Chronic bronchitis

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Nurdina afi ni binti izamudin

introduction

 Chronic bronchitis is defined as a cough that

occurs every day with sputum production that

lasts for at least 3 months, 2 years in a row.
Inflammation and swelling of the lining of the
airways, leading to narrowing and obstruction
generally resulting in daily cough.
The inflammation stimulates production of mucus,
which can cause further blockage of the airways.
Obstruction of the airways, especially with mucus,
increases the likelihood of bacterial lung
infection.
Chronic bronchitisis common in persons who have
smoked for extended periods.

Normal bronchi and bronchi with bronchitis

Aetiology

 Cigarette smoke
Statistics from the US Centers for Disease Control and
Prevention (CDC):
1. 49% of smokers develop chronic bronchitis
2. 24% develop emphysema/COPD
3.

Some researchers suggest that about 90% of cases of

chronic bronchitis are directly or indirectly caused by
exposure to tobacco smoke.

. Inhaled irritants (for example, smog, industrial

pollutants, and solvents) can also result in chronic

bronchitis.
.Viral and bacterial infections that result in acute
bronchitis may lead to chronic bronchitis if people
have repeated bouts with infectious agents.

 Underlying disease processes

asthma
2. cystic fibrosis
3. immunodeficiency
4. congestive heart failure
5. familial genetic predisposition to bronchitis
6. congenital
7. acquired dilation of the bronchioles, known
asbronchiectasis) may cause chronic bronchitis
to develop
but these are infrequent causes compared to
cigarette smoking.
1.

pathophysiology

 Chronic bronchitis results from inflammation of the bronchi.

Increasing mucus production, chronic cough, and eventual

scarring of the bronchial lining.

The clinical manifestations of chronic bronchitis is continue for

at least 3 months of the year for 2 consecutive years.

Chronic bronchitis is characterized by the following:
1.

An increase in the size and number of submucus glands in

large bronchi, which increases mucus production.

2.

An increased number of goblet cells, which also secrete

mucus.

3.

Impaired ciliary function, which reduces mucus clerance.

. The lungs mucociliary defenses are impaired, and there is

increased susceptibility to infection.

. When infection occurs, mucus production is greater, and the

bronchial walls become inflamed and thickened.

. Chronic bronchitis initially affects only the larger bronchi but

eventually all the airways are involved.

 The thick mucus and inflamed bronchi obstruct the airways,

especially during expiration.

The airways collapse, and air is trapped in distal portion of

the lung.
This obstruction lead to reduced alveolar ventilation.
An abnormal ventilation-perfusion V/Q ratio develops, with a

corresponding fall in Pa02.

Impaired ventilation may also results in increased levels

Paco2.
As compensation for the hypoxemia, polycythemia

(overproduction of erythrocytes) occurs.

Sign and symptoms

Frequent Hacking Cough

Production of mucus (sputum), which

can be clear, white, yellowish-gray or

green in color depending on bacterial
infection. (sometime tinged with
blood if small blood vessels are
ruptured due to constant coughing)
Fatigue
Slight fever and chills
Chest discomfort

 As chronic bronchitis progresses:

Cough lasts more than three weeks and more

unproductive
Prevent you from sleeping
Is accompanied by fever over 38 C
Produces discolored mucus early in the morning
Produces blood (hemoptysis)
Is associated with wheezing or shortness of breath
Some pain below breastbone during deep breathing
Nasal congestion
Muscle aches
Headaches
Sore throat
Malaise

Doctor mx.

Doc. Diagnosis
o By using a combination of a persons medical history, physical exam, and

diagnostic tests
o A history of a daily cough that lasts at least 3 months, especially if has

occurred two years in a row.

o A history of smoking/ working with noxious chemicals.
o Physical examination:
1.

Listening for wheezing

2.

Determine if there is a prolongation of exhalation

3.

Looking for evidence of cyanosis, which are all signs of airflow obstruction.

4.

A sputum sample showing neutrophil granulocytes (inflammatory white

blood cells)

5.

A positive culture for pathogenic microorganisms such as

Streptococcal species.

6.

For expectorated sputum samples to be considered valid, conventional

wisdom is that there should be fewer than 10 squamous cells and more
than white blood cells per high power microscopic field.

Chest X-ray

1.

To help rule out other lung conditions such as pneumonia,

tubercolosis, or bronchial obstructions.

2.

Can reveal hyperinflation of the lungs or diaphragmatic

flattening which is suggestive of chronic bronchitis, or lung
collapse and consolidation which would support a
diagnosis of pneumonia.

o. Complete blood count

o. Arterial blood gas measurements
o. CT scan of the chest are often done to characterize the

function of lungs and help exclude other serious conditions

such as lung cancer.

Doc. Rx
Two major classes of medications used to threat chronic

bronchitis:
1)

Bronchodilators

2)

Corticosteroids

. Wheezing and shortness of breath are treated by reducing

bronchospasm with bronchodilators such as:

1.

Inhaled anticholinergics

2.

Inhaled beta-adrenergic agonists

3.

Methylated xanthine derivatives

. Inflammation and oedema of the respiratory epithelium may

be reduced with inhaled corticosteroids and PDE4 inhibitors.

. Over- the- counter (OTC) drugs can be helpful for

expectoration and suppressing cough reflex.