DIFFERENTIAL DIAGNOSIS

(CHRONIC BRONCHITIS)
Chronic Bronchitis
Chronic bronchitis is a clinical diagnosis
requiring patients to have a chronic cough
productive of sputum for at least 3 months a
year for at least 2 consecutive years in the
absence of other diseases such as:
asthma
bronchial tumors
bronchiectasis
chronic lung infections
Chronic Bronchitis
Rare patients develop chronic bronchitis with
minimal or no history of cigarette smoking or other
exposures associated with the condition
The pathology of chronic bronchitis is bronchial
inflammation, which differs from the eosinophilic
inflammation of asthma
Manifestations:
In the large airways increases in the size and number
of mucous glands and goblet cells are noted
Smooth muscle increases and partial destruction of
bronchial cartilage and adventitial fibrosis occurs
Chronic Bronchitis
A neutrophilic infiltrate is present, which is much
less dramatic than the inflammatory infiltrates seen
in asthma
In the small airways, the lumen may be completely
occluded by mucus and inflammatory cell infiltrates,
and fibrosis is present in the bronchiolar walls
Chronic Bronchitis
Persistent cough productive of sputum is the
cardinal symptom
Dyspnea may eventually develop on exertion
Other elements of COPD may develop with
continued smoking such as:
Hypercapnia
Hypoxemia
Mild cyanosis
How does it causes cough?
Any disorder resulting in inflammation,
constriction, infiltration, or compression of
airways can be associated with cough

Presence of sputum serves as an irritant coughing

Timing:
Chronic productive cough followed by slowly progressive
dyspnea
Aggravating factors:
Exertion, inhaled irritants, respiratory infections

Relieving factors:
Expectoration, rest, though dyspnea may become
persistent
Symptoms:
Chronic productive cough

Setting:
History of smoking, air pollutants, recurrent respiratory
infections
 Chronic bronchitis

Age 40-45

Dyspnea Mild; late

Cough Early; copious sputum

Appearance Blue bloaters

Infection Common

Respiratory insufficiency Repeated

Cor pulmonale Common

Airway resistance Increased

Elastic recoil Normal

Chest radiograph Prominent vessels; large heart

PE
Ausculation
Wheezes
Crackles
Laboratory Exams
Decreased pO2
Normal Values: 75 -100 mmHg
With chronic Bronchitis: 4560 mm Hg
Increased pCO2
Normal values: 3545 mm Hg
With chronic bronchitis: 50-60 mmHg