Chronic Bronchitis
Related Subjects:
|Emphysema
|Chronic Bronchitis
🧾 Chronic Bronchitis is a clinical diagnosis defined by chronic productive cough.
⚠️ COPD diagnosis requires spirometry (FEV1/FVC <0.7 post-bronchodilator).
📖 About
- Often co-exists with emphysema → part of the COPD spectrum.
⚠️ Aetiology & Pathophysiology
- 🚬 Chronic irritant exposure (especially smoking).
- 🧪 Mucous gland hypertrophy + goblet cell hyperplasia → excess mucus.
- 🌀 Ciliary dysfunction → impaired mucociliary clearance.
- 🔄 Squamous metaplasia → reduced defence against pathogens.
- 🔥 Chronic inflammation → airway narrowing and fibrosis.
📌 Clinical Definition
- Productive cough ≥3 months/year for ≥2 consecutive years 🗓️
- Dyspnoea, wheeze, recurrent infections
- 🔵 Cyanosis (“blue bloater” phenotype)
- 🫁 Signs of hypercapnia (late): drowsiness, CO₂ retention
- ❤️ Cor pulmonale: ↑ JVP, oedema, hepatomegaly
🔍 Differentials
- Asthma (reversible obstruction)
- Bronchiectasis (purulent sputum, coarse crackles)
- Heart failure (overlapping dyspnoea)
🧪 Investigations
- 📉 Spirometry (diagnostic): FEV1/FVC <0.7 post-bronchodilator
- 🩸 FBC: polycythaemia in chronic hypoxia
- 🫁 CXR: may show hyperinflation or bronchial wall thickening
- 🧪 ABG: hypoxia ± hypercapnia (Type 2 RF in advanced disease)
- 💓 BNP if heart failure suspected
💊 Management
- 🚭 Smoking cessation → most important intervention
- 🏋️ Pulmonary rehabilitation (core NICE recommendation)
- 💨 Bronchodilators:
- SABA/SAMA → PRN
- LABA or LAMA → maintenance
- LABA + LAMA ± ICS if frequent exacerbations
- 💊 Exacerbations: Prednisolone 30 mg for 5 days
- 🫁 Oxygen therapy:
- Target 88–92% if risk of hypercapnic respiratory failure
- Otherwise target 94–98%
- 🏠 LTOT: if PaO₂ ≤7.3 kPa (or ≤8 kPa with complications), in stable patients
📚 References
- NICE NG115: Chronic Obstructive Pulmonary Disease
- GOLD Report (Global Initiative for Chronic Obstructive Lung Disease)
