Chronic Bronchitis

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Original Editors - Students from Glasgow Caledonian University's Cardiorespiratory Therapeutics Project.

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Normal Lung Function & Anatomy

The two lungs are organs responsible for respiration, air enters and leaves the lungs via main bronchi, which are branches of the trachea. The lungs supply the body with oxygenated blood, which allows us to live.The pulmonary arteries deliver deoxygenated blood to the lungs from the right ventricle of the heart. Oxygenated blood returns to the left atrium via the pulmonary veins and is then pump through the rest of the body to deliver oxygen where needed.

Proper lung function is essential for quality of life, there are many ways this can be disrupted including disease and infection. If not monitored and treated these can cause spasms, sputum retention, inflammation and irritation which all leading to poor lung function, work of breathing and reduced quality of life.

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Definition/Description

Chronic Bronchitis (CB) is defined as a chronic cough and sputum production for at least 3 months a year for two consecutive years.  It is covered under the umbrella term of Chronic obstructive pulmonary disease (COPD). The COPD spectrum ranges from Emphysema to Chronic bronchitis and it occurs when the airways become inflamed and the air sacs in your lungs are damaged. Emphysema occurs when your alveolar membrane breaks down where as CB is the inflammation and excessive mucus build-up in your bronchi. Many patients have characteristics of both, putting them somewhere along the spectrum.

http://www.blf.org.uk/DynamicImages/903bad21-9812-4876-aadf-a2d900ab7bbb/copd-diagram-of-lungs-blf-695.jpg

Epidemiology

COPD kills around 30,000 people per year in the UK alone and it is estimated that around 3 million people in the UK have COPD, 2 million of which are undiagnosed. CB occurs in 3.4 to 22% of the US adults population and rates are even higher in patients with COPD.The prevalence of the disease has a great impact on society and on the health care system around the world.

The primary risk factor for CB is smoking, and up to 25% of long-term smokers will go on to develop COPD. Other factors are long-term exposure to air pollution, fumes, and dust from the environment or work place.

Aetiology

CB is caused by overproduction and hyper secretion of mucus by goblet cells, increasing airflow obstruction. This can be due to an infection caused by a virus or bacteria.

As mentioned, smoking is the primary risk factor, this can be from those who inhale second-hand smoke as well as smokers. This is caused by the inflammation and permanent damage to the airways due to toxins in cigarette smoke. Other factors include fumes and dust and air pollution which can all affect your lung tissue when inhaled.

There is also a genetic factor associated with COPD, it is a deficiency in alpha-1-antitrypsin. This genetic marker is indicative of Emphysema, but many patients on the COPD spectrum have characteristics of both Emphysema and CB and should be taken into account.

Pathophysiology

The pathological foundation for CB is due to the over-production of mucus is in response to the inflammatory signals. In COPD patients this overproduction and hypersecretion is due to the goblet cells, and decreased elimination of mucus.

Mucus hypersecretion is one of the risk associated with cigarette smoke exposure, viral infections, bacterial infections, or inflammatory cell activation. When combined with poor ciliary function, distal airway occlusion, ineffective cough, respiratory muscle weakness and reduced peak expiratory flow clearing secretions is extremely difficult and requires high energy consumption. 

Investigations

If a patient presents with some or all of the symptoms your doctor will follow up with more investigations such as:

- Spirometry Test: This is a breathing test to assess how well your lung work. You breath into a machine and two measurements are taken; forced expiratory volume (FEV1) and forced vital capacity (FVC). The readings are then compared to normal ranges for your age, to determine if your airways are compromised.

- Chest X-ray: This will show whether there are other lung conditions that may be causing the symptoms, or in what area the obstruction is in. 

- Blood test: This is to see if your symptoms could be due to anaemia, or to see if the symptoms are due to the genetic marker alpha-1-antitrypsin deficiency.

- Phlegm sample: This is to check to see if there is an infection that is causing the symptoms.

Clinical Manifestations

The clinical presentation can be increased exacerbation rate, accelerated decline in lung function, worse health-related quality of life and increase in mortality. 

Common symptoms outline by the British Lung Foundation include:

-Wheezing, particularly breathing out

- Breathlessness when resting or active

- Tight chest

- Cough

- Producing more mucus or phlegm than usual

These symptoms would be persistent for at least 3 months a year for 2 consecutive years to be considered Chronic Bronchitis.

Physiotherapy and Other Management

The treatment of chronic bronchitis may include a variety of treatments including management through medications, education, physical exercise and respiratory exercises. The goal of the physiotherapist should involve education, improving exercise tolerances, reducing exacerbations and hospitalization, assist in sputum clearance and increase thoracic mobility and lung volume.

Education

Exercise

Postural Drainage

Active Cycle of Breathing

Autogenic Drainage

Percussion, Vibrations & Shaking

Self Management

Prevention

There is presently no cure for chronic bronchitis. However, with lifestyle changes, education and proper management it is possible to prevent exacerbations of the condition.

Stopping Smoking

Physical Fitness

Occupational Health

Avoiding Irritants

Practice Proper Hygiene

Education

Resources

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Recent Related Research (from Pubmed)

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References

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