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SOURCE

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Source: Blackford MG, Glover ML, Reed MD. Lower respiratory tract infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071234. Accessed March 31, 2017.

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DEFINITION

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  • Presence of chronic cough productive of sputum lasting >3 consecutive months of the year for 2 consecutive years without underlying etiology of bronchiectasis or tuberculosis.

  • Clinical diagnosis for nonspecific disease of adults.

    • Component of chronic obstructive pulmonary disease (COPD)

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ETIOLOGY

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  • Contributing factors:

    • Cigarette smoking.

    • Exposure to occupational dusts, fumes, and environmental pollution.

    • Host factors (eg, genetic factors)

    • Bacterial or viral infections.

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PATHOPHYSIOLOGY

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  • Bronchial wall is thickened.

  • Increased number of mucus-secreting goblet cells in surface epithelium of both larger and smaller bronchi.

  • Hypertrophy of mucous glands and dilation of mucous gland ducts.

    • Mucus impairs normal lung defenses.

    • Smaller airways have mucus plugging.

    • Continued progression results in:

      • Scarring of small bronchi.

      • Airway obstruction.

      • Weakened bronchial walls.

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EPIDEMIOLOGY

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  • Affects most patients with COPD.

  • More common in men than women.

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PREVENTION

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  • Avoid exposure to triggers (eg, cigarette smoke, occupational dusts, etc.)

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RISK FACTORS

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  • Forced expiratory volume in first second of expiration (FEV1) <50% predicted.

  • Age >64 years.

  • >4 exacerbations per year.

  • Home oxygen use.

  • Underlying cardiac disease.

  • Use of immunosuppressants or antibiotics in past 3 months.

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CLINICAL PRESENTATION

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  • Presence of chronic cough productive of sputum lasting >3 consecutive months of the year for 2 consecutive years.

  • Clinical classification system (Figure 1):

    • Simple chronic bronchitis: No major risk factors.

    • Complicated chronic bronchitis: Two or more disease-associated risk factors listed above.

    • Severe complicated chronic bronchitis: Symptoms as in group above but clinically much worse.

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FIGURE 1.

Clinical algorithm for diagnosis and treatment of chronic bronchitic patients with an acute exacerbation incorporating principles of clinical classification system (AECB, acute exacerbation of chronic bronchitis; COPD, chronic obstructive pulmonary disease; CB, chronic bronchitis; TMP/SMX, trimethoprim/sulfamethoxazole). Reprinted with permission from Wells BG, DiPiro JT, Schwinghammer TL, et al. Pharmacotherapy Handbook. 10th ed. New York, NY: McGraw-Hill; 2017.

Graphic Jump Location
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SIGNS AND SYMPTOMS
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  • Hallmark of chronic bronchitis: cough ranging from mild “smoker’s cough” to severe incessant cough producing purulent sputum.

  • Excessive sputum production.

  • Dyspnea.

  • Cyanosis with advanced disease.

  • Obesity.

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DIAGNOSIS

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MEANS OF CONFIRMATION AND DIAGNOSIS
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  • History and physical examination.

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LABORATORY TESTS
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  • CBC

    • Erythrocytosis with advanced disease.

  • Sputum.

    • Common bacterial isolates in patients with acute exacerbation of chronic bronchitis (Table 1).

    • Microscopic assessment provides insight into disease progression.

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