Chronic bronchitis. (Clinical Keeper #3).

Chronic bronchitis is an obstructive pulmonary disease that causes definitive changes to the airways of the patients afflicted. This results in structural changes to the airways, airway inflammation, excessive mucus production, and permanent air flow obstruction. The pathology is significant in that patients with chronic bronchitis become quite debilitated and require substantial medical care.

Chronic bronchitis and pulmonary emphysema comprise the disease classification known as chronic obstructive pulmonary disease (COPD), the fourth leading cause of death in the United States behind heart disease, cancer, and cerebrovascular disease. The vast majority of COPD patients have both chronic bronchitis and pulmonary emphysema. Only a small minority have either chronic bronchitis or pulmonary emphysema alone. Chronic bronchitis was originally described around the turn of the 19th century in the UK. That time corresponds with the industrialization movement throughout the Western world. Therefore, heavy exposure to industrial pollutants was implicated as the cause because smoking was not widespread during that period.

ETIOLOGY

Smoking is by far the leading etiologic factor in the modern world. The type and pattern of smoking influence the degree of risk. For example, cigarette smokers have the greatest risk compared to cigar and pipe smokers. Cigarette smokers demonstrate a more rapid decline in lung function in comparison to nonsmokers. In fact studies have indicated that persons who smoke more than a pack of cigarettes per day experience a 30-fold increased risk for developing chronic bronchitis compared to nonsmokers. Prolonged and/or concentrated exposure to occupational pollutants is a high risk factor for chronic bronchitis, for example, coal dust inhalation. Chronic bronchitis can also develop from frequent bouts of acute bronchitis.

EPIDEMIOLOGY

Approximately, 14 million Americans have chronic bronchitis. Estimates indicate that about 80,000 deaths are attributed to this and other chronic airway diseases each year. From a morbidity …