Chronic Bronchitis

Cardiac Physical Therapy

2. Structural characteristics
of the airway passage
structure division
Trachea
Main bronchi
Lobar bronchi
Segmental bronchi
Small bronchi
Bronchioles & terminal
bronchioles
Respiratory bronchioles
Alveolar duct
Alveolar sacs
0
1
2-3
4
5-11
12-16
17-19
20-22
23

3. 3
Bronchitis
Bronchitis is
inflammation of the
mucous membranes of
the large and medium
bronchi.
Inflammation
stimulates the glands in
the wall of the bronchi
to produce abundant
amounts of mucus.

4. 4
Bronchitis
Acute bronchitis caused
by infection and
inflammation, if limited
in duration, does not
cause permanent
damage.
Chronic bronchitis is a
result of repeated
infection or
inflammation.

5. 5
Acute Bronchitis
Symptoms
Phlegm producing cough.
Mild fever
Possible wheezing
Treatment
Medications to reduce mucus production --
antihistamines.
If the cough produces green or yellow phlegm, the
doctor will prescribe antibiotics.

6. 6
Healthy Bronchi
Mucus produced by
goblet cells and mucus
glands forms a thin
protective layer on the
inside of each bronchi.
The mucus traps inhaled
particles and small hair
like protrusions called
cilia move the mucus
upward to be coughed
out or swallowed.

7. 7
Acute Bronchitis
Limiting the infection
Cilia (fine hairs) lining the
airways transport mucus
upward, preventing
infection of the lung.
The infection may spread
to the lungs in young
children, older people,
people with compromised
immune systems, or
diseased lungs.
Cilia Goblet Cells

8. 8
Chronic Bronchitis
Repeated infection or
inflammation (caused
by irritating smoke)
causes increased mucus
production.
Mucus glands and goblet
cells increase in number.
Cigarette smoke
damages the cilia and
reduces their ability to
move mucus upward.
More goblet
cells
More mucous
glands
Damaged
Cilia

9. 9
Chronic Bronchitis
When cilia can no longer
move excess mucus, it
stays in the airways,
narrowing them.
Retained mucus
encourages bacterial
growth which increases
inflammation.
Retained Mucous
Bacteria

10. 10
Chronic Bronchitis
Eventually, the
bronchial lining
becomes do damaged
that the cilia are
completely destroyed
and chronic
inflammation, infection
and mucus build-up
occur.
Inflammation
Cells without cilia

12. Normal versus Diseased Bronchi

13. Simple type
of Chronic
Bronchitis
(without
gasping)
Cough
Sputum expectoration
Chronic
Bronchitis
with
gasping
Cough
Sputum expectoration
Gasping
Classification of Chronic
Bronchitis

14. Stages Time Courses
ExacerbationIn a week
Chronic lag
phase
One month or longer
stable Lasts for two months
Stages of Chronic
Bronchitis

16. PATHOPHYSIOLOGY
Smoking, chemical fumes and dust.
Recent infections.
Hypertrophy and hyperplasia of mucus glands.
Increase mucus production blocks the trachea.
Secondary infections destroys the cilia.
Abnormal lung expansion and V/Q mismatch.

17. CLINICAL FEATURES
Cough :- . severity increases every yr
. initially without sputum
. later with sputum
Wheezing :- . Early morning
. Both inspiratory and expiratory
Sputum :- .mainly mucoid and tenacious
. Mucopurulent during infective
exacerbations.
Dyspnea :- .early morning
Deformity :- .barrel chest due to hyperinflation.
Cyanosis :- . central cyanosis.
. Presence of desaturated Hb

18. INVESTIGATIONS
PFTs
ABG analysis
Chest X ray
MRI
ECG
CT scan
Bronchoscopy
Exercise testing

19. Figure 11-2. Chest X-ray film of a patient with chronic bronchitis. Note the translucent (dark) lung
fields, depressed diaphragms, and long and narrow heart.

20. This condition , usually called as “blue bloaters”

21. “Blue bloaters” often
have a severely low
blood oxygen level that
gives their lips and
tongue a blue
appearance.
They tend to be
overweight, breathless,
and have swollen ankles
and abdomens from fluid
retention.
Overweight and bloated

22. COMPLICATIONS(core pulmonale)

23. TREATMENT
Smoking cessation
Medications :- pneumococcal and influenza
vaccines
Beta 2 agonists
Bronchodilators
Corticosteroids
Avoidance of environmental irritants
Avoidance of beta adrenergic blockers and
antihistamines
Early treatment of infections
O2 therapy

24. MESSAGE
A cigarette is a pinch of tobacco,
Rolled in a paper
With the fire on one end and………..
………………a fool on another end.

25. Thank you all for listening
THE END