Bronchitis, Chronic

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.

• 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)

• Contributing factors:
  • Cigarette smoking
  • Exposure to occupational dusts, fumes, and environmental pollution
  • Host factors (e.g., genetic factors)
  • Bacterial or viral infections

• 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

• Affects most patients with COPD.

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

• 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

• 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

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

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.