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Dictionary The Respiratory System

Bronchitis

Clinical features, Diagnosis, Management, Prognosis,

    Strict criteria have been developed for diagnosis of chronic bronchitis to be made: productive cough on most days on at least three consecutive months for more than two successive years, providing other causes of productive cough such as bronchiectasis and untreated chronic asthma have been excluded. Chronic bronchitis appears develops in response to the long-continued action of various types of irritants on the bronchial mucosa in susceptible individuals. These are:

           cigarette tobacco smoke (the most important one)

           dust

           smokes and fumes occurring at workplace in certain industries (apparently cadmium is especially toxic)

           general atmospheric pollution in industrial cities and towns particularly with sulphur dioxide and particulates (increasingly important problem) 

    Infection usually with Streptococcus pneumoniae (pneumococcus) and/or Haemophilus influenzae is very important in aggravating the established condition, but it is not essential for development/progression of the condition. In other words chronic bronchitis is not a chronic bacterial infection. It is now known that many exacerbations of chronic bronchitis are due to upper respiratory viral infections (e.g., rhinoviruses) and to environmental factors such as exposure to dampness, sudden changes in temperature and to fog. Pathologically, there is mucosal oedema with infiltration with macrophages and neutrophils, hypertrophy of bronchial glands and permanent structural damage (scaring) of the airway walls that reduce the calibre of the air passages. 

    A major proportion of airflow obstruction in chronic bronchitis is irreversible unlike the airflow obstruction in chronic asthma. Air becomes “trapped?in the alveoli because the degree of obstruction is greater during expiration. Overdistension of the alveoli results and disruption of their walls may occur (emphysema). 

    Chronic bronchitis can occur in several forms that to some extent reflect the natural progression of the disease:

             Initially patients tend to have simple chronic bronchitis; the productive cough raises mucoid sputum, but airflow is not obstructed; this type can not be regarded as COPD

             If the sputum also contains pus, presumably because of secondary infections, the patient is said to have chronic mucopurulent bronchitis; also not included in COPD

             Some patients with chronic bronchitis may demonstrate hyper-responsive airways and intermittent episodes of asthma. This condition, termed chronic asthmatic bronchitis, is often difficult to distinguish from real asthma. Actually it appears that in cases like this there is concomitant asthma.

             Eventually bronchitic patients develop persistent airway obstruction, and they are said to have chronic obstructive bronchitis; this form is associated with substantial morbidity and mortality

Clinical features:  < BACK TO TOP >

           The main feature is repeated attacks of productive cough, usually after colds during the winter months, but eventually cough is present all the year round.

           Morning cough with large amounts of sputum is characteristic, especially in heavy smokers (smoking reduces ciliary clearance of mucus).

           Sputum may be mucoid and tenacious and occasionally streaked with blood (haemoptysis); purulent sputum was thought to be an indication of bacterial infection, but this may not be the case in all patients.

           Wheeze, breathlessness and tightness in the chest are almost always found, central cyanosis due to impaired gas exchange and hypoxaemia may follow when the mucous membranes of the lips and tongue appear bluish.

           For reasons not entirely clear, the patients tend to be obese.

           Clinical pattern often referred to as the “blue and bloated?/i> type may be seen in late stage of chronic bronchitis; these patients are cyanosed and bloated from obesity and right-sided heart failure (see below) with consequent peripheral oedema. 

    Important complications:

           Pulmonary hypertension due to reflex constriction of pulmonary arterioles in hypoventilated areas of the lungs as well as due to destruction of the pulmonary vascular bed by associated emphysema.

           Right ventricular failure (cor pulmonale) is a final consequence of the pulmonary hypertension and the major cause of death in these patients.

Diagnosis:  < BACK TO TOP >

           It is largely clinical when above mentioned criteria are met.

           X-ray of the lungs usually produces no characteristic abnormalities.

           Pulmonary function tests are abnormal ?TLC, RV are reduced, forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) and VC are reduced which is consistent with airflow obstruction. These findings are not substantially improved by inhaled bronchodilators although most patients report subjective improvement.

           In more advanced stages hypoxaemia (reduction of PO2) can be found, later on followed by hypercapnia (a rise in PCO2).

           Exercise test (e.g., distance walked in 10 minutes, number of stairs the patient can climb in a continuous attempt) is a valuable estimate of everyday disability.

Management  < BACK TO TOP >

           Reduction of bronchial irritation is achieved through stopping smoking (the only measure that can slow down progression of the disease), avoidance of dusty and smoke-laden atmospheres and even a change of occupation if necessary.

           Treatment of respiratory infection (if identified) is very important; the vast majority of bacterial infections are caused by Streptococcus pneumoniae and Haemophilus influenzae which respond to many broad-spectrum antibiotics; however this type of treatment does not significantly alter the course of the disease.

           It is useful to try to stimulate expectoration by giving the patient plenty of fluid, hot drinks or inhalations of steam (drugs which claim to reduce sputum viscosity such as guaiphenesin [Robitussin], bromhexine [Bisolvon] and acetylcysteine [Mucomyst] are of little or no value).

           Bronchodilator drugs can be tried, and their value in each particular case should be assessed. In general they are much less effective than in bronchial asthma, but they still improve symptoms and exercise tolerance.

           The type of chronic inflammation found in chronic bronchitis does not respond well to corticosteroids in contrast to bronchial asthma.

           In case of severe exacerbations hospital treatment is necessary with bronchodilator therapy, intravenous rehydration, oxygen therapy and physiotherapy (tapping massage) to assist expectoration.

Prognosis  < BACK TO TOP >

  • - - 

Nutrition  < BACK TO TOP >

Nutrition that alleviate or prevent bronchitis :-

Herbs  < BACK TO TOP >

Herbs that alleviate or prevent bronchitis :-
Codonopsis pilosula (Codonopsis)
Glycyrrhiza glabra (Licorice),

(source : Dr Zoran Pletikosa)

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