Chronic Bronchitis: Overview and Practice Questions (2023)

Chronic bronchitis is a prevalent respiratory condition that affects millions of individuals worldwide.

Characterized by persistent inflammation and irritation of the bronchial tubes, this ailment can significantly impact a person’s quality of life.

In this article, we will explore the key aspects of chronic bronchitis, including its causes, symptoms, and management strategies, to provide a concise and informative overview of this chronic respiratory disorder.

What is Chronic Bronchitis?

Chronic bronchitis is a condition in which the bronchial tubes become inflamed and produce excess mucus. This leads to a persistent cough with mucus, shortness of breath, wheezing, and chest tightness. It is primarily caused by smoking and is a form of chronic obstructive pulmonary disease (COPD).

Causes

Chronic bronchitis is primarily caused by long-term exposure to irritants that damage the lungs and airways. The most common irritant is cigarette smoke.

Other causes include air pollution, dust, toxic gases in the environment or workplace, and repeated episodes of acute bronchitis. Genetic factors may also play a role in an individual’s susceptibility.

Signs and Symptoms

The signs and symptoms of chronic bronchitis include:

• Persistent coughing
• Increased mucus production
• Dyspnea
• Shortness of breath
• Wheezing
• Chest discomfort
• Fatigue and malaise
• Frequent respiratory infections
• Cyanosis
• Hypercapnia
• Ventilatory failure

Note: These symptoms may worsen during periods of exacerbation and can significantly impact the patient’s quality of life.

Diagnosis

Diagnosing chronic bronchitis typically involves a combination of clinical evaluation and diagnostic tests:

• Medical History and Physical Examination: The doctor will ask about the patient’s symptoms, smoking history, exposure to lung irritants, and family history of respiratory diseases.
• Spirometry Test: This is a noninvasive test to assess lung function. The patient blows into a tube connected to a spirometer, which measures the amount of air inhaled and exhaled and the speed of exhalation.
• Chest X-ray: Helps in ruling out other lung conditions that might cause similar symptoms, such as pneumonia.
• CT Scan: Provides a more detailed look at the lungs and the extent of damage or inflammation.
• Arterial Blood Gas Analysis: Assesses the levels of oxygen and carbon dioxide in the blood.
• Pulmonary Function Tests (PFTs): These tests measure the overall performance of the lungs and can detect chronic bronchitis even before symptoms develop.
• Sputum Examination: Analysis of the cells in the sputum can reveal inflammation and identify infections that may require antibiotic treatment.
• Pulse Oximetry: A noninvasive test that measures the oxygen saturation in the blood.
• Complete Blood Count (CBC): Can detect signs of infection or other conditions that may affect lung health.

Note: If the results indicate chronic bronchitis, ongoing management and monitoring will be recommended since it’s a long-term condition.

Treatment

Treatment for chronic bronchitis focuses on relieving symptoms, preventing complications, and slowing the progression of the disease:

• Bronchodilators: Medications that help relax the muscles of the airways, making it easier to breathe.
• Inhaled Steroids: These can reduce airway inflammation and help prevent exacerbations.
• Phosphodiesterase-4 Inhibitors: A type of drug that decreases airway inflammation and relaxes the airways.
• Oxygen Therapy: For those with low oxygen levels, supplemental oxygen can improve quality of life and is sometimes necessary.
• Antibiotics: Used for treating exacerbations caused by bacterial infections.
• Vaccinations: Flu and pneumonia vaccines are recommended to prevent infections that can worsen chronic bronchitis.
• Pulmonary Rehabilitation: A program that includes exercise training, education, and support to help patients learn to breathe more easily and improve their quality of life.
• Mucolytics: Medications that help clear mucus from the lungs.
• Lifestyle Changes: Quitting smoking, avoiding lung irritants, following a healthy diet, and getting regular exercise can all help manage symptoms.
• Surgery: In severe cases, surgical options like lung volume reduction surgery or a lung transplant might be considered.

Note: The management plan should be individualized and may involve a combination of these treatments based on the patient’s specific condition and symptoms. Severe exacerbations may require intubation and mechanical ventilation. 

Acute vs. Chronic Bronchitis

Acute bronchitis and chronic bronchitis are distinct forms of bronchial inflammation, mainly differing in duration and etiology.

Acute bronchitis typically develops from a cold or other respiratory infection and is a short-term inflammation of the bronchial tubes. Symptoms, which include cough, mucus production, and chest discomfort, generally resolve within a few weeks.

On the other hand, chronic bronchitis is a long-term condition characterized by a persistent cough that produces mucus for at least three months each year for two consecutive years.

It is most commonly caused by prolonged exposure to irritants like cigarette smoke, pollution, or occupational dust and chemicals.

Unlike the acute form, chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) and requires ongoing management to alleviate symptoms and slow progression.

Chronic Bronchitis Practice Questions

1. What is the definition of chronic bronchitis?
Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD) where there is persistent inflammation of the bronchial tubes, leading to a long-term cough with mucus production.

2. What is the classification of chronic bronchitis?
It is defined clinically rather than pathologically and is termed “chronic” when it lasts for at least three consecutive months of the year for two or more successive years.

3. What is the primary cause of chronic bronchitis?
Cigarette smoking

4. What is the nickname for a patient with chronic bronchitis?
“Blue bloater”

5. What are the typical ABG results for chronic bronchitis?
Acute alveolar hyperventilation and hypoxemia.

6. Chronic bronchitis is a type of what?
COPD

7. What type of disease is chronic bronchitis?
Obstructive lung disease

8. What is the pathophysiology of chronic bronchitis?
The pathophysiology of chronic bronchitis involves chronic inflammation and swelling of the lining of the bronchial tubes, leading to narrowed airways, increased mucus production, subsequent airflow obstruction, and reduced ability to clear airway secretions.

9. What is the experience typically like before a patient is diagnosed with chronic bronchitis?
Patients often deny symptoms because the onset is gradual, and they have become accustomed to symptoms. They do not consider symptoms serious until an exacerbation occurs as a result of an acute infection.

10. What are the symptoms of chronic bronchitis?
Increased cough, increased sputum production leading to mucoid (clear and thick), purulent (containing pus), hemoptysis (blood from rupture of superficial blood vessels), shortness of breath (dyspnea), mild at first but gradually increases over time, increases with exertion and eventually shortness of breath persists at rest.

11. What are the signs of chronic bronchitis?
Accessory muscle use, breath sounds are prolonged, expiratory wheezing, and crackles that may clear with a cough.

12. What is the cause of cyanosis in chronic bronchitis?
Hypoxemia and polycythemia.

13. What are the characteristics of a blue bloater?
Stocky, overweight, has a chronic productive cough, mildly distressed, cyanotic, swollen ankles and legs (i.e., pitting edema), distended neck veins as a result of cor pulmonale (i.e., right-sided heart failure), episodes of right side heart failure (blood vessels divert blood for less damage of the lung and oxygen is more available constricted vessels cause high blood pressure in the lungs), pulmonary hypertension, bluish color of the lips and skin, severe airway disease with less emphysema, relatively mild dyspnea, no weight loss, large heart, polycythemia, hypercapnia, and hypoxemia.

14. What can be seen in the radiographic findings of a patient with chronic bronchitis?
Hyperlucency (due to air trapping), flattened diaphragms, teardrop-shaped heart, and enlarged heart if right heart failure is present.

15. What can be observed on the pulmonary function tests of patients with chronic bronchitis?
Decrease in respiratory flows and vital capacity; expiratory flows may improve post-bronchodilator if bronchospasm is present, diffusing capacity is generally normal, and as the disease increases in severity, the RV and FRC will increase.

16. What are the laboratory findings of patients with chronic bronchitis?
Increased RBC (i.e., polycythemia), increased HCT and HB, and increased WBC when an infection is present, ABG results will show respiratory acidosis with acute exacerbation and hypoxemia, decreased pH, increased PaCO2. Compensated respiratory acidosis develops as the disease progresses.

17. What are the ABG results of patients with chronic bronchitis?
ABG results will show respiratory acidosis and hypoxemia with an acute exacerbation (i.e., decreased pH, increased PaCO2) and compensated respiratory acidosis as the disease progresses.

18. What types of airway clearance therapy are used to treat chronic bronchitis?
Chest physiotherapy (CPT) and airway clearance devices (e.g., flutter valve, acapella).

19. What aerosolized medications are helpful in treating chronic bronchitis?
Sympathomimetics (e.g., albuterol, Xopenex) and anticholinergics/parasympatholytics (e.g., Atrovent, Spiriva, Tudorza), which are used in combination with other bronchodilators.

20. What are the primary ways to manage chronic bronchitis?
Stop smoking, bronchodilator therapy, reduce exposure to irritants, get adequate rest, proper hydration, and physical reconditioning.

21. What is the prognosis of chronic bronchitis?
The prognosis is variable because a patient may have a chronic productive cough for years without impairment of lung function and may progress quickly to disability. Some patients may have frequent infections with exacerbations and may progress to emphysema.

22. What are the chest assessment findings of patients with chronic bronchitis?
Decreased tactile and vocal fremitus, hyperresonant percussion note, diminished breath sounds, crackles/rhonchi/wheezes on auscultation, and the use of accessory muscles while breathing.

23. What are the major pathological changes associated with chronic bronchitis?
Chronic inflammation and swelling of the wall of the peripheral airways, excessive mucus production and accumulation, partial or total mucus plugging of the airways, smooth bronchial airways (i.e., bronchospasm), and air trapping and hyperinflation of alveoli.

24. What are the two major types of bronchitis?
Acute bronchitis and chronic bronchitis.

25. What is acute bronchitis?
Acute bronchitis is a temporary inflammation of the bronchial tubes, typically due to infection, that causes coughing and mucus production, usually resolving within a few weeks.

26. What is the difference between acute and chronic bronchitis?
Acute bronchitis is a short-term inflammation of the bronchial tubes usually caused by an infection, whereas chronic bronchitis is a long-term condition characterized by persistent inflammation and cough, often resulting from prolonged exposure to irritants like cigarette smoke.

27. What is the prognosis for chronic bronchitis?
Premature morbidity and mortality and may have an acute exacerbation of chronic bronchitis, also known as acute on chronic.

28. What is chronic bronchitis brought on by?
Inspired irritants (e.g., cigarette smoke)

29. What does chronic bronchitis do to the body?
Chronic bronchitis persistently inflames and obstructs the bronchial tubes, leading to coughing, mucus production, and difficulty breathing, and can cause long-term damage to the lung’s airways.

30. What parts of the lung does chronic bronchitis affect?
It initially only affects the larger bronchi, but eventually, all airways are affected.

31. What can chronic bronchitis cause over long periods of time?
Right-sided heart failure (i.e., cor pulmonale)

32. Is chronic bronchitis reversible?
Chronic bronchitis is generally considered irreversible as it involves structural changes to the airways, but its symptoms and progression can be managed or partly alleviated with appropriate treatment.

33. What is the difference between emphysema and chronic bronchitis?
Emphysema is characterized by damage to the alveoli, leading to impaired oxygen exchange, while chronic bronchitis involves inflammation of the bronchial tubes with increased mucus production and chronic cough.

34. What can infections do to patients with chronic bronchitis?
Bacterial and viral infections in patients with chronic bronchitis generally exacerbate the condition.

35. When does cor pulmonale happen with chronic bronchitis?
It occurs in the later stages due to an increased workload on the right ventricle.

36. What are the common symptoms of chronic bronchitis that can be seen on a physical exam?
Increased coughing and sputum production.

37. What is included in the sputum production of chronic bronchitis?
It includes mucoid, may be purulent, and may contain blood due to the rupture of blood vessels in the bronchi from coughing.

38. How does shortness of breath present in chronic bronchitis?
It’s mild at first, then gradually increases over time. It increases with exertion, and eventually, shortness of breath persists at rest.

39. What kind of breath sounds may clear with a cough?
Rhonchi due to the clearing of secretions.

40. When can oxygen therapy be used for chronic bronchitis?
It is indicated when the PaO2  is less than 55 mmHg on room air.

41. Why is the prognosis considered variable for chronic bronchitis?
Because patients may have a chronic productive cough for years without any impairment of lung function.

42. What will patients with severe chronic bronchitis demonstrate?
Peripheral edema, distended neck veins, elevated Hb concentration, and cyanosis.

43. What types of patients typically have chronic bronchitis?
Patients who are overweight and between the ages of 30-40.

44. What are the four causes of chronic bronchitis?
Cigarette smoking, repeated airway infections, genetic disposition, and inhalation of physical or chemical irritants.

45. What are the four ways chronic bronchitis can develop?
Chronic inflammation of bronchial mucosa resulting in scarring, hyperplasia of bronchial mucous gland/goblet cells, increased bronchial wall thickness, and pulmonary hypertension.

46. What are the clinical manifestations of chronic bronchitis?
Shortness of breath, excessive sputum, chronic cough (more excessive in the mornings), evidence of excess body fluids, and cyanosis (late stages).

47. What are the four methods of diagnosing chronic bronchitis?
Clinical manifestations, chest x-ray, pulmonary function testing, and ABG analysis.

48. What factors should you look for in the chest x-ray of a patient with chronic bronchitis?
Increased bronchial vascular markings, congested lung field, enlarged horizontal cardiac silhouette, and evidence of a previous infection.

49. What factors should you look for in the PFT results of a patient with chronic bronchitis?
Normal TLC, increased RV, and decreased FEV1.

50. What factors should you look for in the ABG of a patient with chronic bronchitis?
Elevated PaCO2 and decreased O2.

51. What medications are used to treat chronic bronchitis?
Inhaled short-acting beta-2 agonists, inhaled anticholinergic bronchodilators, cough suppressants, antimicrobial agents, inhaled corticosteroids, theophylline, and low-dose oxygen.

52. Why is low-dose oxygen preferred in patients with chronic bronchitis?
Because too much oxygen can affect the hypoxic drive.

53. Does chronic bronchitis develop after a cold or respiratory infection?
No, that is acute bronchitis.

54. What is recommended yearly to help prevent chronic bronchitis?
Vaccinations

55. What are the other obstructive lung diseases?
Cystic fibrosis, asthma, bronchiectasis, and emphysema.

Final Thoughts

Chronic bronchitis is a chronic respiratory condition that demands attention and awareness.

While it may pose challenges to those who suffer from it, understanding its causes, recognizing its symptoms, and implementing effective management strategies can help individuals lead a more comfortable and fulfilling life.

By raising awareness and fostering a better understanding of chronic bronchitis, we can work towards reducing its prevalence and improving the overall well-being of those affected by this condition.