Chronic bronchitis is defined as a persistent cough with sputum production for at least 3 months in two consecutive years. The most common cause is cigarette smoking. Clinical features include persistent cough, sputum production, wheezing, and breathlessness. In later stages, patients develop hypercapnia, hypoxemia, and mild cyanosis known as "blue boaters." Assessment of a patient with chronic bronchitis involves collecting demographic information, medical history, subjective reports of symptoms like cough and breathlessness, and objective measures including reduced lung function, increased pCO2, and chest x-ray abnormalities in later stages.
4. Etiology
Cigarette smoking – Most common cause
Air pollutants
Toxic industrial inhalants
Respiratory tract infection
5. Clinical features
Persistent cough with sputum production
Fever
Wheezing and tightness of chest
Breathlessness-late in onset
Blue boaters-distinctive clinical pattern seen in chronic
bronchitis; Low pao2,high paco2 ,right heart failure
6. Clinical features
Usually affect middle – aged men
who are heavy smokers
Early symptoms – Persistent
productive cough for many years,
fever
Later stage
Dyspnea on exertion
Blue boaters : Pts. Develop
Hypercapnia, hypoxemia and
mild cyanosis.
7. Leading causes of death in COPD
Respiratory failure
Lung cancer
Cardiovascular disease
9. .
Chief complaints:he/she feels difficulty in breathing,early
morning cough since many years.
History:
1.h/o present illness:
2.h/o past medical or surgical conditions
3.h/o family:
.4.personal habits: smoking
5.h/o environmental:ask about their residence and type of
workplace
10. [C] subjective assessment
1.breathlessness
o Progressive exertional dyspnea
o Duration:
o Severity (assessed by NYHA scale)
o Pattern: orthopnea
o Precipitating factors: on exertion,exposure with pollutants
o Relieving factors:rest,bronchodilators
11. 2.Cough-present
o Type: chronic productive cough
o Frequency: It is intermittent in initial stage,and becomes
continuous progressively.
o Duration: morning
o Severity: increased by infections, fog,worst in winter season.
13. 4.hemoptysis:-may be present
5.wheeze: present during expiration.
Wheeze-More during morning and in winter
6.chest pain: absent
Other symptoms: fever in acute exacerbation,
Fatigue, peripheral edema
14. [D]objective assessment
On observation:
1.General observation:-
o Level of consciousness-alert
o General health and body built:-obese in blue boaters.
o cyanosis-present
o Peripheral cyanosis
2.observation of chest:
o Shape-barrel shaped chest
o Breathing pattern-abnormal apical breathing
o Use of accessory muscles-present
16. On examination:-
Vitals:- RR decreased in exacerbation
Chest expansion:-
Auscultation (heart sounds):-S1 and S2 present
Breath sound: Vesicular sound with Prolonged expiration; rhonchi
may be heard
ROM :-shoulder joint reduced, thoracic spine reduced
Exercise tolerance -Reduced
17. Investigations
PFT:-reduced FEV1/FVC
ABG:-paco2 increased,pao2 decreased
Chest x ray:-no characteristic abnormality in early
stages
ECG-show features of right atrial and ventricular
hypertrophy; Tall p waves.