COPD

Chronic Bronchitis

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Chronic Bronchitis, Blue Bloater

  • 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
  • Epidemiology
  1. Occurs in Cigarette smokers 10-12 years after starting
  2. Affects 10-15% of smokers
  • 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
  • Symptoms
  1. Dyspnea
    1. Initially on exertion
    2. Latter at rest
  2. Chronic productive cough
  • 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
  • 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
  1. Normal or increased lung markings
  • Risks/Complications
  1. Recurrent respiratory infection or Pneumonia
  2. Pulmonary Hypertension (Cor Pulmonale)
  3. Chronic Respiratory Failure
  • Management
  • Prognosis
  1. Ten year mortality of age 60 smokers: 60%
  • Staging
  • 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]