CHRONIC BRONCHITIS

Definition:
 Chronic excessive production of mucus from the bronchi not due to known specific
disease (TB, Lung cancer, CHF, etc.)
 It manifests clinically by cough and increased sputum production for at least 3
consecutive months each year for 2 years
 The anatomical course is an increase in size and number of mucus producing elements in
the bronchi

Etiology:
 Major factors
o Cigarette smoking
o Recurrent respiratory tract infections
 More common in:
o Cigarette smokers
o Occupational exposure to noxious fumes/gases
o Host factors (genetics)
 Most common type of COPD
 Infections with respiratory viruses (childhood infections that may cause permanent
airway damage) is probably a common precipitating cause of acute exacerbation
 Important points to remember:
o Increase in number of doctor visits
o Increase in number of hospitalizations
o Increase in health care dollars
 Cigarette smoking leads to (80-90% of all COPD deaths):
o Chronic cough
o Chronic phlegm production
o Impaired lung function with evidence of obstructive patterns
o Pathological changes of airflow obstruction
o More rapid rate of decline in lung function
o Increase incidence of respiratory tract infections
o Increase incidence of death (3rd leading cause of death in the U.S.)

Pathology:
 Pathologic changes with Chronic Bronchitis include:
o Hypertrophy and hyperplasia of bronchial mucus glands
o Increase in goblet cells
o Widespread inflammation
 Other findings include:
o Narrowing of airways
o Increase in airway resistance
o Increase in mucus
o Edema
Pathophysiology:
 Physiologic changes due to hypertrophy & hyper-reactivity of the mucus glands Early
stages – chronic cough & increased mucus production
  Later stages – progression to airway obstruction, deterioration of Pulmonary Function
Testing (PFT) values and may lead to respiratory failure.

Clinical Manifestations:
 At first the symptoms of cough and expectoration is normal to the patient and they will
not seek help
 Later on – dyspnea (indicates significant airway obstruction)
 Patient with stable disease – normal vital signs and sensorium at rest
 With progression of disease – less exertion causes significant dyspnea
 Physical exam:
o Rhonchi & wheezing on auscultation
o JVD (jugular vein distention)
 Chest x-ray shows hyperinflation & increase in bronchvescicular markings
 PFT’s:
o Increase in RV
o Decrease in FVC and expiratory flows
o Normal static compliance & diffusing capacity

Management:
 Establish diagnosis of Chronic Bronchitis
 Optimize lung function
o Stop smoking
o Medications
o Home Oxygen
 Maximize patient’s functional status
o Nutritional Status
o Pulmonary rehabilitation
 Simplify medical regimen as much as possible
 Goal – prolong survival
 Instruct patient of on proper bronchial hygiene by:
o Avoid smoking, smoke, and air pollutants
o Adequate fluid intake
o CPT to loosen secretions, as necessary
o Bronchodilators
o Antibiotics, when necessary, for infections
 Educate and instruct

Disease Course & Prognosis:

 Most patients will have symptoms of chronic cough and expectoration without
developing disabilities – will have a normal life
 On the other hand, some patients will progress to increased airway obstruction,
deterioration of PFT’s, and perhaps, respiratory failure
 Pulmonary emphysema is a common complication of Chronic Bronchitis
 Once a patient shows evidence of pulmonary function abnormality, the prognosis is less
favorable
 Cessation of smoking and proper therapy will influence the outcome.