Chronic Bronchitis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Introduction
- Chronic bronchitis is a result of several contributing factors, including cigarette smoking; exposure to occupational dusts, fumes, and environmental pollution; host factors [e.g., genetic factors]; and bacterial or viral infections.
- Chronic bronchitis is defined clinically as the presence of a chronic cough productive of sputum lasting more than 3 consecutive months of the year for 2 consecutive years without an underlying etiology of bronchiectasis or tuberculosis.
Clinical Presentation of Chronic Bronchitis
Signs and symptoms- Excessive sputum expectoration Cyanosis (advanced disease)
Physical examination: Chest auscultation usually reveals inspiratory and expiratory rales, rhonchi, and mild wheezing with an expiratory phase that is frequently prolonged. Hyperresonance on percussion with obliteration of the area of cardiac dullness. Normal vesicular breathing sounds are diminished. Clubbing of digits (advanced disease) Obesity Chest radiograph Increase in the anteroposterior diameter of the thoracic cage (observed as a barrel chest) Depressed diaphragm with limited mobility
Laboratory tests Erythrocytosis (advanced disease) Pulmonary function tests Decreased vital capacity Prolonged expiratory flow.
Treatment
- Goals of Therapy: The goal is to reduce the severity of symptoms, to ameliorate acute exacerbations, and to achieve prolonged infection-free intervals.
- Oral or aerosolized bronchodilators (eg, albuterol aerosol) may be of benefit to some patients during acute pulmonary exacerbations.
- Long-term inhalation of ipratropium (or tiotropium) decreases the frequency of cough, severity of cough, and volume of expectorated sputum.