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03-18-2009, 10:18 AM
Chronic Bronchitis


Definition: it is a disease of the bronchial tree characterized by:
Productive cough on most days of at least 3 consecutive ms for at least 2 successive years.

Causes: (chronic irritation)
Smoking dust and air fumes (as part of atmospheric
pollution industrial cities)

Role of infection:
It is an exacerbating factor rather than a cause.
Also exposure to dampness, sudden changes in temperature and to fog à execrations.


Pathological stages:
1- Simple bronchitis
mucosal edema congestion due to irritation
hypertrophy of mucous secreting glands and
no of goblet cell of bronchial tree à* mucous production
2- Mucopurulant 2ry (infection)
so the sputum à yellowish (during intercurrent infection)
3- Late, organic narrowing (Irreversible), it is called obstructive
stage, this stage is due to fibrosis and squamous metaplasia of bronchial wall


C/P
• Age > 40
• Sex: male > female
• Cough: Ch. Ch. see the definition
Sputum whitish
mucoid
yellowish (during infection)
more at the morning (up regulation of bronchial receptors at early morning)
• Dyspnea à usually with emphysema or bsonchosposm on top
• Respiration. failure (no top of chest infection)
N.B. Pt. With chronic Bronchitis


Chest infection (ppt. Factor)

Respiratory failure
(dyspnea + cyanosis + deterioration of consciousness)
To hospital
Chest care unit
• O2 therapy • Antibiotic
• Ventilator • Bronchodilatocy

General Exam
Signs of core pulmonale neck Veins
Lower Limb edema
congested Liver
Neck Veins epigastric pulsation (Rt. V++)
expiratory filling
with emphysema
Clubbing pulse P. paradoxius
Co2 *à bounding pulse
rare except with
Bronchiectasis on top

Local:
Inspection: Movementment ŻŻ (bilateral)
Signs of emphysema (see later)
Palpation:
● T.V.F. ŻŻ with emphysema (TVF equal on both sides)
● palpable rhonchi.
● epigastric pulsations.
Percussion: Hyper-resonance with emphysema.
Auscultation: Harsh Vesicular. breathing
ħ adventitious Sounds

rhonchi (obstruction)crepitations (secretion)
due to secretion or super imposed bronchospasm
N.B. complications of chronic. Bronchitis / emphysema.
• respiratory failure • P++
• 2ry polycythaemia • bronchiectasis
• Rt. V failure • bronchial Carcinoma
• Peptic ulcer


Investigations:
1. X-ray bronchovascularity - marking
signs of emphysema (late).
2. ECG à Rt. v++ - Rt. Axis D.
3. Blood gasses à ( 02 - Co2 ) with type II respiratory failure.
4. Respiratory Function tests à reveal ventilation defect


Treatment
• Avoid irritation, Antibiotic during by streptococci infections
• Expectorant + mucolytics H- influenza
Pneumococci
Bronchial drainage
• ħ bronchodilator, ħ long term domiciliary O2 therapy.
• Indications. Of steroids (controversy)
Used in Potentially reversible Pts
i.e. improvement of respiratory function
test after bronchodilator
OR if there are allergic element
Method 20 - 25 mg prednisolone / day
+follow up with respiratory function test
with improvement no response
gradual withdrawal gradual withdrawal
then replaced by and then stop
inhaled steroid
Role of steroids mucosal edema
fibrosis
antiallergic
Prognosis of chronic bronchitis
It is usually progressive disease with exacerbation and remission and eventually causing respiratory and right side heart failure.

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What is chronic bronchitis? video


Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)