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Common risk factors in the development of chronic bronchitis include cigarette smoking, air pollution, genetic factors, increasing age, male gender, [[allergy]], and repeated airway [[infections]]<ref name="pmid13735539">{{cite journal |vauthors=PIERCE JA, HOCOTT JB, EBERT RV |title=The collagen and elastin content of the lung in emphysema |journal=Ann. Intern. Med. |volume=55 |issue= |pages=210–22 |year=1961 |pmid=13735539 |doi= |url=}}</ref><ref name="pmid20956146">{{cite journal |vauthors=Raherison C, Girodet PO |title=Epidemiology of COPD |journal=Eur Respir Rev |volume=18 |issue=114 |pages=213–21 |year=2009 |pmid=20956146 |doi=10.1183/09059180.00003609 |url=}}</ref><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="pmid20956146">{{cite journal |vauthors=Raherison C, Girodet PO |title=Epidemiology of COPD |journal=Eur Respir Rev |volume=18 |issue=114 |pages=213–21 |year=2009 |pmid=20956146 |doi=10.1183/09059180.00003609 |url=}}</ref><ref name="pmid10843939">{{cite journal |vauthors=Jeffery PK |title=Comparison of the structural and inflammatory features of COPD and asthma. Giles F. Filley Lecture |journal=Chest |volume=117 |issue=5 Suppl 1 |pages=251S–60S |year=2000 |pmid=10843939 |doi= |url=}}</ref>. | Common risk factors in the development of chronic bronchitis include cigarette smoking, air pollution, genetic factors, increasing age, male gender, [[allergy]], and repeated airway [[infections]]<ref name="pmid13735539">{{cite journal |vauthors=PIERCE JA, HOCOTT JB, EBERT RV |title=The collagen and elastin content of the lung in emphysema |journal=Ann. Intern. Med. |volume=55 |issue= |pages=210–22 |year=1961 |pmid=13735539 |doi= |url=}}</ref><ref name="pmid20956146">{{cite journal |vauthors=Raherison C, Girodet PO |title=Epidemiology of COPD |journal=Eur Respir Rev |volume=18 |issue=114 |pages=213–21 |year=2009 |pmid=20956146 |doi=10.1183/09059180.00003609 |url=}}</ref><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="pmid20956146">{{cite journal |vauthors=Raherison C, Girodet PO |title=Epidemiology of COPD |journal=Eur Respir Rev |volume=18 |issue=114 |pages=213–21 |year=2009 |pmid=20956146 |doi=10.1183/09059180.00003609 |url=}}</ref><ref name="pmid10843939">{{cite journal |vauthors=Jeffery PK |title=Comparison of the structural and inflammatory features of COPD and asthma. Giles F. Filley Lecture |journal=Chest |volume=117 |issue=5 Suppl 1 |pages=251S–60S |year=2000 |pmid=10843939 |doi= |url=}}</ref>. | ||
==Screening== | ==Screening== | ||
There is no recommendation for routine screening for adults who have none of features of chronic bronchitis such as: cough, dyspnea or chest pain beacause, asymptomatic decrease in lung capacities does not need treatment<ref>{{Cite journal | |||
| author = [[Amir Qaseem]], [[Timothy J. Wilt]], [[Steven E. Weinberger]], [[Nicola A. Hanania]], [[Gerard Criner]], [[Thys van der Molen]], [[Darcy D. Marciniuk]], [[Tom Denberg]], [[Holger Schunemann]], [[Wisia Wedzicha]], [[Roderick MacDonald]] & [[Paul Shekelle]] | |||
| title = Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society | |||
| journal = [[Annals of internal medicine]] | |||
| volume = 155 | |||
| issue = 3 | |||
| pages = 179–191 | |||
| year = 2011 | |||
| month = August | |||
| doi = 10.7326/0003-4819-155-3-201108020-00008 | |||
| pmid = 21810710 | |||
}}</ref>. | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
*Depending on the severity of airflow obstruction which could be measured by [[FEV1]], [[FVC]] and [[spirometry|FEV1/FVC]] and at the time of diagnosis the prognosis may vary. It has a very wide range of severity from well controlled chronic bronchitis to severe obstructed airways with multiple exacerbations that needs hospitalization and even may develop to lung cancer<ref name="pmid12728157">{{cite journal |vauthors=Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC |title=Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study |journal=Thorax |volume=58 |issue=5 |pages=388–93 |year=2003 |pmid=12728157 |pmc=1746680 |doi= |url=}}</ref>.COPD usually gradually gets worse over time and can lead to death if left untreated. | |||
*Common complications of chronic bronchitis include: ''recurrent pneumonia'', ''depression'', ''cor pulmonale'', ''anemia'', ''polycythemia''. | |||
*A good prognosis of COPD relies on an early diagnosis and prompt treatment. Most patients will have improvement in lung function once treatment is started. | |||
==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | Chronic bronchitis is generally part of a syndrome called [[chronic obstructive pulmonary disease]] (COPD); it is defined clinically as a persistent [[cough]] that produces [[sputum]] (phlegm), for at least three months in two consecutive years. Bronchitis may be indicated by an [[expectorate|expectorating]] [[cough]] (also known as a productive cough, i.e. one that produces [[sputum]]), shortness of breath ([[dyspnea]]) and wheezing. Occasionally [[chest pain]]s, [[fever]], and [[Fatigue (physical)|fatigue]] or [[malaise]] may also occur<ref name="pmid27264777">{{cite journal |vauthors=Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM |title=Management of chronic obstructive pulmonary disease beyond the lungs |journal=Lancet Respir Med |volume= |issue= |pages= |year=2016 |pmid=27264777 |doi=10.1016/S2213-2600(16)00097-7 |url=}}</ref>. | ||
==History and Symptoms== | |||
The hallmark of chronic bronchitis is [[dyspnea]]. A positive history of chronic productive [[cough]] and [[dyspnea|shortness of breath]] is suggestive of chronic bronchitis. Some patients describe the dyspnea as air hunger because of sensation of gasping for air<ref name="pmid24485129">{{cite journal |vauthors=Festic E, Bansal V, Gajic O, Lee AS |title=Prehospital use of inhaled corticosteroids and point prevalence of pneumonia at the time of hospital admission: secondary analysis of a multicenter cohort study |journal=Mayo Clin. Proc. |volume=89 |issue=2 |pages=154–62 |year=2014 |pmid=24485129 |pmc=3989069 |doi=10.1016/j.mayocp.2013.10.028 |url=}}</ref>. | |||
===Physical Examination=== | ===Physical Examination=== | ||
Revision as of 14:02, 22 September 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Overview
Bronchitis is an inflammation of the bronchi (medium-size airways) in the lungs. Acute bronchitis is usually caused by viruses or bacteria and may last several days or weeks. Chronic bronchitis is not necessarily caused by infection and is generally part of a syndrome called chronic obstructive pulmonary disease (COPD); it is defined clinically as a persistent cough that produces sputum (phlegm) and mucus, for at least three months in two consecutive years.
Historical Perspective
- Bronchitis was first described by Charles Badham in 1808. Rene Laennec, described COPD in details and categorized it as emphysema and chronic bronchitis[1][2].
Pathophysiology
- Hyperplasia and hypertrophy of the goblet cells (mucous gland) of the airway are the common pathologic features of chronic bronchitis. Chronic inflammation due to lymphocyte infiltration seen on microscopy[3].
- On microscopic histopathological analysis there is infiltration of the airway walls with inflammatory cells, particularly CD8+ T-lymphocytes and neutrophils[4].
- Inflammation is followed by scarring and remodeling that thickens the walls resulting in narrowing of the small airways
Causes
- Chronic bronchitis as a subtype of COPD is caused by multiple environmental and genetic factors. Smoking is the leading cause of chronic bronchitis. Other causes include: air pollutants, occupational exposures to dusts and coal and auto-immune diseases[5][6][7][8].
Differentiating Chronic bronchitis from other Diseases
Chronic bronchitis must be differentiated from other causes of chronic cough and dyspnea which include:congestive heart failure, chronic asthma, bronchiectasis, and bronchiolitis obliterans[9][10].
Epidemiology and Demographics
- COPD occurs in 34 out of 1000 greater than 65 years old[11] or possibly approximately 25 million people if undiagnosed cases are included.[12].
- COPD is the third cause of death in the U.S[13].
- Hispanics were less likely to report COPD than non-Hispanic whites and blacks (4.0% compared with 6.3% and 6.1%, respectively)[14].
- Chronic bronchitis mortality rates are higher among whites than among blacks or persons of all other races.
- Women were more likely to report COPD than men (6.7% compared with 5.2%)[14][15].
- Age adjusted death rates of men has decreased between 1999 till 2014 but this rate was stable among women.
Risk Factors
Common risk factors in the development of chronic bronchitis include cigarette smoking, air pollution, genetic factors, increasing age, male gender, allergy, and repeated airway infections[16][17][18][17][19].
Screening
There is no recommendation for routine screening for adults who have none of features of chronic bronchitis such as: cough, dyspnea or chest pain beacause, asymptomatic decrease in lung capacities does not need treatment[20].
Natural History, Complications, and Prognosis
- Depending on the severity of airflow obstruction which could be measured by FEV1, FVC and FEV1/FVC and at the time of diagnosis the prognosis may vary. It has a very wide range of severity from well controlled chronic bronchitis to severe obstructed airways with multiple exacerbations that needs hospitalization and even may develop to lung cancer[21].COPD usually gradually gets worse over time and can lead to death if left untreated.
- Common complications of chronic bronchitis include: recurrent pneumonia, depression, cor pulmonale, anemia, polycythemia.
- A good prognosis of COPD relies on an early diagnosis and prompt treatment. Most patients will have improvement in lung function once treatment is started.
Diagnosis
Chronic bronchitis is generally part of a syndrome called chronic obstructive pulmonary disease (COPD); it is defined clinically as a persistent cough that produces sputum (phlegm), for at least three months in two consecutive years. Bronchitis may be indicated by an expectorating cough (also known as a productive cough, i.e. one that produces sputum), shortness of breath (dyspnea) and wheezing. Occasionally chest pains, fever, and fatigue or malaise may also occur[22].
History and Symptoms
The hallmark of chronic bronchitis is dyspnea. A positive history of chronic productive cough and shortness of breath is suggestive of chronic bronchitis. Some patients describe the dyspnea as air hunger because of sensation of gasping for air[23].
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
CT
Ultrasound
Other Imaging Studies
Other Diagnostic Studies
Treatment
Medical Therapy
Primary Prevention
Secondary Prevention
References
- ↑ terms(2016)https://lunginstitute.com/blog/history-of-chronic-bronchitis/accessed on September,13 2016
- ↑ Klippe HJ, Kirsten D (2009). "[200 years of bronchitis--from 1808 to 2008]". Pneumologie (in German). 63 (4): 228–30. doi:10.1055/s-0028-1119572. PMID 19343614.
- ↑ Hogg JC (2004). "Pathophysiology of airflow limitation in chronic obstructive pulmonary disease". Lancet. 364 (9435): 709–21. doi:10.1016/S0140-6736(04)16900-6. PMID 15325838.
- ↑ Baraldo S, Turato G, Badin C, Bazzan E, Beghé B, Zuin R, Calabrese F, Casoni G, Maestrelli P, Papi A, Fabbri LM, Saetta M (2004). "Neutrophilic infiltration within the airway smooth muscle in patients with COPD". Thorax. 59 (4): 308–12. PMC 1763819. PMID 15047950.
- ↑ MedicineNet.com - COPD causes
- ↑ Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD (2009). "COPD prevalence is increased in lung cancer, independent of age, sex and smoking history". Eur. Respir. J. 34 (2): 380–6. doi:10.1183/09031936.00144208. PMID 19196816. Unknown parameter
|month=ignored (help) - ↑ Devereux, Graham (2006). "Definition, epidemiology, and risk factors". BMJ. 332 (7550): 1142–4. doi:10.1136/bmj.332.7550.1142. PMC 1459603. PMID 16690673. Unknown parameter
|month=ignored (help) - ↑ Kennedy SM, Chambers R, Du W, Dimich-Ward H (2007). "Environmental and occupational exposures: do they affect chronic obstructive pulmonary disease differently in women and men?". Proceedings of the American Thoracic Society. 4 (8): 692–4. doi:10.1513/pats.200707-094SD. PMID 18073405. Unknown parameter
|month=ignored (help) - ↑ Busse WW (2011). "Asthma diagnosis and treatment: filling in the information gaps". J. Allergy Clin. Immunol. 128 (4): 740–50. doi:10.1016/j.jaci.2011.08.014. PMID 21875745.
- ↑ Prina E, Ranzani OT, Torres A (2015). "Community-acquired pneumonia". Lancet. 386 (9998): 1097–108. doi:10.1016/S0140-6736(15)60733-4. PMID 26277247.
- ↑ wrongdiagnosis.com > Prevalence and Incidence of COPD Retrieved on Mars 14, 2010
- ↑ MORBIDITY & MORTALITY: 2009 CHART BOOK ON CARDIOVASCULAR, LUNG, AND BLOOD DISEASES National Heart, Lung, and Blood Institute
- ↑ Kenneth D. Kochanek, M.A.; Jiaquan Xu, M.D.; Sherry L. Murphy, B.S.; Arialdi M. Minin˜o, M.P.H.; and Hsiang-Ching Kung, Ph.D., Division of Vital Statistics, Deaths: Final Data for 2009, 2011, 60,National Vital Statistics Reports, http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf
- ↑ 14.0 14.1 Morbidity and Mortality Weekly Report (MMWR).(2011).https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6146a2.htm Accessed on September 19,2016
- ↑ Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, Cherniack RM, Rogers RM, Sciurba FC, Coxson HO, Paré PD (2004). "The nature of small-airway obstruction in chronic obstructive pulmonary disease". N. Engl. J. Med. 350 (26): 2645–53. doi:10.1056/NEJMoa032158. PMID 15215480.
- ↑ PIERCE JA, HOCOTT JB, EBERT RV (1961). "The collagen and elastin content of the lung in emphysema". Ann. Intern. Med. 55: 210–22. PMID 13735539.
- ↑ 17.0 17.1 Raherison C, Girodet PO (2009). "Epidemiology of COPD". Eur Respir Rev. 18 (114): 213–21. doi:10.1183/09059180.00003609. PMID 20956146.
- ↑ 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.
- ↑ Jeffery PK (2000). "Comparison of the structural and inflammatory features of COPD and asthma. Giles F. Filley Lecture". Chest. 117 (5 Suppl 1): 251S–60S. PMID 10843939.
- ↑ Amir Qaseem, Timothy J. Wilt, Steven E. Weinberger, Nicola A. Hanania, Gerard Criner, Thys van der Molen, Darcy D. Marciniuk, Tom Denberg, Holger Schunemann, Wisia Wedzicha, Roderick MacDonald & Paul Shekelle (2011). "Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society". Annals of internal medicine. 155 (3): 179–191. doi:10.7326/0003-4819-155-3-201108020-00008. PMID 21810710. Unknown parameter
|month=ignored (help) - ↑ Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC (2003). "Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study". Thorax. 58 (5): 388–93. PMC 1746680. PMID 12728157.
- ↑ Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM (2016). "Management of chronic obstructive pulmonary disease beyond the lungs". Lancet Respir Med. doi:10.1016/S2213-2600(16)00097-7. PMID 27264777.
- ↑ Festic E, Bansal V, Gajic O, Lee AS (2014). "Prehospital use of inhaled corticosteroids and point prevalence of pneumonia at the time of hospital admission: secondary analysis of a multicenter cohort study". Mayo Clin. Proc. 89 (2): 154–62. doi:10.1016/j.mayocp.2013.10.028. PMC 3989069. PMID 24485129.