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SOURCE

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.

DEFINITION

  • 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)

ETIOLOGY

  • Contributing factors:

    • Cigarette smoking.

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

    • Host factors (eg, genetic factors)

    • Bacterial or viral infections.

PATHOPHYSIOLOGY

  • 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.

EPIDEMIOLOGY

  • Affects most patients with COPD.

  • More common in men than women.

PREVENTION

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

RISK FACTORS

  • 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.

CLINICAL PRESENTATION

  • 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.

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.

SIGNS AND SYMPTOMS

  • 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.

DIAGNOSIS

MEANS OF CONFIRMATION AND DIAGNOSIS

  • History and physical examination.

LABORATORY TESTS

  • 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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