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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. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. http://www.accesspharmacy.com/content.aspx?aid=8001618. Accessed July 12, 2012.

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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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  • Contributing factors:
    • Cigarette smoking
    • Exposure to occupational dusts, fumes, and environmental pollution
    • Host factors (e.g., 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:
      • Scarring of small bronchi
      • Airway obstruction
      • Weakened bronchial walls

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  • Affects most patients with COPD.

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

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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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  • 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.
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Clinical algorithm for diagnosis and treatment of chronic bronchitic patients with 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. 8th ed. New York: McGraw-Hill, 2012.

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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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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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Table Graphic Jump Location
Table 1. Common Bacterial Isolates in Chronic Bronchitis

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