Chronic Bronchitis Diagnosis and Pathophysiology

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary focus of management in chronic bronchitis?

Relief of bronchospasm

Airway inflammation (correct)

Reversibility of airflow obstruction

Management of airflow obstruction

What is a limitation of theophylline therapy in chronic bronchitis?

Inability to relieve bronchospasm

Lack of efficacy in airflow obstruction

Narrow therapeutic range (correct)

High cost of medication

What is the role of antibiotics in chronic bronchitis?

Relief of bronchospasm

Prevention of COPD

Long-term management of airflow obstruction

Treatment of acute exacerbations (correct)

What is a key aspect of chronic bronchitis excluded by the diagnostic criteria?

Transient causes of cough associated with sputum production Signup and view all the answers

What is the ranking of chronic obstructive pulmonary disease (COPD) as a cause of death in the United States?

Fourth leading cause of death Signup and view all the answers

What percentage of patients with chronic bronchitis have a smoking history?

Over 90 percent Signup and view all the answers

What is the 10-year mortality rate following the diagnosis of chronic bronchitis?

50 percent Signup and view all the answers

What is the ratio of FEV1 to FVC that defines end-stage obstructive airway disease?

Less than 50 percent Signup and view all the answers

What is the annual decline in FEV1 due to age-related physiologic changes in the elasticity of the lungs?

30 mL per year Signup and view all the answers

What is the percentage of acutely symptomatic patients with COPD in which definite organisms are not revealed?

Over 50 percent Signup and view all the answers

What is the primary motivation for smokers with chronic bronchitis to quit smoking?

To reduce the risk of future morbidity from chronic bronchitis Signup and view all the answers

What is the significance of a Reid index in chronic bronchitis?

It quantitates pathological changes in the airways Signup and view all the answers

What is the role of Gram stain in directing initial antibiotic therapy in acute exacerbation of chronic bronchitis?

It is de-emphasized due to the likelihood of multiple organisms Signup and view all the answers

What is the characteristic of a valid expectorated sputum sample?

Fewer than 10 squamous cells and more than 25 white blood cells per high-power microscopic field Signup and view all the answers

What is the significance of a median survival of four years in patients with an FEV1 of less than 1 L?

It indicates a poor prognosis Signup and view all the answers

In which patients is a dosage reduction of theophylline necessary?

Patients with hepatic failure or congestive heart failure Signup and view all the answers

What is the recommended duration of oxygen therapy to produce any reduction in mortality?

At least 18 hours daily Signup and view all the answers

Which vaccination is not expected to be helpful in patients with chronic bronchitis?

Haemophilus b conjugate vaccine Signup and view all the answers

What is the primary goal of rapid dosage reduction in systemic steroid therapy?

To minimize long-term side effects Signup and view all the answers

What guides initial antibiotic therapy in acute exacerbations of chronic bronchitis?

Local resistance patterns in streptococcal species, Haemophilus species and Moraxella catarrhalis Signup and view all the answers

What is the primary advantage of using a combination of ipratropium and a sympathomimetic agent for the management of chronic bronchitis?

It provides sustained relief of bronchospasm while minimizing adrenergic side effects. Signup and view all the answers

What is the primary limitation of using oral sympathomimetic agents in the management of chronic bronchitis?

They can worsen concomitant cardiovascular disease. Signup and view all the answers

What is the primary benefit of using a spacing device with a metered-dose inhaler in the management of chronic bronchitis?

It reduces the amount of wasted medication and increases drug effectiveness. Signup and view all the answers

Why may an increased dosage of theophylline be required in some patients with chronic bronchitis?

Because patients who continue to smoke or take certain medications may require higher dosages to achieve therapeutic levels. Signup and view all the answers

What is the primary advantage of using a long-acting theophylline preparation in the evening in patients with chronic bronchitis?

It is especially useful in patients whose symptoms worsen at night and in whom more frequent inhaler use would further disrupt sleep. Signup and view all the answers

Which of the following treatments is considered a standard treatment for most patients with chronic bronchitis?

Oxygen therapy Signup and view all the answers

What is the purpose of oxygen-conserving devices in patients with chronic bronchitis?

To provide a fixed dose of oxygen only during inhalation Signup and view all the answers

Which of the following is a recommended method for coughing up retained secretions in patients with chronic bronchitis?

Leaning forward and 'huffing' repeatedly Signup and view all the answers

What is the primary goal of pulmonary rehabilitative efforts in patients with chronic bronchitis?

To improve airway function and allow greater mobility Signup and view all the answers

What is a requirement for patients being considered for lung transplantation?

An established social support network Signup and view all the answers

What is the primary function of Haemophilus influenzae in the given context?

To release histamine and enhance histamine release from human bronchoalveolar cells Signup and view all the answers

What is the main difference between patients with asthma and patients with chronic bronchitis?

Elevated substance P content in induced sputum Signup and view all the answers

What is the purpose of measuring cell products in bronchial lavage fluid?

To assess bronchial inflammation in chronic bronchitis Signup and view all the answers

What is the focus of the article by McCue JD?

Oral antibiotic transition therapy for elderly patients with acute exacerbations of chronic obstructive pulmonary disease Signup and view all the answers

What is the copyrighted material owned by?

AAFP Signup and view all the answers

What is the purpose of the copyright notice?

To restrict the use and reproduction of the material Signup and view all the answers

What is the limitation of printing the material?

One printout per person for personal use only Signup and view all the answers

What is the purpose of the permission request?

To request permission to reproduce the material in any medium Signup and view all the answers

What is the significance of the year 1995 in the context?

It is the year when all the studies were published Signup and view all the answers

What is the common theme among the studies mentioned?

Respiratory diseases Signup and view all the answers

Study Notes

Diagnosis of Chronic Bronchitis

Characterized by a cough productive of sputum for over three months' duration during two consecutive years and the presence of airflow obstruction
Pulmonary function testing aids in the diagnosis by documenting the extent of reversibility of airflow obstruction

Pathophysiology of Chronic Bronchitis

Airflow obstruction is caused by excessive tracheobronchial mucus production
Distinct from the anatomic findings of distal air space distention and alveolar septa destruction, which define emphysema

Risk Factors

Cigarette smoking is the most important risk factor for the development of chronic bronchitis
Over 90% of patients with chronic bronchitis have a smoking history

Mortality Rate

The overall 10-year mortality rate following the diagnosis of chronic bronchitis is 50%

Acute Exacerbations

Often precipitated by bacterial infection, manifested by purulent sputum, fever, and a worsening of symptoms
Other known precipitants include viral upper respiratory infections, seasonal changes in the weather, medications, and exposure to irritant inhalants

Bacterial Pathogens

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the three leading bacterial pathogens isolated from the lower bronchi of patients with chronic bronchitis

Management of Chronic Bronchitis

Inhaled ipratropium bromide and sympathomimetic agents are the current mainstays of management
Oral steroid therapy should be reserved for use in patients with demonstrated improvement in airflow not achievable with inhaled agents
Antibiotics play a role in acute exacerbations, but have been shown to lead to only modest airflow improvement
Strengthening of the respiratory muscles, smoking cessation, supplemental oxygen, hydration, and nutritional support also play key roles in long-term management

Pulmonary Function Testing

Documentation of airflow obstruction by pulmonary function testing is critical for the diagnosis of chronic bronchitis
A measured forced expiratory volume in one second (FEV1) of less than 70% of the total forced vital capacity (FVC) defines obstructive airway disease

Smoking Cessation

The single most effective way to reduce the risk of future morbidity from chronic bronchitis
Use of various smoking cessation tools, such as nicotine replacement systems, behavior modification training, and support groups, can be helpful

Pharmacologic Management

Inhaled anticholinergic or anti-inflammatory agents, such as ipratropium bromide and sympathomimetic agents, are the mainstays of therapy
Theophylline has a narrow therapeutic range and relatively common medication interactions, limiting its use
Steroids can be delivered by inhalation or systemic therapy, but long-term oral steroid therapy should be reserved for use in patients with documented symptomatic improvement in airflow not achievable with inhaled preparations### Pulmonary Rehabilitation
Training inspiratory muscles against progressive resistance loads improves exercise tolerance, especially when combined with abdominal breathing exercises to reduce thoracic respiratory muscle fatigue.

Nutritional Support

Increased respiratory muscle work during pulmonary rehabilitation requires enhanced nutritional support.

Hydration and Sputum Mobilization

Improved hydration through increased fluid intake and airway humidity facilitates sputum mobilization more effectively than pharmacologic expectorants or mucolytic agents.

Chronic Obstructive Pulmonary Disease (COPD)

The American Thoracic Society has established standards for the diagnosis and care of patients with COPD.