CHRONIC BRONCHITIS

Written by:
Sanabila Yasmin M
030.07.231

FACULTY OF MEDICINE
TRISAKTI UNIVERSITY
JAKARTA
2010

CONTENT
CONTENT
PREFACE..
ABSTRACT
CHAPTER 1 : INTRODUCTION
1.1 BACKGROUND..
1.2 PROBLEM...
1.3 LIMITATION OF PROBLEM.
1.4 OBJECTIVES..
CHAPTER 2 : CHRONIC BRONCHITIS
2.1 DEFINITION..
2.2 SIGN AND SYMTOMPS...
2.3 CAUSES.
2.4 RISK FACTOR...
2.5 PATHOPHISIOLOGY...
2.6 TEST AND
DIAGNOSIS.
2.7 TREATMENTS AND DRUGS..
2.8 DIFFERENTIAL DIAGNOSIS..
2.9 COMPLICATION...
2.10 PREVENTION
REFERENCES.
CONCULSION...................
PREFACE

First of all, the author would like to thank Allah SWT for His blessing, so the author
could finish the paper titled Chronic Bronchitis. The author also would like to thank everyone
who involved regarding the completion of this literature review:

dr. Henie Widowati Sp.P who is always been there in helping and guided the author
through the completion of this paper review.

My parents, friends, and everyone who supports the author from the beginning until the
finishing of this literature review.
The purpose of writing this paper review is to complete Task 3 English Assignment in

medical faculty of Trisakti University.

The author would like to apologize for any mistakes made through out this paper..
Hopefully, this paper review would be usefull for all the readers in the present and in the future,
especially for everyone who is medical related. The author believes that critics and suggestions is
necessary and would be very helpful for a better paper in the future.

Jakarta, 18 January 2011

Sanabila Yasmin M
030.07.231

ABSTRACT

According to estimates from national interviews taken by the National Center for Health
Statistics in 2006, approximately 9.5 million people, or 4% of the population, were diagnosed
with chronic bronchitis. These statistics may underestimate the prevalence of chronic obstructive
pulmonary disease by as much as 50%, because many patients underreport their symptoms, and
their conditions remain undiagnosed.
An overdiagnosis of chronic bronchitis by patients and clinicians has also been
suggested, however. The term bronchitis is often used as a common descriptor for a nonspecific
and self-limited cough, thereby falsely increasing its incidence even though the patient does not
meet the criteria for diagnosis
Chronic bronchitis, one of the two major diseases of the lung grouped under COPD, is
diagnosed when a patient has excessive airway mucus secretion leading to a persistent,
productive cough. An individual is considered to have chronic bronchitis if cough and sputum
are present on most days for a minimum of 3 months for at least 2 successive years or for 6
months during 1 year. In chronic bronchitis, there also may be narrowing of the large and small
airways making it more difficult to move air in and out of the lungs.
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease
that causes a heavy health and increasing economic burden both in around the world. Most of the
risk factors for COPD are well known and include smoking, occupational exposures, air
pollution, airway hyperresponsiveness, asthma, and certain genetic variations, although many
questions, such as why a minority of smokers develop significant airway obstruction, remain.
Major medical organizations have agreed on a common definition of COPD, although newer
measures, such as functional status or exercise capability, have emerged as important in
determining the prognosis of COPD patients. In most of the world, COPD prevalence and
mortality are still increasing and will likely continue to rise in response to increases in smoking,
particularly by women and adolescents. Resources aimed at smoking cessation and prevention,
COPD education and early detection, and better treatment will be of the most benefit in our
continuing efforts against this important cause of morbidity and mortality.

CHAPTER 1

INTRODUCTION

1.1 Background
Bronchitis is one of the top conditions for which patients seek medical care. It is characterized
by inflammation of the bronchial tubes (or bronchi), the air passages that extend from the trachea
into the small airways and alveoli.
Chronic bronchitis is a progressive, recurring inflammation of the lower airways of the lungs
called the bronchi and the bronchioles. The hallmark of chronic bronchitis is a persistent wet
cough and difficulty with breathing that slowly gets worse over time. Chronic bronchitis is a kind
of chronic obstructive pulmonary disease. Chronic bronchitis is a seriously disabling disease
with the potential for major complications. Chronic bronchitis is often eventually fatal and is also
a major cause of disability. Chronic bronchitis differs from acute bronchitis in that acute
bronchitis is caused by a viral infection or bacterial infection and is a relatively short-term
illness. Chronic bronchitis develops most often as a result of smoking, but can also occur from
long-term inhalation of irritants into the lungs, such as such as air pollution, chemical fumes, or
dust. Chronic bronchitis can also develop due to long-term exposure to second hand smoke. The
longer the lungs are exposed to smoke, pollution, or irritants, the higher the risk for developing
chronic bronchitis (1)

1.2 Problem
Chronic Bronchitis can be one of the most desease of Chronic Obstructive Pulmonary
Disease (COPD). COPD is a preventable and treatable disease that causes a heavy health and
increasing economic burden both in the United States and around the world. Most of the risk
factors for COPD are well known and include smoking, occupational exposures, air pollution,
airway hyperresponsiveness, asthma, and certain genetic variations, although many questions,
such as why a minority of smokers develop significant airway obstruction, remain. Major
medical organizations have agreed on a common definition of COPD, although newer measures,
such as functional status or exercise capability, have emerged as important in determining the
prognosis of COPD patients. In most of the world, COPD prevalence and mortality are still
increasing and will likely continue to rise in response to increases in smoking, particularly by

women and adolescents. Resources aimed at smoking cessation and prevention, COPD education
and early detection, and better treatment will be of the most benefit in our continuing efforts
against this important cause of morbidity and mortality.
1.3 Limitation of problem
What causes Chronic Bronchitis?
What are Chronic Bronchitis symptoms?
What is the risk factor of Chronic Bronchitis?
How is an Chronic Bronchitis diagnosed?
What is the treatment of Chronic Bronchitis?
1.4 Objectives
To know the definition of Chronic Bronchitis
To Know the patophisiology of Chronic Bronchitis
To know how to prevent Chronic Bronchitis

CHAPTER 2
2.1 Definition
Chronic bronchitis is a type of chronic obstructive pulmonary disease, is defined by a
productive cough that lasts for 3 months or more per year for at least 2 years. Other symptoms
may include wheezing and shortness of breath, especially upon exertion. The cough is often
worse soon after awakening, and the sputum produced may have a yellow or green color and
may be streaked with blood. Many of the bronchi develop chronic inflammation with swelling
and excess mucus production. The mucus often becomes infected and discolored from the
bacterial overgrowth and the body's inflammatory response to it. The inflammation, swelling,
and mucus frequently and significantly inhibit the airflow to and from the lung alveoli by
narrowing and partially obstructing the bronchi and bronchioles.

2.2 Sign and Symptoms

The severity of symptoms of chronic bronchitis varies between individuals and the
amount of lung damage that has been done. Symptoms are related to the lung damage, impaired
breathing and the lower levels of oxygen in the blood that is the result of chronic bronchitis.
Chronic bronchitis include a loose, wet cough productive of heavy mucus during most
days of the month, three months of a year, in two successive years without another explanation
for the cough. In contrast, acute bronchitis manifests in a similar type of cough, but only for a
brief time in conjunction with a cold or upper respiratory infection. Symptoms of chronic
bronchitis can also include shortness of breath, especially with exertion, wheezing, and chest
tightness. Other symptoms can include change in alertness or mental status, confusion, anxiety,
fatigue, dizziness, and pallor or cyanosis (blue tinged coloring of the skin, especially around the
mouth in the extremities). These symptoms are related to a lack of adequate amounts of oxygen
in the blood. People with chronic bronchitis may also experience frequent respiratory infections,
bouts of the flu, and swelling in the feet, ankles and legs.
Using a stethoscope, your healthcare professional may also hear rales and/or wheezing in
your lungs as you breathe. Rales are abnormal, wet, "bubbling" sounds made with breathing.
Wheezing is an abnormal whistling sound. Not all listed symptoms are always related to chronic
bronchitis. Although a wet, loose, productive cough is typical of chronic bronchitis, it and other
symptoms can be related to many other potentially serious conditions, including pneumonia and
congestive heart failure.
2.3 Causes
Chronic bronchitis is most frequently caused by long term irritation of the bronchial
tubes. Bronchitis is considered "chronic" if symptoms continue for three months or longer. There
can be many causes of chronic bronchitis, but the main cause is cigarette smoke. Statistics from
the US Centers for Disease Control and Prevention (CDC) suggest that about 49% of smokers
develop chronic bronchitis and 24% develop emphysema/COPD. Some researchers suggest that
about 90% of cases of chronic bronchitis are directly or indirectly caused by exposure to tobacco
smoke. Many other inhaled irritants (for example, smog, industrial pollutants, and solvents) can

also result in chronic bronchitis. Viral and bacterial infections that result in acute bronchitis may
lead to chronic bronchitis if people have repeated bouts with infectious agents.
Also,

underlying

disease

processes

(for

example,

asthma,

cystic

fibrosis,

immunodeficiency, congestive heart failure, familial genetic predisposition to bronchitis, and

congenital or acquired dilation of the bronchioles, known as bronchiectasis) may cause chronic
bronchitis to develop, but these are infrequent causes compared to cigarette. smoking.

2.5 Pathophisiology

During an episode of acute bronchitis, the cells of the bronchial-lining tissue are irritated
and the mucous membrane becomes hyperemic and edematous, diminishing bronchial
mucociliary function. Consequently, the air passages become clogged by debris and irritation
increases. In response, copious secretion of mucus develops, which causes the characteristic
cough of bronchitis.
In the case of mycoplasmal pneumonia, bronchial irritation results from the attachment of
the organism (Mycoplasma pneumoniae) to the respiratory mucosa, with eventual sloughing of
affected cells. Acute bronchitis usually lasts approximately 10 days. If the inflammation extends

downward to the ends of the bronchial tree, into the small bronchi (bronchioles), and then into
the air sacs, bronchopneumonia results.
Chronic bronchitis is associated with excessive tracheobronchial mucus production
sufficient to cause cough with expectoration for 3 or more months a year for at least 2
consecutive years. The alveolar epithelium is both the target and the initiator of inflammation in
chronic bronchitis.
A predominance of neutrophils and the peribronchial distribution of fibrotic changes
result from the action of interleukin 8, colony-stimulating factors, and other chemotactic and
proinflammatory cytokines. Airway epithelial cells release these inflammatory mediators in
response to toxic, infectious, and inflammatory stimuli, in addition to decreased release of
regulatory products such as angiotensin-converting enzyme or neutral endopeptidase.
Chronic bronchitis can be categorized as simple chronic bronchitis, chronic mucopurulent
bronchitis, or chronic bronchitis with obstruction. Mucoid sputum production characterizes
simple chronic bronchitis. Persistent or recurrent purulent sputum production in the absence of
localized suppurative disease, such as bronchiectasis, characterizes chronic mucopurulent
bronchitis.
Chronic bronchitis with obstruction must be distinguished from chronic infective asthma.
The differentiation is based mainly on the history of the clinical illness: patients who have
chronic bronchitis with obstruction present with a long history of productive cough and a late
onset of wheezing, whereas patients who have asthma with chronic obstruction have a long
history of wheezing with a late onset of productive cough.
Chronic bronchitis may result from a series of attacks of acute bronchitis, or it may
evolve gradually because of heavy smoking or inhalation of air contaminated with other
pollutants in the environment. When so-called smoker's cough is continual rather than
occasional, the mucus-producing layer of the bronchial lining has probably thickened, narrowing
the airways to the point where breathing becomes increasingly difficult. With immobilization of

the cilia that sweep the air clean of foreign irritants, the bronchial passages become more
vulnerable to further infection and the spread of tissue damage
2.6 Test and Diagnosis
Pulmonary Function Testing
Is executed to evaluate the extent and progress of chronic bronchitis. There is no need for
fasting since this is not a noninvasive test; however, tobacco products, bronchodilators.

Ventilation-perfusion scanning
May be performed to find out the extent to which lung tissue is ventilated but not
perfused, or perfused but inadequately ventilated. A radioactive substance is injected or inhaled
to illustrate areas of shunting and absent capillaries.
Arterial blood gases (ABGs)
Are drawn to assess gas exchange particularly during acute exacerbation of chronic
bronchitis. Oxygen saturation levels are low due to low levels of oxygen in the blood.
Pulse oximetry
Iis used to monitor oxygen saturation of the blood. The normal oxygen saturation is
between 96% to 100%.Exhaled carbon dioxide (capnogram) may be measured to evaluate
alveolar ventilation. The normal reading is 35 to 45 mmHg; it is evaluated when ventilation is
inadequate, and decreased when pulmonary perfusion is impaired. Chest X-ray may show
changes in the respiratory anatomy like the flattening of the diaphragm due to hyperinflation and
evidence of pulmonary infection.
2.7 Treatment and Drugs
The goal of therapy for chronic bronchitis is to relieve symptoms, prevent complications
and slow the progression of the disease. Quitting smoking is also essential for patients with
chronic bronchitis, since continuing to use tobacco will only further damage the lungs. Our
Tobacco Education Center offers classes as well as individual consultations with doctors trained

in treating tobacco addiction. We help smokers maximize the likelihood of success in their
efforts to quit.
Treatment may include:

Bronchodilator Medications
Inhaled as aerosol sprays or taken orally, bronchodilator medications may help to relieve
symptoms of chronic bronchitis by relaxing and opening the air passages in the lungs.

Steroids
Inhaled as an aerosol spray, steroids can help relieve symptoms of chronic bronchitis.
Over time, however, inhaled steroids can cause side effects, such as weakened bones, high
blood pressure, diabetes and cataracts. It is important to discuss these side effects with your
doctor before using steroids.

Antibiotics
Antibiotics may be used to help fight respiratory infections common in people with
chronic bronchitis.

Vaccines
Patients with chronic bronchitis should receive a flu shot annually and pneumonia shot every
five to seven years to prevent infections.

Oxygen Therapy
As a patient's disease progresses, they may find it increasingly difficult to breathe on their
own and may require supplemental oxygen. Oxygen comes in various forms and may be
delivered with different devices, including those you can use at home.

Surgery
Lung volume reduction surgery, during which small wedges of damaged lung tissue are
removed, may be recommended for some patients with chronic bronchitis.

Pulmonary Rehabilitation
An important part of chronic bronchitis treatment is pulmonary rehabilitation, which
includes education, nutrition counseling, learning special breathing techniques, help with
quitting smoking and starting an exercise regimen. Because people with chronic bronchitis
are often physically limited, they may avoid any kind of physical activity. However, regular
physical activity can actually improve a patient's health and wellbeing

2.8 Differential Diagnosis

Acute bronchitis

AIDS-related complex

Asthma

Bronchiectasis

Emphysema

Lung cancer

Pharyngitis

Pneumonia

Sinusitis

Tonsillitis

Tuberculosis

2.9 Complication
The major complications of chronic bronchitis are as follows:

Dyspnea, sometimes severe,

Respiratory failure,

Pneumonia,

Cor pulmonale
enlargement and weakness of right heart ventricle due to lung disease

Pneumothorax
collection of air or gas in lung causing lung collapse

Polycythemia
abnormally high concentration of red blood cells needed to carry oxygen

COPD
some NIH investigators consider chronic bronchitis a type of COPD

Emphysema

Chronic advancement of the disease, and

High mortality (death) rate (COPD is the 4th leading cause of death in the United States).

2.10 Prevention
There are ways to prevent chronic bronchitis. Even if you already have chronic
bronchitis, there are ways to prevent your chronic bronchitis from getting worse, and to minimize
the chances of attacks or exacerbations.
Avoid smoking

You can significantly reduce your chances of developing chronic bronchitis by not
smoking, and moreover by avoiding second hand smoke.
Avoid Lung Irritants
Irritants in the air, such as fumes, pollen, and air pollutants in general, can bring on acute
exacerbations of chronic bronchitis in people that have chronic bronchitis. People that are
exposed to these irritants frequently and for long period of time put themselves at more risk of
developing chronic bronchitis. If lung irritants are present in your job environment, be sure to
wear a face mask to reduce the irritants that you breathe in.
Avoid Respiratory Infections
The common flu is normally quite harmless, but if youre subject to it frequently it can
damage your lungs to result in chronic bronchitis. If you already have chronic bronchitis, the flu
can kill you. For this reason, getting the annual flu shot is highly recommended. The same goes
for pneumonia, so getting a pneumonia shot may also be a good idea
Ask your doctor about a pneumonia shot
If you are an older adult, or you are at a high risk of diseases such as diabetes, heart
disease and emphysema, consider having a pneumonia shot. Vaccine are also available to protect
young children against pneumonia. It is recommended that all children under age 2 and for
children 2 years and older who are at particular risk of pneumococcal disease, such as those with
an immune system deficiency, asthma, cardiovascular disease or sickle cell anemia. Side effects
of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the
injection site.
Wash your hands
To reduce your risk of catching a viral infection, wash your hands frequently and get in
the habit of using hand sanitizers

Conclusions

Chronic bronchitis due to cigarette smoking or other exposures to inhaled noxious agents
is one of the most common causes of chronic cough in the general population. The most effective
way to eliminate cough is the avoidance of all respiratory irritants. When cough persists despite
the removal of these inciting agents, there are effective agents to reduce or eliminate cough.
Bronchitis symptoms are not that hard to deal with. Most of the time, people hate dealing
with bronchitis just because it comes right as you are getting over a cold. Thus, you have to go
through the coughing all over again. Just make sure that you drink lots of fluids, and that you get
tons of rest. If you are able to do that, then you will be able to get over your bronchitis before
you know it. If it does not get any better, it is a good idea to go see your doctor.

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