Pulmonology Book

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Chronic Bronchitis

Aka: Chronic Bronchitis
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  1. Definition
    1. Chronic Obstructive Pulmonary Disease
    2. Productive Cough on most days
      1. Frequency: more than 3 months per year
      2. Duration: 2 years or more
  2. Epidemiology
    1. Occurs in Cigarette smokers 10-12 years after starting
    2. Affects 10-15% of smokers
  3. Pathophysiology: "Sputum, spasm, and swelling"
    1. Chronic excessive mucus secretion
      1. Hypertrophy of mucus-secreting glands
    2. Smooth muscle hyperplasia
    3. Bronchial Hyperresponsiveness
      1. Occurs in 50% of COPD patients
    4. HaemophilusInfluenzae colonizes airway of smokers
      1. Creates an immune reaction in airways
      2. Isolated from Sputum in 60% stable Chronic Bronchitis
  4. Symptoms
    1. Dyspnea
      1. Initially on exertion
      2. Latter at rest
    2. Chronic productive cough
  5. Signs
    1. "Blue Bloater"
      1. Stocky and obese, markedly hypoxic and cyanotic
      2. Contrast with "Pink Puffer" of Emphysema
    2. Coarse rhonchi and Wheezes
    3. Right ventricular heave
    4. S3 Gallop rhythm
    5. Edema
    6. Assess Lung excursion on each side
      1. Place one hand anterior to lower chest
      2. Place one hand posterior to lower chest
      3. Patient takes a deep breath
      4. Compare sides
      5. Reassess excursion after Inhaled Bronchodilator
    7. Assess bilateral airway Sputum
      1. Palpate anterior superior chest
      2. Ask patient to cough
      3. Compare vibration from side to side
      4. Consider self chest percussion to bring up Sputum
  6. Labs
    1. Arterial Blood Gas (ABG)
      1. Markedly reduced arterial pO2
      2. Elevated arterial pCO2 (40-50 mmHg)
    2. Pulmonary Function Tests
      1. Residual Volume increased
      2. FEV1 decreased
      3. FEV1/FVC decreased
      4. FEF 25-75 (mid-flows) decreased
      5. Diffusion capacity (DLCO) near normal
  7. Radiology: Chest XRay
    1. Normal or increased lung markings
  8. Risks/Complications
    1. Recurrent respiratory infection or Pneumonia
    2. Pulmonary Hypertension (Cor Pulmonale)
    3. Chronic respiratory failure
  9. Management
    1. See COPD Management
  10. Prognosis
    1. Ten year mortality of age 60 smokers: 60%
  11. Staging
    1. See COPD Staging
  12. References
    1. Pell (2001) CMEA Medicine Lecture, San Diego
    2. Pell (1998) CMEA Medicine Lecture, San Diego
    3. Heath (1998) Am Fam Physician 57:2365-78
    4. Martinez (1998) Postgrad Med 103(4):112-25

Bronchitis, Chronic (C0008677)

Definition (MSH) A subcategory of CHRONIC OBSTRUCTIVE PULMONARY DISEASE. The disease is characterized by hypersecretion of mucus accompanied by a chronic (more than 3 months in 2 consecutive years) productive cough. Infectious agents are a major cause of chronic bronchitis.
Definition (CSP) condition characterized by persistent coughing, increased secretion from the bronchial mucosa, obstruction of the respiratory passages, scanty or profuse expectoration, and necrosis and fibrosis of the respiratory tract.
Concepts Disease or Syndrome (T047)
MSH D029481
ICD9 491.9, 491
ICD10 J42
SnomedCT 155566007, 195956002, 63480004, 155572007, 266395007
English Unspecified chronic bronchitis, BRONCHITIS, CHRONIC, CHRONIC BRONCHITIS, BRONCHITIS CHRONIC, Chronic bronchitis, NOS, Chronic bronchitis NOS, Chronic bronchitis, clinical syndrome, Chronic emphysema syndrome, chronic bronchitis, chronic bronchitis (diagnosis), Bronchitis chronic NOS, Chronic bronchitis, unspecified, Chronic bronchitis NOS (disorder), Bronchitis, Chronic [Disease/Finding], Bronchitis;chronic, Bronchitis, Chronic, Chronic Bronchitis, Bronchitis chronic, Chronic bronchitis, Chronic bronchitis (disorder), bronchitis; chronic, chronic; bronchitis
Dutch chronische bronchitis, chronische bronchitis, niet-gespecificeerd, bronchitis chronisch NAO, niet-gespecificeerde chronische bronchitis, Chronische bronchitis, bronchitis; chronisch, chronisch; bronchitis, Niet gespecificeerde chronische bronchitis, bronchitis chronisch, Bronchitis, chronische
French Bronchite chronique SAI, Bronchite chronique non précisée, Bronchite chronique
German chronische Bronchitis, unspezifisch, unspezifische chronische Bronchitis, Bronchitis chronisch NNB, Nicht naeher bezeichnete chronische Bronchitis, chronische Bronchitis, Bronchitis, chronische
Italian Bronchite cronica non specificata, Bronchite cronica NAS, Bronchite cronica
Portuguese Bronquita crónica NE, Bronquite crónica NE, Bronquite crónica, Bronquite Crônica
Spanish Bronquitis crónica no especificada, Bronquitis crónica NEOM, Chronic bronchitis NOS, Chronic bronchitis, bronquitis crónica (trastorno), bronquitis crónica, SAI (trastorno), bronquitis crónica, SAI, bronquitis crónica, Bronquitis crónica, Bronquitis Cronica, Bronquitis Crónica
Japanese 慢性気管支炎ＮＯＳ, 詳細不明の慢性気管支炎, 慢性気管支炎、詳細不明, ｼｮｳｻｲﾌﾒｲﾉﾏﾝｾｲｷｶﾝｼｴﾝ, ﾏﾝｾｲｷｶﾝｼｴﾝ, ﾏﾝｾｲｷｶﾝｼｴﾝNOS, ﾏﾝｾｲｷｶﾝｼｴﾝｼｮｳｻｲﾌﾒｲ, 慢性気管支炎, 気管支炎-慢性
Swedish Bronkit, kronisk
Czech bronchitida chronická, Blíže neurčená chronická bronchitida, Chronická bronchitida, Chronická bronchitida, blíže neurčená, Chronická bronchitida NOS
Finnish Krooninen keuhkoputkitulehdus
Russian BRONKHIT KHRONICHESKII, БРОНХИТ ХРОНИЧЕСКИЙ
Korean 상세불명의 만성 기관지염
Polish Zapalenie oskrzeli przewlekłe, Przewlekłe zapalenie oskrzeli
Hungarian Chronikus bronchitis, Chronikus bronchitis k.m.n., Bronchitis chronica, Chronikus bronchitis, nem meghatározott, Nem meghatározott chronikus bronchitis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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