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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§ionid=146071234. Accessed March 31, 2017.
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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.
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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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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:
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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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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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MEANS OF CONFIRMATION AND DIAGNOSIS
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