Bronchitis, Chronic
A form of chronic obstructive pulmonary disease, chronic bronchitis is marked by excessive production of tracheobronchial mucus that is sufficient to cause a cough for at least 3 months each year for 2 consecutive years. The severity of the disease is linked to the amount of cigarette smoke or other pollutants inhaled and the duration of the inhalation. A respiratory tract infection typically exacerbates the cough and related symptoms. However, few patients with chronic bronchitis develop significant airway obstruction. About 20% of males have chronic bronchitis.
Causes
Cigarette smoking is the most common cause of chronic bronchitis, although some studies suggest a genetic predisposition to the disease as well.
The disease is directly correlated to heavy pollution and is more prevalent in people exposed to organic or inorganic dusts and noxious gases.
Pediatric pointerChildren of parents who smoke are at higher risk for respiratory tract infections that can lead to chronic bronchitis. Most children experience acute bronchitis. Chronic, recurrent bronchitis is not clearly understood. Chronic bronchitis in children tends to be a symptom of an underlying pulmonary disorder and a risk factor for chronic respiratory problems as an adult.
Chronic bronchitis results in hypertrophy and hyperplasia of the bronchial mucous glands, increased goblet cells, ciliary damage, squamous metaplasia of the columnar epithelium, and chronic leukocytic and lymphocytic infiltration of bronchial walls. Additional effects include widespread inflammation, airway narrowing, and mucus within the airways—all producing resistance in the small airways and, in turn, a severe ventilation-perfusion imbalance.
Complications
Chronic bronchitis can lead to cor pulmonale, pulmonary hypertension, right ventricular hypertrophy, and acute respiratory failure.
Assessment
The patient’s history typically reflects a longtime smoker who has frequent upper respiratory tract infections. Usually, the patient seeks treatment for a productive cough and exertional dyspnea. He may describe his cough as initially prevalent in the winter months but gradually becoming a year-round problem with increasingly severe episodes. He also typically reports progressively worsening dyspnea that takes increasingly longer to subside. Since young children tend to swallow the cough secretions, it’s common for them to vomit.
Inspection usually reveals a cough, producing copious gray, white, or yellow sputum. The patient may appear cyanotic, and he may use accessory respiratory muscles for breathing (a “blue bloater”). Vital signs usually include tachypnea; other typical findings include substantial weight gain.
Palpation may disclose pedal edema and neck vein distention. Auscultation findings include wheezing, prolonged expiratory time, and rhonchi.
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