Chronic Bronchitis
🧾 Chronic Bronchitis is a clinical & historical diagnosis – not purely radiological. It often co-exists with emphysema to form COPD.
📖 About
- Frequently seen with emphysema as part of the COPD spectrum.
⚠️ Aetiology & Pathophysiology
- Chronic irritant exposure (esp. 🚬 smoking, pollutants).
- Hypertrophy of bronchial mucous glands → excessive mucus.
- Ciliary dysfunction → impaired clearance.
- Squamous metaplasia of airway epithelium (columnar → squamous).
- Chronic inflammation & airway wall fibrosis → narrowed bronchioles.
📌 Clinical Definition
- Productive cough > 3 months/year for 2 consecutive years 🗓️.
- SOB, cough, wheeze, haemoptysis (sometimes).
- Exercise intolerance & frequent infective exacerbations.
- Systemic features: weight loss, cachexia, cyanosis (“blue bloater”), pursed-lip breathing.
- Right heart failure (cor pulmonale): ↑ JVP, peripheral oedema, hepatomegaly.
🔍 Differentials
- Asthma (reversible obstruction).
- Bronchiectasis (purulent sputum, recurrent infections, coarse crackles).
- Bronchiolitis obliterans (post-viral or inhalational injury).
🧪 Investigations
- 🩸 FBC/U&E/CRP: polycythaemia (chronic hypoxia); ↑ WCC/CRP if infection.
- 🫁 CXR: may show hyperinflation; bronchial wall thickening.
- 📉 PFTs: obstructive pattern (FEV1/FVC < 0.7).
- 🧪 ABG: Type 1 (hypoxaemia) or Type 2 RF (hypercapnia).
- 💓 BNP: if heart failure suspected.
- 🧾 D-dimer / CTPA: if PE suspected in acute SOB.
💊 Management
- 🚭 Smoking cessation = single most effective intervention.
- Oxygen: controlled therapy, target sats 88–92%.
- Inhaled bronchodilators:
- SABA (Salbutamol/Albuterol)
- SAMA (Ipratropium)
- Consider LABA/LAMA combinations if persistent symptoms.
- 💊 Steroids: Prednisolone 30 mg × 7 days for acute exacerbations.
- 🏠 LTOT: if PaO₂ ≤ 7.3 kPa, or ≤ 8 kPa with cor pulmonale/polycythaemia.
- 🏋️♂️ Pulmonary rehabilitation for exercise capacity & QOL.
📚 References
- 📖 NICE NG115: COPD diagnosis and management.
- 📖 GOLD COPD 2025 report.
