II. Definition
- Chronic Obstructive Pulmonary Disease
- Productive Cough on most days
- Frequency: more than 3 months per year
- Duration: 2 years or more
III. Epidemiology
- Occurs in Cigarette smokers 10-12 years after starting
- Affects 10-15% of smokers
IV. Pathophysiology: "Sputum, spasm, and swelling"
- Chronic excessive mucus secretion
- Hypertrophy of mucus-Secreting glands
- Smooth Muscle hyperplasia
-
Bronchial Hyperresponsiveness
- Occurs in 50% of COPD patients
-
Haemophilus Influenzae colonizes airway of smokers
- Creates an immune reaction in airways
- Isolated from Sputum in 60% stable Chronic Bronchitis
V. Symptoms
-
Dyspnea
- Initially on exertion
- Latter at rest
- Chronic productive cough
VI. Signs
- "Blue Bloater"
- Stocky and obese
- Hypoventilation despite marked Hypoxia
- Blue Bloaters under-recognize exacerbations (in contrast to the Hyperventilation of Pink Puffers)
- Hypercarbia resulting in increased sedation and lethargy
- Cyanotic (polycythemic with increased desaturated Hemoglobin >5 g/dl)
- Contrast with "Pink Puffer" of Emphysema
- Coarse rhonchi and Wheezes
- Right sided Heart Failure
- Assess Lung excursion on each side
- Place one hand anterior to lower chest
- Place one hand posterior to lower chest
- Patient takes a deep breath
- Compare sides
- Reassess excursion after Inhaled Bronchodilator
- Assess bilateral airway Sputum
- Palpate anterior superior chest
- Ask patient to cough
- Compare vibration from side to side
- Consider self chest percussion to bring up Sputum
VII. Labs
-
Arterial Blood Gas (ABG)
- Markedly reduced arterial pO2
- Elevated arterial pCO2 (40-50 mmHg)
-
Pulmonary Function Tests
- Residual Volume increased
- FEV1 decreased
- FEV1/FVC decreased
- FEF 25-75 (mid-flows) decreased
- Diffusion capacity (DLCO) near normal
VIII. Radiology: Chest XRay
- Normal or increased lung markings
IX. Risks/Complications
- Recurrent respiratory infection or Pneumonia
- Pulmonary Hypertension (Cor Pulmonale)
- Chronic Respiratory Failure
X. Management
- See COPD Management
XI. Prognosis
- Ten year mortality of age 60 smokers: 60%
XII. Staging
- See COPD Staging
XIII. References
- Pell (2001) CMEA Medicine Lecture, San Diego
- Pell (1998) CMEA Medicine Lecture, San Diego
- Heath (1998) Am Fam Physician 57:2365-78 [PubMed]
- Martinez (1998) Postgrad Med 103(4):112-25 [PubMed]
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| Definition (MEDLINEPLUS) |
Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It causes a cough that often brings up mucus, as well as shortness of breath, wheezing, and chest tightness. There are two main types of bronchitis: acute and chronic. Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed bronchi produce a lot of mucus. This leads to cough and difficulty getting air in and out of the lungs. Cigarette smoking is the most common cause. Breathing in other fumes and dusts over a long period of time may also cause chronic bronchitis. Treatment will help your symptoms, but chronic bronchitis is a long-term condition that keeps coming back or never goes away completely. NIH: National Heart, Lung, and Blood Institute |
| Definition (NCI) | A type of chronic obstructive pulmonary disease characterized by chronic inflammation in the bronchial tree that results in edema, mucus production, obstruction, and reduced airflow to and from the lung alveoli. The most common cause is tobacco smoking. Signs and symptoms include coughing with excessive mucus production, and shortness of breath. |
| 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, 155572007, 266395007, 195956002, 63480004 |
| LNC | LA10560-3 |
| English | Unspecified chronic bronchitis, chronic bronchitis, chronic bronchitis (diagnosis), Bronchitis chronic NOS, Chronic bronchitis, unspecified, Bronchitis, Chronic [Disease/Finding], Bronchitis;chronic, Chronic bronchitis NOS, Bronchitis, Chronic, Chronic Bronchitis, Chronic bronchitis NOS (disorder), -- Chronic Bronchitis, Bronchitis chronic, Chronic bronchitis, Chronic bronchitis (disorder), bronchitis; chronic, chronic; bronchitis, Chronic bronchitis, NOS |
| 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, bronquitis crónica, SAI (trastorno), bronquitis crónica, SAI, bronquitis crónica (trastorno), bronquitis crónica, Bronquitis crónica, 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 |
| Norwegian | Kronisk bronkitt |
