//fpnotebook.com/
Chronic Bronchitis
Aka: Chronic Bronchitis, Blue Bloater
- See Also
- COPD
- Emphysema
- COPD Management
- Acute Exacerbation of Chronic Bronchitis
- Antibiotic Use in COPD Exacerbation
- COPD Exacerbation Prevention
- COPD Action Plan
- Definition
- Chronic Obstructive Pulmonary Disease
- Productive Cough on most days
- Frequency: more than 3 months per year
- Duration: 2 years or more
- Epidemiology
- Occurs in Cigarette smokers 10-12 years after starting
- Affects 10-15% of smokers
- 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
- HaemophilusInfluenzae colonizes airway of smokers
- Creates an immune reaction in airways
- Isolated from Sputum in 60% stable Chronic Bronchitis
- Symptoms
- Dyspnea
- Initially on exertion
- Latter at rest
- Chronic productive cough
- 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
- Right ventricular heave
- S3 Gallop rhythm
- Leg Edema
- 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
- 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
- Radiology: Chest XRay
- Normal or increased lung markings
- Risks/Complications
- Recurrent respiratory infection or Pneumonia
- Pulmonary Hypertension (Cor Pulmonale)
- Chronic Respiratory Failure
- Management
- See COPD Management
- Prognosis
- Ten year mortality of age 60 smokers: 60%
- Staging
- See COPD Staging
- 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]