SHAHD ALALI

CHRONIC BRONCHITIS

• It is characterized by a chronic productive cough lasting at least 3 months over a minimum of 2 years.• Common among smokers • Most have both emphysema & chronic bronchitis

• Early stages of the disease: •Productive cough •Mucoid sputum

ETIOLOGY

• Smoking • Air pollutants • Sulfur dioxide • Nitrogen dioxide• Cystic fibrosis • Coexistent emphysema • Experimental evidence: Increase transcription of

mucin gene

PATHOGENESIS

• Charactirized by hypertrophy of bronchial mucinous glands thus hypersecretion of mucus • Increased thickness of mucus glands (Reid index

increases to >50%) • Casing inflammation (CD8+, lymphocytes….• In contrast with asthma there are no

eosinophils• Microbial infection often is present

MORPHOLOGY

• Large airways gross specimens:•Hyperemic •Swollen by edema fluid •Covered by a layer of mucinous secretion•Increase of goblet cells

•Histological examination of trachea & bronchi:•Enlargement of mucus-secreting glands •Inflammatory cells (mononuclear / mixed with

neutrophils)

• Chronic bronchiolitis:•Goblet cell metaplasia •Mucous plugging •Inflammation•Fibrosis

CLINICAL FEATURES

• Prominent cough & production of sputum • Cyanosis “Blue bloaters” • Increase risk of infection • Tend to be stocky or obese • Wheezing• Hypoxemia • Dyspnea

PULMONARY FUNCTION TEST

• Less increased TLC & RV than emphysema • Chronic respiratory acidosis

COMPLICATIONS

• Respiratory failure• Cor pulmonale