What Is Chronic Bronchitis?

Chronic bronchitis is a chronic, non-specific inflammation of the trachea, bronchial mucosa, and surrounding tissues. Clinically, the main symptoms are cough and sputum. The incidence lasts for 3 months each year for 2 consecutive years or more. Other diseases with cough, sputum, wheezing symptoms (such as tuberculosis, pneumoconiosis, pulmonary abscess, heart disease, cardiac insufficiency, bronchiectasis, bronchial asthma, chronic nasopharyngitis, esophageal reflux syndrome, etc.) need to be further excluded.

Basic Information

English name: chronic bronchitis
Visiting department: Respiratory
Multiple groups: Middle-aged and elderly

Common causes: May be related to harmful gases and particles, viruses, bacteria and other infections
Common symptoms: Common symptoms are cough, expectoration, or wheezing

Causes of chronic bronchitis

The etiology of this disease is not completely clear, and may be the result of long-term interactions of multiple factors.

1. Harmful gases and particles

Such as cigarettes, smoke, dust, irritating gases (sulfur dioxide, nitric oxide, chlorine, ozone, etc.);

2. Infectious factors

Virus, mycoplasma, bacteria and other infections are one of the important reasons for the occurrence and development of chronic bronchitis;

3. Other factors

Immunity, age, and climate are all related to chronic bronchitis.

Clinical manifestations of chronic bronchitis

Slow onset, long duration, repeated exacerbations and exacerbations. The main symptoms are cough, expectoration, or wheezing. Acute exacerbation refers to the sudden exacerbation of cough, expectoration, wheezing and other symptoms. The main cause of acute exacerbation is respiratory infection. Pathogens can be viruses, bacteria, mycoplasma and chlamydia.

Cough

Coughing in the morning is common, and coughing or expectoration occurs during sleep.

Sputum

It is usually white mucus and serous foamy, and occasionally bloody. Spitting is more frequent in the morning, and sputum can be stimulated after getting up or changing body position.

3. Wheezing or shortness of breath

Those with obvious wheezing are often called asthmatic bronchitis, and some may be associated with bronchial asthma. If accompanied by emphysema can be manifested as shortness of breath after work or activity.

There were no abnormal signs in the early stage. During the acute attack, dry and wet murmurs can be heard on the back or at the bottom of both lungs, which can be reduced or disappeared after coughing. If combined with asthma, extensive wheezing can be heard and prolonged expiration.

Chronic bronchitis examination

1. X-ray inspection

There may be no abnormalities in the early stage. Repeated attacks cause thickening of the bronchial wall, infiltration or fibrosis of bronchiolar or alveolar interstitial inflammatory cells, manifested as thickened and disordered lung texture, reticulated or strand-like, and spot-shaped shadows, which are obvious in the double lower lung fields.

2. Respiratory function test

No abnormalities in early stage. If there is a small airway obstruction, the maximum expiratory flow-volume curve is significantly reduced at 75% and 50% of lung volume.

3. Blood test

Occurrence of bacterial infection may occasionally increase the total number of white blood cells and / or increase in neutrophils.

4. Sputum examination

Can cultivate pathogenic bacteria. The smear can find Gram-positive or Gram-negative bacteria, or a large number of damaged white blood cells and damaged goblet cells.

Diagnosis of chronic bronchitis

Based on cough, sputum, or wheezing, the disease lasts for 3 months each year and continues for 2 years or more, and excludes other chronic airway diseases.

Differential diagnosis of chronic bronchitis

Cough variant asthma

It is characterized by irritating cough, which is easily induced by dust, oil fume, cold air, etc., and often has a family or personal history of allergic diseases. Ineffective for antibiotic treatment, a positive bronchial provocation test can be identified.

2.Eosinophilic bronchitis

The clinical symptoms are similar. There is no obvious change in X-ray examination or increased lung texture, and the bronchial provocation test is negative, which is easy to be misdiagnosed clinically. An increase in eosinophils (3%) can be diagnosed by induced sputum.

3. Tuberculosis

Fever, fatigue, night sweats, and weight loss are common. Sputum can be identified by looking for acid-fast bacilli and chest X-ray examination.

4. Bronchial lung cancer

Most have several years of smoking history, refractory irritating cough or past history of cough, recent changes in cough properties, and often blood in sputum. Sometimes it is manifested as repeated obstructive pneumonia in the same part, and it does not completely disappear after antibacterial treatment. Examination of sputum exfoliation cytology, chest CT, and fiberbronchoscope can confirm the diagnosis.

5. pulmonary interstitial fibrosis

The clinical course was slow, and only cough and sputum started, and occasionally shortness of breath. On auscultation, a crackling sound (Velcro murmur) can be heard on the lower back. Blood gas analysis showed that the arterial blood oxygen partial pressure decreased, while the carbon dioxide partial pressure did not increase.

6. Bronchodilation

Typical manifestations are repeated recurrent hemoptysis or hemoptysis. X-ray chest radiographs often have coarse or wild-textured lung texture. High-resolution spiral CT is helpful for diagnosis.

Treatment of chronic bronchitis

1. Acute exacerbation

(1) Antibacterial drugs for controlling infections can be taken orally with quinolone, macrocyclic esters, and -lactams. In severe cases, they can be administered intravenously. Such as levofloxacin and azithromycin, if pathogenic bacteria can be cultured, antibacterial drugs can be selected according to drug sensitivity tests.

(2) For antitussive and expectorant, try compound licorice mixture, or add the expectorant drug bromhexine, ambroxol hydrochloride, myrtle oil, and antitussive drugs such as dextromethorphan for those with dry cough.

(3) Asthma Patients with asthma can add antispasmodic antiasthmatic drugs, such as aminophylline, or theophylline controlled release agent, or long-acting 2 agonist with glucocorticoid inhalation.

2. Remission phase treatment

(1) Quit smoking and avoid inhalation of harmful gases and other harmful particles.

(2) Strengthening physique and preventing colds is also one of the main contents of preventing and treating chronic bronchitis.

Chronic bronchitis prevention

Some patients can be controlled without affecting work and study; some patients can develop obstructive pulmonary disease and even pulmonary heart disease with a poor prognosis. Pulmonary function changes of chronic bronchitis should be monitored in order to timely select effective treatment options and control the development of the disease.