Chronic Bronchitis


Article Author:
Allen Widysanto


Article Editor:
George Mathew


Editors In Chief:
Susan Johnson
Alexandra Caley


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon


Updated:
8/3/2019 3:10:56 PM

Introduction

Chronic bronchitis can be defined as a chronic productive cough lasting more than 3 months occurring within a span of 2 years. There is a strong causal association with smoking and is very often secondary to chronic obstructive pulmonary disease (COPD). [1]

Etiology

There are many known causes of chronic bronchitis, but the most important causative factor is exposure to cigarette smoke either due to active smoking or passive inhalation. Many inhaled irritants to the respiratory tract such as smog, industrial pollutants, and toxic chemicals can cause chronic bronchitis. Although bacterial and viral infections usually cause acute bronchitis repeated exposure to infections can cause chronic bronchitis. The predominant viruses that are causative are Influenza type A and B, and the dominant bacterial agents are Staphylococcus, Streptococcus, and Mycoplasma pneumonia. People who have an associated background in respiratory diseases such as asthma, cystic fibrosis, or bronchiectasis have a higher predisposition to develop chronic bronchitis. People who have repeated exposure to environmental pollutants such as dust or airborne chemicals such as ammonia and sulfur dioxide have a higher risk of developing chronic bronchitis. Chronic gastroesophageal reflux is a well documented but less frequent cause of chronic bronchitis. [1]

Epidemiology

The occurrence of Chronic bronchitis in the general population has been documented to vary between 3% to 7% of healthy adults. However, it is estimated to be as high as 74% among those diagnosed to have COPD. Many among those in the general population experiencing symptoms of chronic bronchitis may not have a definitive respiratory diagnosis. It has been documented that subjects under the age of 50 years who are otherwise healthy and have chronic bronchitis are at a higher risk of morbidity and mortality when compared to healthy subjects.The increasing prevalence of chronic bronchitis is thought to be associated with increasing age, tobacco smoking, occupational exposure, and socioeconomic status.[2]

Pathophysiology

Chronic bronchitis is thought to be caused by overproduction and hypersecretion of mucus by goblet cells. Epithelial cells lining the airway response to toxic, infectious stimuli by releasing inflammatory mediators such as interleukin 8, colony stimulating factor and other pro-inflammatory cytokines.There is also an associated decrease in the release of regulatory substances such as angiotensin-converting enzyme and neutral endopeptidase.The alveolar epithelium is both the target as well as the initiator of the inflammatory process in chronic bronchitis.During an acute exacerbation of chronic bronchitis, the bronchial mucous membrane becomes hyperemic and edematous with diminished bronchial mucociliary function.This, in turn, leads to airflow impediment because of luminal obstruction to small airways. The airways become clogged by debris and this further increases the irritation.The characteristic cough of bronchitis is caused by the copious secretion of mucus in chronic bronchitis.[3]

Histopathology

Gross pathology reveals boggy mucosa with excessive mucinous secretion, pus, prominence of bronchial pits overlying the orifice of bronchial mucous glands.

Early changes in chronic bronchitis on microscopic histology shows hypersecretion of mucus in large airways with hypertrophy of submucosal glands in the trachea and bronchus.Later an increase in goblet cells in small airways contributes to airway obstruction due to excessive mucous. Submucosal mucous glands occupy an increasing proportion of bronchial wall. This is measured by Reid's index which is the ratio of the thickness of the mucous gland layer to the thickness of the wall between epithelium and cartilage. The standard Reid's index is 0.4. In chronic bronchitis, Reid's index is increased. Chronic bronchitis is also associated with a varying degree of dysplasia, squamous metaplasia.[4]

History and Physical

The most common symptom of patients with chronic bronchitis is a cough. The history of a cough typical of chronic bronchitis is characterized to be present for most days in a month lasting for 3 months with at least 2 such episodes occurring for 2 years in a row. A productive cough with sputum is present in about 50% of patients. The sputum color may vary from clear, yellow, green or at times blood tinged. The color of sputum may be dependent on the presence of secondary bacterial infection. Very often changes in sputum color can be due to peroxidase released by leucocytes in the sputum. Therefore, color alone is not a definite indication of bacterial infection.

It is of prime importance to elicit a complete history from the patient including information regarding possible exposure to inhaled irritants or chemicals as well as full details regarding smoking habits. Fever is uncommon in chronic bronchitis and when present can be suggestive of associated influenza or pneumonia. Generalised malaise is a commonly associated symptom. Rarely patients may complain of chest pain or abdominal muscle pain caused by continuous forceful coughing. When there is inflammation of the airway, there can be an associated wheeze.

Uncomplicated chronic bronchitis presents with a cough, and there is no evidence of airway obstruction physiologically. When patients have chronic asthmatic bronchitis, there is usually a wheeze present due to a hyperactive airway leading to intermittent bronchospasm. When there is obstructive bronchitis which is the more severe end of the spectrum of the disease, there is small airway disease which at times results in emphysema.[1]

Evaluation

The most critical factor in the diagnosis of chronic bronchitis is a typical history to exclude other possible diseases of the lower respiratory tract. 

The investigations which assist in confirming the diagnosis of chronic bronchitis are a complete blood count with differential. A serum procalcitonin level can help in distinguishing associated bacterial from non-bacterial infection. A chest x-ray in the elderly and when physical findings suggest pneumonia is important. A culture of the sputum when a bacterial infection is suspected is indicated. The additional investigations which are a helpful measurement of oxygen saturation, and pulmonary function test.[3]

Treatment / Management

The primary aim of treatment for chronic bronchitis is to relieve symptoms, prevent complication and slow the progression of the disease. The primary goals of therapy are aimed at reducing the overproduction of mucus, controlling inflammation and lowering cough. These are achieved by pharmacological as well as nonpharmacological interventions. [5][6][7]

The mainstay of pharmacological interventions are the following:

  1. Bronchodilators: Short and long-acting β-Adrenergic receptor Agonists as well as Anticholinergic help by increasing the airway lumen, increasing ciliary function and by increasing mucous hydration.
  2. Glucocorticoids: Reduce inflammation and mucus production.Inhaled corticosteroids reduce exacerbation and improve quality of life.However, it is administered under medical supervision and for short periods of time as long-term usage can induce osteoporosis, diabetes, and hypertension.
  3. Antibiotic therapy: is not indicated in the treatment of chronic bronchitis however macrolide therapy has been shown to have anti-inflammatory property and hence may have a role in the treatment of chronic bronchitis.
  4. Phosphodiesterase-4 inhibitors: decrease inflammation and promote airway smooth muscle relaxation by preventing the hydrolysis of cyclic adenosine monophosphate a substance when degraded leads to the release of inflammatory mediators.

Non Pharmacological Measures

The most critical nonpharmacological intervention is smoking cessation. Smoking cessation improves mucociliary function and decreases goblet cell hyperplasia. Smoking cessation has also been shown to reduce airway injury resulting in lower levels of exfoliated mucus in tracheobronchial cells.

Pulmonary rehabilitation is an important part of treatment for chronic bronchitis is pulmonary rehabilitation which consists of education, lifestyle modification, regular physical activity and avoidance of exposure to known pollutants either at work or living environment.[8]

Prognosis

The presence of chronic bronchitis is known to cause of worsening airflow obstruction and a deterioration in lung function. Large epidemiological studies have shown that chronic mucus hypersecretion was associated with a decline in FEV1. Patients with chronic bronchitis symptoms had a threefold increased risk of developing new COPD compared to the asymptomatic population.Chronic bronchitis increases mortality. Those suffering from chronic bronchitis were found to have higher levels of serum IL8 and C reactive protein which indicates that systemic inflammatory response could increase the risk of cardiac disease and other comorbidities. Chronic Bronchitis also leads to a lessened quality of life.[8]

Enhancing Healthcare Team Outcomes

The management of chronic bronchitis is complex and life long. There is no cure for the disorder and the patients are prone to many complications. Thus, the condition is best managed with a multidisciplinary team that consists of a primary care physician, nurse practitioner, pulmonologist, infectious disease expert, radiologist and an internist. Chronic bronchitis has a significant impact on morbidity and quality of life. Smoking is a major contributor hence smoking cessation needs to form an important strategy in prevention. Alteration in lifestyle and regular vaccination for influenza as well as pneumonia can reduce the morbidity in those who have chronic bronchitis. The overall prognosis for most patients is poor, with many patients being disabled from the progressive shortness of breath. [9][10][11]


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Chronic Bronchitis - Questions

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A patient with a designation of a blue bloater is most likely to have what condition?



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An increase in the Reid index is seen in patients with which disease?



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Which of the following is the most important intervention for a patient diagnosed with chronic bronchitis?



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Which of the following defines chronic bronchitis?



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What is a typical feature of chronic bronchitis?



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Which of the following is a common causative agent that exacerbates chronic bronchitis?



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By definition, how long does the cough of chronic bronchitis last?



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What is the definition of chronic bronchitis?



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Which lung disorder is associated with increased mucus production?



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Which of the following statements about chronic bronchitis is false?



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In chronic bronchitis, what is the duration of excessive sputum production with a cough?



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What percentage of chronic bronchitis sufferers have bacterial colonization?



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What is the histological hallmark of chronic bronchitis?



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What is the most likely diagnosis in a patient with a 60 pack-year smoking history, chronic cough and frequent respiratory infections?



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A patient has advanced, severe chronic bronchitis. Which is the most likely description of this cough?



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A 60-year-old female with a 50 pack per year history of smoking presents with increasing dyspnea. She has a chronic productive cough. She is obese and cyanotic. Lung exam shows wheezes and rhonchi in all lung fields. If lung biopsy was performed, which of the following would be most probable?



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What is the most serious complication of chronic bronchitis?



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What disease process is characterized by blue bloater?



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Which is a characteristic of a patient with end-stage chronic bronchitis?



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What microscopical diagnosis is determined by using the Reid index?



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A 60-year-old man presents to the clinic with chronic productive cough and expectoration of copious sputum. He has a history of smoking for the past 30 years. His blood pressure is 110/80 mmHg, temperature 38.2 C, pulse rate 104/min, respiratory rate 30/min, and lung examination reveals coarse crackles in both lungs. Radiographic finding shows increase broncho-vascular marking on both lungs. Which of the following best describes the pathophysiology of the patient's condition?



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A 45-year-old male presents to the clinic with shortness of breath, chronic productive cough, and greenish sputum for the past two weeks. He has worked in a chemical factory for the past fifteen years. Physical examination reveals a blood pressure of 120/80 mmHg, temperature of 37 C, a pulse of 102/minute, and respiratory rate of 30/minute. Lung examination reveals vesicular sound on both lungs and coarse crackles on the right lower lobe. The blood test shows leucocyte 15000/microL. Which of the following action can reduce the exacerbation of the disease?



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A 55-year-old male presents to the clinic with recurrent chronic cough, copious sputum, and shortness of breath for 2 weeks. He has a 30-pack-year smoking history. His blood pressure is 120/80 mmHg, pulse 96/minute, and temperature 37 C. Physical examination reveals prolonged expiration, diffuse wheezing, and crackles on both lung. What is the most appropriate step to prevent worsening of the disease?



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Chronic Bronchitis - References

References

Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study., Mejza F,Gnatiuc L,Buist AS,Vollmer WM,Lamprecht B,Obaseki DO,Nastalek P,Nizankowska-Mogilnicka E,Burney PGJ,, The European respiratory journal, 2017 Nov     [PubMed]
Peripheral airway dysfunction and relationship with symptoms in smokers with preserved spirometry., Jetmalani K,Thamrin C,Farah CS,Bertolin A,Chapman DG,Berend N,Salome CM,King GG,, Respirology (Carlton, Vic.), 2017 Nov 15     [PubMed]
Characteristics of COPD patients according to GOLD classification and clinical phenotypes in the Russian Federation: the SUPPORT trial., Arkhipov V,Arkhipova D,Miravitlles M,Lazarev A,Stukalina E,, International journal of chronic obstructive pulmonary disease, 2017     [PubMed]
Imran S,Shan M,Muazam S, A Comparative Histological Study of Submucosal Gland Hypertrophy in Trachea of Mice Exposed to Cigarette and Shisha Smoke. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2018 Mar;     [PubMed]
Ferré A,Fuhrman C,Zureik M,Chouaid C,Vergnenègre A,Huchon G,Delmas MC,Roche N, Chronic bronchitis in the general population: influence of age, gender and socio-economic conditions. Respiratory medicine. 2012 Mar;     [PubMed]
Song DJ,Song WJ,Kwon JW,Kim GW,Kim MA,Kim MY,Kim MH,Kim SH,Kim SH,Kim SH,Kim ST,Kim SH,Kim JK,Kim JH,Kim HJ,Kim HB,Park KH,Yoon JK,Lee BJ,Lee SE,Lee YM,Lee YJ,Lim KH,Jeon YH,Jo EJ,Jee YK,Jin HJ,Choi SH,Hur GY,Cho SH,Kim SH,Lim DH, KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea. Allergy, asthma     [PubMed]
Perotin JM,Launois C,Dewolf M,Dumazet A,Dury S,Lebargy F,Dormoy V,Deslee G, Managing patients with chronic cough: challenges and solutions. Therapeutics and clinical risk management. 2018;     [PubMed]
Smith DRM,Dolk FCK,Pouwels KB,Christie M,Robotham JV,Smieszek T, Defining the appropriateness and inappropriateness of antibiotic prescribing in primary care. The Journal of antimicrobial chemotherapy. 2018 Feb 1;     [PubMed]
Reddel HK,Gerhardsson de Verdier M,Agustí A,Anderson G,Beasley R,Bel EH,Janson C,Make B,Martin RJ,Pavord I,Price D,Keen C,Gardev A,Rennard S,Sveréus A,Bansal AT,Brannman L,Karlsson N,Nuevo J,Nyberg F,Young SS,Vestbo J, Prospective observational study in patients with obstructive lung disease: NOVELTY design. ERJ open research. 2019 Feb;     [PubMed]
Kania A,Krenke R,Kuziemski K,Czajkowska-Malinowska M,Celejewska-Wójcik N,Kuźnar-Kamińska B,Farnik M,Bokiej J,Miszczuk M,Damps-Konstańska I,Grabicki M,Trzaska-Sobczak M,Sładek K,Batura-Gabryel H,Barczyk A, Distribution and characteristics of COPD phenotypes - results from the Polish sub-cohort of the POPE study. International journal of chronic obstructive pulmonary disease. 2018;     [PubMed]
Golpe R,Suárez-Valor M,Martín-Robles I,Sanjuán-López P,Cano-Jiménez E,Castro-Añón O,Pérez de Llano LA, Mortality in COPD patients according to clinical phenotypes. International journal of chronic obstructive pulmonary disease. 2018;     [PubMed]

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