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chronic bronchitis

Cough with sputum for 3 or more months/year for 2 or more consecutive years. Patients with chronic bronchitis are the blue bloaters of COPD. Etiology: 1) cigarette smoking (most common cause) 2) occupational exposure & air pollution contribute to exacerbations 3) chronic bronchitis with multiple exacerbations of acute bronchitis in never smokers & in younger patients may be due to bronchiectasis [2] Epidemiology: onset > 50 years of age Pathology: 1) ratio of bronchial mucous glands to bronchial wall thickness (Reid index) is increased 2) development of cor pulmonale is common 3) nocturnal oxygen desaturation a) common b) correlates with an increase in pulmonary artery pressure Clinical manifestations: 1) cough productive of sputum 2) tend to appear cyanotic 3) generally overweight 4) infections exacerbate symptoms 5) dyspnea is moderate to marked Special laboratory: 1) Pulmonary function testing: - increased pCO2 - decreased pO2 - DLCO normal or slightly decreased - FEV1 is decreased & FEV1/FVC decreased in most but not all patients [3] - total lung capacity is normal or slightly increased - residual volume is normal or slightly increased 2) sleep study if sleep apnea is suspected - polycythemia or cor pulmonale despite daytime pO2 > 60 mm Hg Radiology: - chest X-ray shows increased markings Differential diagnosis: - bronchiectasis (never smokers, younger patients) - emphysema: FEV1/FVC is low (all patients) - asthma: reversible airway obstruction - tracheobronchomalacia: - dynamic collapse of the airway during expiration (bronchoscopy) Management: see COPD.

Related

features of chronic bronchitis vs pulmonary emphysema Reid index

Specific

eosinophilic bronchitis

General

chronic obstructive pulmonary disease (COPD) bronchitis

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 738-39, 744
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
  3. Mejza F, Gnatiuc L, Buist AS et al Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study. Eur Respir J. 2017 Nov 22;50(5):1700621. PMID: 29167298 PMCID: PMC5699921 Free PMC article.