PATHO CH. 22 – Obstructive Pulmonary Disorders

Part 2: Chronic Bronchitis

major causes of chronic bronchitis

• cigarette smoking (90%)

• repeated airway infections

• genetic predisposition

• inhalation of physical or chemical irritants

chronic bronchitis (type B COPD; “blue bloater”)

diagnosed symptomatically by:

• hypersecretion of bronchial mucus &

• a chronic or recurrent productive cough of more than 3 months duration & occurring each year for 2 or more successive years

for patients w/ chronic bronchitis & emphysema, airway obstruction is

persistent & irreversible

pathogenesis of chronic bronchitis

• chronic inflammation & swelling of bronchial mucosa = scarring

• increased fibrosis of mucous membrane

• hyperplasia & hypertrophy of bronchial mucous glands & goblet cells

• increased bronchial wall thickness

hypertrophy of mucosal glands & goblet cells leads to

increased mucus production

chronic bronchitis patient may appear as a “blue bloater” because of

• oxygen desaturation (drop in blood’s O2 saturation) = cyanosis

• edema (swelling due to fluid accumulation) associated w/ RIGHT SIDED heart failure

destruction of bronchial walls results in

dilation of airway sacs (bronchiectasis)

causes of bronchial wall destruction

• infection from severe streptococcal or staphylococcal pneumonia

• repeated periods of acute bronchitis

• infection w/ the mold Aspergillus fumigatus

• presence of mucous plugs or foreign bodies

• deficiencies in immunologic response

gender and age relation to chronic bronchitis

• 1:2 male to female ratio

• age of 30-40 years or older

clinical manifestations of chronic bronchitis

• overweight

• commonly associated w/ emphysema

• shortness of breath on exertion

• excessive sputum (more severe in morning)

• chronic cough

• evidence of excess body fluids (edema/hypervolemia)

• cyanosis – late sign

measures used to confirm the diagnosis of chronic bronchitis include

• chest x-ray

• arterial blood gas (ABG) evaluation

• presence of secondary polycythemia (increased number of RBCs)

chest x-ray findings for chronic bronchitis

• increased bronchial vascular markings

• congested lung fields

• enlarged horizontal cardiac silhouette

• evidence of previous pulmonary infection

arterial blood gas (ABG) findings for chronic bronchitis

• elevated PaCO2

• decreased PaO2 (less than 65 mmHg)

treatment of chronic bronchitis

• smoking cessation

• agonists & anticholinergic bronchodilator therapy

• reduction to exposure of irritants

• adequate rest

• proper hydration

• physical reconditioning

• yearly influenza & pneumococcal vaccines