANCE

From a histological point of view, bronchopneumonia involves the formation of a suppurative (or purulent ) exudate at the level of the air spaces formed by the alveoli, bronchi and bronchioles.

WHEN TO SEE THE DOCTOR?

It is best to contact your doctor at the first signs of bronchopneumonia, to prevent serious complications from arising.
It represents a medical emergency, to be treated as quickly as possible, bronchopneumonia characterized by severe chest pain, rapid breathing and confusion.

COMPLICATIONS

In case of inadequate treatment or in case of late diagnosis, bronchopneumonia can give rise to various complications, including:

• Sepsis (or septicemia ). In medicine, the term sepsis indicates a serious clinical condition that arises as a result of an abnormal inflammatory response , implemented by the body after the passage of pathogenic microorganisms into the blood .
  The symptoms that characterize a sepsis condition are: high fever, acceleration of the heart rate , acceleration of breathing, hypotension , confusion, paleness , cold chills and loss of consciousness .
• Pleurisy . It is the inflammation of the pleura , i.e. the membrane that lines the lungs and the cavities in which the lungs reside. The pleura has protective functions.
• Respiratory failure .
• Cardiovascular problems.
• Lung abscess .

Diagnosis

Typically, the diagnostic process for identifying bronchopneumonia begins with a thorough physical examination and a detailed medical history . Then, he continues with a complete blood count ( blood test ) and a chest x-ray ( chest x-ray ).
If after this series of evaluations the doctor still has doubts or has not yet fully understood the causes of bronchopneumonia, he may opt to carry out further in-depth tests, such as:

• A CT scan of the thoracic organs . This investigation provides three-dimensional images with a greater number of details than those provided by a chest x-ray . It is a slightly invasive procedure, as it involves exposing the patient to a certain amount of X-rays that are harmful to human health.
• A culture analysis of sputum , i.e. phlegm. This diagnostic test allows you to identify the microorganism responsible for the infection.
• A bronchoscopy . It consists of inserting, starting from the mouth and along the respiratory airways, an instrument equipped with a camera (endoscope), with which the doctor observes the cavities of the bronchial tree. It serves to provide further details on the characteristics of bronchopneumonia.
• Oximetry . _ Simple and immediate, it is a test for measuring oxygen saturation in the blood . To perform it, doctors use an instrument, the oximeter , which they apply to a finger or an earlobe .
  A low oxygen saturation indicates that breathing difficulties (dyspnea, etc.) are of a certain severity and deserve immediate treatment.

OBJECTIVE EXAMINATION

During the physical examination, the doctor first asks the patient to describe the symptoms felt. Afterwards, using a phonendoscope, he evaluates the patient’s breathing capacity, looking for any difficulties or abnormal sounds ( rattles , stridors , etc.).
Generally, the analysis using a phonendoscope is quite precise and allows us to establish which part of the lung or lungs is home to inflammatory foci.

BLOOD CHROME

The blood count allows you to understand whether the infection is bacterial or viral. In fact, the blood count of a person with a bacterial infection shows a high number of granulocytes (a type of white blood cell ), while the blood count of a person with a viral infection shows a high number of lymphocytes (another type of blood cell whites).

CHEST RADIOGRAPHY

The chest x-ray is probably the most reliable diagnostic test for identifying bronchopneumonia.
It is a minimally invasive procedure, as it involves exposing the patient to a small dose of X-rays.

Treatment

The treatment of bronchopneumonia varies based on the underlying causes .
If the origin of pneumonia is viral, doctors generally limit themselves to recommending a complete rest period of about one to two weeks. In these situations, the prescription of antiviral drugs is rare and occurs only when the symptoms are very severe or when the disease does not show appreciable signs of improvement.
For cases of bronchopneumonia of bacterial origin, the situation is decidedly different. Doctors, in fact, prescribe an antibiotic treatment, as this represents the only solution for eliminating the infectious agent. In such circumstances, it is essential that the patient completes the expected course of antibiotic therapies ; otherwise, there is a high risk that bronchopneumonia will return after some time (relapse).

REMEDIES VALID IN ALL CIRCUMSTANCES

Regardless of the cause that induced bronchopneumonia, symptomatic remedies (i.e. effective against the symptoms) are valid:

• Stay at complete rest
• Drink plenty of water and hot drinks. Adequate fluid intake prevents dehydration .
• Take paracetamol against fever

TREATMENT IN SEVERE CASES

Severe bronchopneumonia requires hospitalization . During a hospital stay
for bronchopneumonia, doctors may need to use assisted ventilation and intravenous drug administration .

Prognosis

Generally, bronchopneumonia diagnosed early and treated with the right methods has a positive prognosis.
On the contrary, bronchopneumonia detected late or treated inadequately is at high risk of complications and can even have unpleasant consequences.

Prevention

People at risk of bronchopneumonia can reduce (if not even prevent) the possibility of developing the aforementioned inflammatory condition by taking certain vaccinations .
For viral bronchopneumonia, doctors recommend annual influenza vaccination .
For bacterial bronchopneumonia, however, they recommend the anti-pneumococcal vaccine .

SIMPLE PREVENTIVE MEASURES

Washing your hands regularly, avoiding smoking , not abusing alcohol , keeping away from people suffering from pneumonia, practicing regular physical exercise , getting enough sleep and eating a balanced and healthy diet: these are all easy-to-implement behaviors that reduce the risk of develop a form of bronchopneumonia.

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