II. 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

III. Epidemiology

  1. Occurs in Cigarette smokers 10-12 years after starting
  2. Affects 10-15% of smokers

IV. 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. Haemophilus Influenzae colonizes airway of smokers
    1. Creates an immune reaction in airways
    2. Isolated from Sputum in 60% stable Chronic Bronchitis

V. Symptoms

  1. Dyspnea
    1. Initially on exertion
    2. Latter at rest
  2. Chronic productive cough

VI. Signs

  1. "Blue Bloater"
    1. Stocky and obese
    2. Hypoventilation despite marked Hypoxia
      1. Blue Bloaters under-recognize exacerbations (in contrast to the Hyperventilation of Pink Puffers)
    3. Hypercarbia resulting in increased sedation and lethargy
    4. Cyanotic (polycythemic with increased desaturated Hemoglobin >5 g/dl)
    5. Contrast with "Pink Puffer" of Emphysema
  2. Coarse rhonchi and Wheezes
  3. Right sided Heart Failure
    1. Right ventricular heave
    2. S3 Gallop rhythm
    3. Leg Edema
  4. 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
  5. 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

VII. 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

VIII. Radiology: Chest XRay

  1. Normal or increased lung markings

IX. Risks/Complications

  1. Recurrent respiratory infection or Pneumonia
  2. Pulmonary Hypertension (Cor Pulmonale)
  3. Chronic Respiratory Failure

X. Management

XI. Prognosis

  1. Ten year mortality of age 60 smokers: 60%

XII. Staging

XIII. 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 [PubMed]
  4. Martinez (1998) Postgrad Med 103(4):112-25 [PubMed]

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Related Studies

Ontology: Bronchitis, Chronic (C0008677)

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
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