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{{CMG}}
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{{Chronic bronchitis}}
{{Chronic bronchitis}}
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==Overview==
==Overview==
Chronic bronchitis can be diagnostically evaluated by physical examination through [[auscultation]]. Physical examination is quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be [[cyanosis]], [[tachypnea]], use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the [[Hoover's sign]]), elevated [[jugular venous pulse]], and peripheral [[edema]]. Pulmonary examination findings include: barrel chest ([[emphysema]]), [[wheezing]], hyperresonance, [[crackles]] and [[rhonchi]].<ref name="pmid27087562">{{cite journal |vauthors=Mehta GR, Mohammed R, Sarfraz S, Khan T, Ahmed K, Villareal M, Martinez D, Iskander J, Mohammed R |title=Chronic obstructive pulmonary disease: A guide for the primary care physician |journal=Dis Mon |volume=62 |issue=6 |pages=164–87 |year=2016 |pmid=27087562 |doi=10.1016/j.disamonth.2016.03.002 |url=}}</ref>


==Physical exam==
==Physical Examination==
A [[physical examination]] will often reveal decreased intensity of breath sounds, wheeze ([[rales]]) and prolonged [[Exhalation|expiration]].  Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.
Physical examination is quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.<ref name="pmid27087562">{{cite journal |vauthors=Mehta GR, Mohammed R, Sarfraz S, Khan T, Ahmed K, Villareal M, Martinez D, Iskander J, Mohammed R |title=Chronic obstructive pulmonary disease: A guide for the primary care physician |journal=Dis Mon |volume=62 |issue=6 |pages=164–87 |year=2016 |pmid=27087562 |doi=10.1016/j.disamonth.2016.03.002 |url=}}</ref><ref name="pmid8430714">{{cite journal |vauthors=Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL |title=Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? |journal=Am. J. Med. |volume=94 |issue=2 |pages=188–96 |year=1993 |pmid=8430714 |doi= |url=}}</ref>
===Appearance of the Patient===
* Typically overweight
* [[Cyanosis]], typically in lips and fingers
===Vital Signs===


A variety of tests may be performed in patients presenting with cough and shortness of breath:
====Respiratory Rate====
* Pulmonary Function Tests (PFT) (or [[spirometry]]) must be performed in all patients presenting with chronic cough. An [[FEV1]]/[[FVC]] ratio below 0.7 that is not fully reversible after bronchodilator therapy indicates the presence of [[COPD]], that requires more aggressive therapy and carries a more severe prognosis than simple chronic bronchitis.
* [[Tachypnea]]
* A sputum sample showing [[neutrophil granulocyte]]s (inflammatory white blood cells) and [[microbiological culture|culture]] showing that has pathogenic microorganisms such as [[Streptococcus|Streptococcus spp.]]
===Head===
* A [[blood test]] would indicate inflammation (as indicated by a raised [[white blood cell]] count and elevated [[C-reactive protein]]).
* Elevated [[jugular venous pulse]] (JVP)
**Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
 
**Damage caused by irritation of the airways leads to inflammation and leads to neutrophils being present
===Lungs===
**Mucosal hypersecretion is promoted by a substance released by neutrophils
====Inspection====
**Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis
* Respiratory distress indicated by use of accessory respiratory muscles
**Although infection is not the reason or cause of chronic bronchitis it is seen to aid in sustaining the bronchitis.'''''
* [[Hoover's sign]], presenting as paradoxical indrawing of lower intercostal spaces, is evident
====Auscultation====
* Prolonged expiration; [[wheezing]]
* Diffusely decreased breath sound
* Coarse [[crackles]] with inspiration
* Coarse [[rhonchi]]
===Extremities===
* [[Peripheral edema]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Pulmonology]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]

Latest revision as of 20:56, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Chronic bronchitis can be diagnostically evaluated by physical examination through auscultation. Physical examination is quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be cyanosis, tachypnea, use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover's sign), elevated jugular venous pulse, and peripheral edema. Pulmonary examination findings include: barrel chest (emphysema), wheezing, hyperresonance, crackles and rhonchi.[1]

Physical Examination

Physical examination is quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.[1][2]

Appearance of the Patient

  • Typically overweight
  • Cyanosis, typically in lips and fingers

Vital Signs

Respiratory Rate

Head

Lungs

Inspection

  • Respiratory distress indicated by use of accessory respiratory muscles
  • Hoover's sign, presenting as paradoxical indrawing of lower intercostal spaces, is evident

Auscultation

Extremities

References

  1. 1.0 1.1 Mehta GR, Mohammed R, Sarfraz S, Khan T, Ahmed K, Villareal M, Martinez D, Iskander J, Mohammed R (2016). "Chronic obstructive pulmonary disease: A guide for the primary care physician". Dis Mon. 62 (6): 164–87. doi:10.1016/j.disamonth.2016.03.002. PMID 27087562.
  2. Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.

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