Chronic bronchitis natural history, complications and prognosis
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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
Natural History
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[1].COPD usually gradually gets worse over time and can lead to death if left untreated.
Complications
Common complications of chronic bronchitis include:
- Recurrent pneumonia: Chronic inflammation and airways damage predispose chronic bronchitis patients to recurrent pneumonia either viral or bacterial infections. Additionally, chronic use of inhaled corticosteroids may cause recurrent infections[2].
- Depression: If it happens needs psychiatry consultation[3].
- Cor pulmonale: chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature results in pulmonary hypertension and right sided heart failure which is named as cor pulmonale[4].
- Anemia: Anemia of chronic disease may develop in this patients and indicates a poor prognosis.
- Polycythemia: Secondary to chronic hypoxemia Hematocrit level may rise up to 60 ( normal range: Adult men: 46±4, adult women:40±4).
Prognosis
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. The most important prognostic factor is the FEV1 level. the other determining factors include:
- Cigarette smoking
- BMI≤21
- Decreased exercise capacity
- Increased CRP level
- Co-morbid diseases.
References
- ↑ 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.
- ↑ Singh S, Amin AV, Loke YK (2009). "Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis". Arch. Intern. Med. 169 (3): 219–29. doi:10.1001/archinternmed.2008.550. PMID 19204211.
- ↑ Ohayon MM (2014). "Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population". J Psychiatr Res. 54: 79–84. doi:10.1016/j.jpsychires.2014.02.023. PMID 24656426.
- ↑ Klinger JR, Hill NS (1991). "Right ventricular dysfunction in chronic obstructive pulmonary disease. Evaluation and management". Chest. 99 (3): 715–23. PMID 1995228.