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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)
++
- 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
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- 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
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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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- 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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